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Today is the last day for people in most of the country to sign up for coverage through the Affordable Care Act.

Expand chart

Note: Data includes partial weeks. The 2018 open enrollment window is Nov. 1 to Dec. 15, 2017. The 2017 window was Nov. 1, 2016 to Jan. 31, 2017; Data: Centers for Medicare & Medicaid Services; Chart: Chris Canipe / Axios

The final results from this signup period will help insurance companies figure out whether their outlook for the future is terrible, or merely bad.Be smart: Insurers are already beginning to look ahead to 2019 — and they're seeing a policy landscape that leads directly to higher premiums, if not to giving up altogether on some of the ACA's exchanges. It's impossible for ACA enrollment to make that outlook much better, but a disappointing number this year could make things even worse.

Where it stands: Enrollment ends today in the vast majority of the country. A few state-run exchanges, including New York and California, have extended enrollment into January.

  • The number of sign-ups is surging right now, as the deadline approaches. But it was already so far behind that this year's totals are highly unlikely to match last year's.
  • Enrollment is supposed to be going up. When it goes down, that's bad. And it's probably going to go down.

What's next: Beginning in the spring, insurers will start to take stock of their customer base and make preliminary decisions about whether they want to keep selling insurance through the exchanges — and if so, where.

  • Congress appears highly likely to repeal the ACA's individual mandate in the meantime. And the Trump administration will also move ahead soon with regulations expanding access to cheap, skimpy short-term health plans.
  • Both of those changes will likely pull healthy consumers out of the market for ACA coverage.
  • Insurers almost certainly would respond by seeking major premium hikes. The conventional wisdom within the industry and among policy analysts says some parts of the country probably won't have any insurance plans to choose from after this all shakes out.

The bottom line: No outcome from the enrollment period that ends today could make that landscape look much better.

  • There's simply no universe in which enrollment will be good enough to make ACA insurers comfortable with the loss of the individual mandate and the return of short-term plans.
  • Particularly low enrollment, however, could make this bad landscape look even worse, because insurers would have fewer customers to help absorb the blow from future policy changes.

Go deeper

19 mins ago - Health

FDA panel backs Merck's antiviral COVID pill

The Merck Cherokee Plant in Riverside, Pennsylvania. Photo: Paul Weaver/SOPA Images/LightRocket via Getty Images

A Food and Drug Administration advisory panel on Tuesday voted 13-10 to endorse an antiviral pill developed by Merck and Ridgeback Biotherapeutics to treat adults at high risk of becoming severely ill from COVID-19, despite concerns over its effectiveness and safety.

Why it matters: Oral antiviral drugs designed to prevent or treat COVID-19 could be key pandemic-fighting tools, if proven effective, especially as new variants emerge. If authorized, the Merck drug, known as molnupiravir, would be the first treatment of its kind to be made available in the United States.

Shooting at Michigan high school leaves 3 dead, 6 wounded

Screengrab: CBSN

Three people dead and six others are wounded after a shooting at a high school in Michigan according to the Oakland County Sheriff's Office.

Driving the news: The alleged shooter was a 15-year-old sophomore at Oxford High School and has been arrested, per police.

Fed signals it could yank economic support quicker as inflation sticks around

Federal Reserve chairman Jerome Powell testifies during a hearing before Senate Banking, Housing and Urban Affairs Committee today. Photo: Alex Wong/Getty Images

The Federal Reserve will consider pulling back economic support sooner "as the threat of persistently high inflation has grown," chair Jerome Powell said during a congressional hearing on Tuesday.

Why it matters: This is the biggest signal yet the Fed is backing away from its stance that soaring prices would be fleeting — a change that could shift its policies that underpin the economy.

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