Af­ford­able Care Act

Shorter sign-up means fi­nal en­roll­ment is likely to be down from last year

The Washington Post - - FRONT PAGE - BY AMY GOLD­STEIN

en­roll­ment has been brisk, but a shorter signup sea­son means fi­nal fig­ures are likely to fall short of last year’s.


The num­ber of Amer­i­cans get­ting Af­ford­able Care Act health plans for the com­ing year ac­cel­er­ated last week in states re­ly­ing on the fed­eral in­sur­ance ex­change, bring­ing the to­tal to 3.6 mil­lion sign-ups with less than two weeks left in an ab­bre­vi­ated en­roll­ment sea­son.

The lat­est fed­eral snapshot, com­ing amid fresh po­lit­i­cal tur­bu­lence over the fu­ture of in­sur­ance mar­ket­places cre­ated un­der the law, is slightly ahead of the first five weeks’ pace last fall. But com­pared with data from two-thirds of the way through the longer en­roll­ment sea­sons of past years, the num­ber of con­sumers who have cho­sen health plans is lag­ging far behind.

The 3.6 mil­lion fig­ure is half of the to­tal at the com­pa­ra­ble point in the sign-up pe­riod for 2017 cov­er­age, ac­cord­ing to an anal­y­sis by the Wash­ing­ton-based con­sult­ing firm Avalere Health. To reach the 9.2 mil­lion en­rollees that states re­ly­ing on the fed­eral mar­ket­place had by the fi­nal dead­line, a huge surge of peo­ple would need to take ac­tion by the time the sea­son con­cludes on Dec. 15 or be au­to­mat­i­cally re-en­rolled just af­ter­ward.

Last year, about 1.6 mil­lion peo­ple had their cov­er­age au­to­mat­i­cally re­newed in the 39 states us­ing the fed­eral Health­ web­site. If that num­ber holds steady this year, it would mean about 4 mil­lion con­sumers would have to sign up by the end of next week or the coun­try could see a sharp drop in how many Amer­i­cans are in­sured through the ACA.

Since the health-care law’s mar­ket­places opened in the fall 0f 2013, no two-week span has at­tracted that many en­rollees.

The fi­nal gap may not be as wide as it ap­pears now, be­cause each en­roll­ment sea­son has had an up­surge as deadlines ap­proach, said Larry Le­vitt, se­nior vice pres­i­dent of the Kaiser Fam­ily Foun­da­tion. Still, he said, “It seems a near-cer­tainty that en­roll­ment will end up well be­low last year.”

The last stages of this year’s sixweek sign-up pe­riod co­in­cides with yet an­other bar­rage against the law by con­gres­sional Repub­li­cans — on top of steps by the Trump ad­min­is­tra­tion to un­der­cut the mar­ket­places. Af­ter fail­ing this sum­mer and fall to pass var­i­ous GOP bills that would have dis­man­tled sig­nifi- cant parts of the ACA, the Sen­ate has in­cluded in a mas­sive tax bill it passed late last week a plan to end en­force­ment of the law’s re­quire­ment that most Amer­i­cans carry health in­sur­ance.

This pro­vi­sion will now be part of ne­go­ti­a­tions with House Repub­li­cans to try to re­solve dif­fer­ences be­tween the two cham­bers’ ver­sions of tax leg­is­la­tion.

In the weeks lead­ing to the signup sea­son, pub­lic opin­ion re­search and the ground-level ex­pe­ri­ences of en­roll­ment helpers around the coun­try sug­gested wide­spread pub­lic con­fu­sion about whether the mar­ket­places would still ex­ist. It is un­clear how en­roll­ment might be af­fected by the prospect of the tax penal­ties for flout­ing the man­date no longer be­ing en­forced.

Democrats and other al­lies of the sprawl­ing health-care law con­tend that the man­date is a cru­cial in­gre­di­ent to keep in­sur­ers sell­ing ACA health plans and to pre­vent monthly pre­mi­ums from spik­ing fur­ther.

Since the mar­ket­places opened, though, there has been scant study of how much dif­fer­ence the man­date has made in prompt­ing pre­vi­ously unin­sured peo­ple to be­come cov­ered. Re­search in Mas­sachusetts, which adopted a health-care law in 2006 with many sim­i­lar­i­ties to the ACA, found that its man­date ap­peared to mo­ti­vate some resi- dents to get a health plan.

Other in­di­ca­tions are that, na­tion­ally, the big­ger in­flu­ence may be the fed­eral sub­si­dies avail­able to more than 80 per­cent of peo­ple el­i­gi­ble for ACA cov­er­age.

But over­all, “it is hard to do re­li­able pro­jec­tions on what is mo­ti­vat­ing in­di­vid­ual be­hav­ior,” said Caro­line Pear­son, se­nior vice pres­i­dent at Avalere.

The non­par­ti­san Con­gres­sional Bud­get Of­fice has es­ti­mated that end­ing en­force­ment of the in­di­vid­ual man­date would trans­late into 13 mil­lion more peo­ple with­out cov­er­age over a decade, but its an­a­lysts also have said they are in the midst of re­think­ing the ba­sis of their cal­cu­la­tion.

The lat­est en­roll­ment snapshot, is­sued by the Cen­ters for Medi­care and Med­i­caid Ser­vices, is for the fifth week of sign-up, through this past Sun­day. The 823,000 peo­ple who en­rolled in cov­er­age was about 300,000 more than for the pre­vi­ous week. It was also 13,000 more than the same week a year ago, while the cu­mu­la­tive tally of 3.6 mil­lion is 700,000 ahead.

The fig­ures ex­clude en­roll­ment in 11 states that oper­ate their own in­sur­ance mar­ket­places un­der the ACA. Peo­ple choos­ing health plans be­come in­sured once they be­gin to pay the pre­mi­ums.

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