Health Care

National ACA Marketplace Signups Dipped a Modest 3.7 Percent This Year

National ACA Marketplace Signups Dipped a Modest 3.7 Percent This Year

Marketplace plans were more expensive than those sold outside healthcare.gov for unsubsidized consumers because California and other states asked insurers to load the premium increases stemming from Trump administration directives onto on-market plans.

The annual enrollment tally remains a relatively crude metric that doesn't account for what kind of consumers are signing up for coverage. Overall, the 39 states that use the federal website saw their enrollment slip by about 5 percent.

"The states live in a period of uncertainty, so when you see stable enrollment, it's good", said Trish Riley, the health policy group's executive director.

States which have their own marketplaces fared better.

But in a marked contrast, two-thirds of the marketplaces run by states instead of the federal government saw increased enrollment between 2017 and 2018, including CT and NY. In the 12 fully state-operated marketplaces, enrollment ticked up just slightly by 0.1 percent, ranging from 6.3 percent drop in Vermont to a 12.1 percent increase in Rhode Island.

Several states, including Alaska and Minnesota, already have reinsurance programs.

"Put simply, marketing matters", Lee said.




Trump also repeatedly referred to the health care system, also known as Obamacare after his predecessor, as "dead" and talked of allowing it to implode.

Created under former President Barack Obama's health law, Covered California, the state's insurance marketplace sells health plans to people who do not get coverage from an employer, Medicare or Medicaid.

Numerous federal moves were not helpful, said Heather Korbulic, executive director of Nevada Health Link, which is operated by the state but uses the federal Health care.gov website.

That's down 3.7% from previous year.

Despite the smaller-than-expected decline, enrollment in the ACA's exchanges has fallen from a peak of about 12.7 million in 2016, and the overall individual market has turned out to be smaller than estimated when the health law was passed. Arizona relied on the federal government to operate its marketplace.

They have been buffeted for much of the past year by uncertainty over their future, with insurers in some areas raising rates steeply or exiting markets altogether.

The difference, according to NASHP, was state-based exchanges used "effective communication"-since they didn't cut their advertising budgets like HHS-to reach out to key populations who may be eligible for larger subsidies, shielding them from the double-digit premium increases seen across the country". Those on-market price hikes were largely offset by jumps in tax credits for consumers receiving subsidies.