ACA enrollment season opening with daunting obstacles
In Indianapolis, the director of the state’s largest organization helping people find Affordable Care Act insurance had to lay off nine of 13 staff members last month because the federal government had just taken away more than 80 percent of the grant that paid for their work.
And across Ohio, residents starting to phone a call center for appointments with coaches to renew their coverage are being told that the service no longer exists and that, for help, they should go to a website, a hotline, an insurance broker, a county health department or — if all else fails —their member of Congress.
In the countdown to the annual ACA enrollment season that starts Wednesday, such ground-level disruption suggests that the first sign-up period of the Trump era could be as daunting as any since the fall of 2013, when the federal website HealthCare.gov debuted with such serious defects that consumers trying to buy insurance were stymied for months.
In recent weeks, that website has been taken down for an unusual number of maintenance sessions. The net effect is rampant public confusion, surveys show. And there is a broad expectation that when sign-ups end — Dec. 15 in all but several states that run their own ACA marketplaces — fewer Americans will have gotten ACA coverage.
Outside experts think enrollment will dwindle significantly. Marilyn Tavenner, the president of America’s Health Insurance Plans, a main industry trade group, recently predicted a drop of at least 1 million people nationwide from the 12.2 million who signed up for 2017 coverage. Peter V. Lee, executive director of California’s marketplace, said the decrease could be twice that large.
A narrowed enrollment window — from three months to 45 days — was planned by the Barack Obama administration for the approximately three dozen states that rely on the federal insurance exchange. But the change was to have begun for 2019 coverage; instead, the Health and Human Services Department announced in April that it would take effect for the sign-up period starting Nov. 1.
The other impediments are all Trump administration creations. One of the most significant was the president’s move this month to cut off billions of dollars in payments to ACA insurers to reimburse them for discounts the law requires them to give lower-income customers. That action is driving a substantial increase in premiums for the most popular tier of coverage — 34 percent on average, according to an analysis by the consulting firm Avalere Health. A year ago, congressional Republicans and other opponents of the law expressed outrage over a 25 percent average jump in rates for such “silver” plans.
Most people shopping for marketplace coverage, which is available to consumers who cannot get affordable health benefits through a job, will qualify for larger federal subsidies to offset the higher prices. Yet many of those who earn too much for subsidies will face sticker shock.
As prices have risen and options have shrunk, the administration has lowered the enrollment season’s visibility. It slashed federal spending on advertising and other outreach efforts by 90 percent — to $10 million. Grants for “navigators,” who guide consumers seeking coverage, plummeted by about 40 percent overall.
Across the country, the nonprofit Young Invincibles has broadened its focus beyond young adults. Filling part of the void created by the recent disbanding of another nonprofit group, Enroll America, it is operating an online “Get Covered Connector” for consumers to schedule appointments for help in finding ACA health plans. In addition, it is running digital advertising in 10 states.