Open enrollment for the Affordable Care Act closes tomorrow, and the numbers are still lagging noticeably behind last year’s pace.
The big question: Why now?
- Yes, the Trump administration cut off promotional funding, expanded non-ACA coverage options, and nullified the individual mandate. But a whole lot of that was baked in last year, when premiums skyrocketed.
- “Last year, of all years, you would have expected the exchange market to crash … [but] the number of people paying for insurance went up,” Avalere’s Chris Sloan told me.
- Compared to this time a year ago, premiums are down, choices are up and politics are more stable. So, why is enrollment lower now than it was in the middle of all that chaos?
Premiums may be down some this year, but they’re still super expensive for people who don’t get financial help — and the lowest premiums come with deductibles that average more than $6,000.
- “If you’re not sick or you can’t predict your health care needs, and predict them to be high, there is not a ton of incentive to purchase insurance at that cost,” Sloan said.
- Low unemployment may also be hurting ACA enrollment, though probably not very much, since the exchanges serve people who don’t get insurance through work.
The bottom line: Nullifying the individual mandate certainly didn’t help, but there’s a growing consensus among policy experts that it wasn’t very effective, and this year’s outreach budget isn’t much lower than last year’s. So, some of this is about Trump, Sloan said — but probably not all of it.
- “It’s not going to be hard to concoct a narrative” if enrollment does end up significantly lower, he said. “I also don't think it’s that hard to concoct a narrative the other way … There are enough storylines to justify any outcomes in this market.”