Sign-ups for ACA off sharply

Ariz. enrollment is down 18% from early Dec. 2017

With just days left to sign up, Arizona enrollment in Affordable Care Act health insurance plans is lagging.

Arizona enrollment as of Dec. 1 was at 55,090, which is 18 percent lower than it was as of Dec. 2 last year, according to federal data. Enrollment is down nationwide, too.

Saturday is the deadline for individuals and families to purchase health insurance on the federal marketplace created by the Affordable Care Act. Such insurance is often referred to as “Obamacare.”

The marketplace sells private insurance, and those who qualify are eligible for federal subsidies to help pay for it. Most Arizonans who bought marketplace insurance for 2018 qualified for subsidies.

ACA insurance is purchased by a minority of Americans — working-age people who are not covered by employer-sponsored coverage or by government insurance such as Medicaid.

Health-policy experts say the ACA marketplace is nonetheless an important factor in overall health costs. If too many people in this population go without insurance, there’s a higher risk that hospital costs for uncompen-

sated care will rise.

That can cause cost-shifting, saddling the entire health system with more expenses, said Dr. Daniel Derksen, a health-policy expert at the University of Arizona who helped draft a portion of the ACA.

Here are six reasons why Arizona’s numbers could be down:

1. Lack of awareness

The Trump administration slashed federal “navigator” grants to states that are meant to help educate and enroll people in health insurance. Arizona’s allotment of money dropped by 74 percent — to $300,000 this year from $1.17 million last year.

“We can only surmise that with the big decrease in marketing over the past two years, a significant proportion of people don’t know about open enrollment,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers.

The alliance partnered with 14 entities to help Arizonans enroll in health insurance last year. This year, the number of partnerships fell to four.

Open enrollment ends at midnight Pacific time on Saturday. That means the system will allow Arizonans to sign up through 1 a.m. Sunday, Gjersvig said.

2. In 2019, no penalties

In prior years, Americans who did not have ACA-compliant health insurance faced a federal fine.

But in 2019, those penalties are going away. There’s no clear consensus on whether that will make a difference in the tally of people who enroll in ACA plans.

The absence of penalties may make less-expensive short-term medical plans more attractive to some Americans. Since those plans are not ACAcompliant, anyone who bought them in the past had to pay a penalty, too.

Derksen said, “Clearly having a penalty in place, as mild as it was, there is some effect.”

3. Cost could be a barrier

People who earn more than 400 percent of the federal poverty level don’t qualify for federal subsidies to help them pay for ACA insurance. For some people who just miss that 400 percent cutoff, that can mean prohibitively high costs.

Take, for example, a 45-year-old single woman in Yavapai County who earns $50,000 per year, which is too much to qualify for a federal subsidy. The choice of Blue Cross Blue Shield plans for that woman range from $562.70 to $856.39 per month, according to healthcare.gov. The annual deductibles are all $6,000 or more.

Cost is still a major barrier for millions of Americans without health insurance, a new study from the Kaiser Family Foundation says.

For the first time since most provisions of the ACA were implemented in 2014, the number of uninsured people in the U.S. last year increased by 700,000 people to 27.4 million, the study says.

In Arizona, the number of uninsured people here rose by 11,600 people between 2016 and 2017, the study says.

4. Auto-enrollments uncounted

The most recent data also doesn’t include people who signed up after Dec. 2.

And anyone who had ACA insurance in 2017 and takes no action to disenroll, to enroll in a different plan or to actively re-enroll has not yet been counted, either.

Michael Malasnik, an independent Phoenix insurance broker, said he’s encountered numerous clients in Maricopa County who are keeping their Ambetter from Arizona Complete Health plans from 2018.

“People just want to stay put,” he said.

In all Arizona counties except Maricopa and Pima, Blue Cross Blue Shield is the only insurance company selling marketplace plans, so people in those counties may just end up sitting back and auto-renewing what they had.

5. Getting coverage at work

The economy has improved, and more people are getting jobs. Average hourly wages have gone up, too. The number of Arizonans enrolled in Medicaid, a government insurance program for low-income Arizonans, is down 2 percent from the same time last year.

6. Procrastination

There’s a procrastination factor in signing up for ACA plans, experts say.

“The last week is always the biggest week of enrollment. Unless this year is somehow different, that is always the pattern,” Gjersvig said.