including cutting the law’s advertising budget by 90%.
But nearly 12 million people signed up or were re-enrolled in coverage for 2018, a similar figure as the previous year. The number of consumers who paid their continuing premiums, however, slid to around 10 million, because not everyone pays their monthly bill and others may get insurance later from another source such as an employer. This type of falloff has happened each year and is typical in the individual insurance market.
Many consumers’ expenses didn’t soar this year. Roughly 85% of enrollees received a tax credit to help reduce their premiums. The average credit covered about 85% of the total premium cost, making the average premium after the subsidy $80 a month.
Analysts had warned 2019 could usher in higher premiums on the individual market—both off and on the exchanges—because of the repeal of the penalty for lacking insurance and because of Mr. Trump’s decision to end billions of dollars in payments to insurers that covered certain cost-sharing subsidies.
But that spike hasn’t happened. Average premiums sold under the ACA will fall 1.5% next year, according to the Centers for Medicare and Medicaid Services, while more insurers are participating or expanding their footprints in the exchanges.
Both are signs that the ACA’s exchange markets are becoming increasingly stable—despite predictions of its imminent demise from all sides. One likely reason: consumer demand has remained unexpectedly steady, which in turn has helped insurers’ bottom lines. Additionally, many insurers set high premium levels in past years, allowing them to keep increases to a minimum this year.
Uncertainty still looms. Twenty Republican-led states are asking a U.S. district judge in Texas for a preliminary injunction to invalidate the entire ACA, arguing that the repeal of the penalty invalidates the health law overall. The Justice Department has also weighed in, asking the judge to strike down key parts of the ACA, including its protections for people with pre-existing health conditions. Mr. Trump, however, has said Republicans will protect pre-existing conditions.
A hearing on the case was held in September and a decision could come any time, although legal experts expect it to land after next Tuesday’s election.
While the Trump administration has significantly cut outreach funds, states that run their own exchanges are working to get the word out about the signup period.
Connecticut will hold enrollment fairs with free in-person assistance, for example, while California got a jump start by beginning its open-enrollment season in mid-October. Minnesota is providing free walk-in enrollment help at a variety of locations.
Consumers have been able to go online at the federal exchange, HealthCare.gov, to preview plans and prices before open enrollment begins. The Centers for Medicare and Medicaid Services, which oversees the ACA, is staffing a call center as usual.
CMS is also encouraging consumers who are currently enrolled to update their information, shop, and pick a plan that suits their needs before the December 15 deadline. As in previous years, CMS will automatically sign up consumers who don’t re-enroll in the same plan or a similar one.