HEALTH

L'Opinion - - The Wall Street Jour­nal - Ste­pha­nie Ar­mour

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.

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