ACA 2019 Enrollment Down: 5 Things Health Execs Should Know

Approximately 8.5 million people signed up to obtain health insurance for 2019 through the ACA marketplace exchange. This was slightly less than the 8.8 million individuals who signed up in 2018. The numbers were preliminary, however, and don’t represent final enrollment figures, CMS stated in a press release.

“This administration has taken strong steps to promote a more competitive, stable health insurance market and these steady enrollment numbers are yet another sign that the administration’s efforts are working,” says CMS Administrator Seema Verma. “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer-based coverage, and don’t need exchange plans.”

Here are five things health execs should know about ACA enrollment for 2019, and what actions may or may not have affected it.

• Funding was cut. The Trump administration has cut advertising to promote the exchanges by 90% since 2016 (from $100 to $10 million). In addition, the funding for navigators that assist with ACA sign-ups shrank from $62.5 million in 2016 to $10 million in 2019. “While having a definite impact, health plans, nonprofit health organizations, and some state governments picked up the slack to educate the public with information about applying for health insurance subsidies, filing appeals, and spreading awareness about exchange plans, among other promotional activities,” says Hector De La Torre, executive director of the national nonprofit Transamerica Center for Health Studies.

• Alternative health insurance coverage options were promoted. In 2018, the Trump administration made non-ACA options available through short-term or association health plans. Most of these plans are high-deductible options with cheaper monthly premiums. Some of these plans can deny coverage, deny renewal, or increase the price for individuals with pre-existing conditions, and can leave out coverage of essential health benefits required by the ACA (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health).

The administration allowed short-term, three-month healthcare plans to be extended to a full year and renewed up to three years, although many states have their own restrictions on these plans. “By allowing lower cost alternatives, regardless of the coverage they provide, these plans will certainly siphon off consumers,” De La Torre says.

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• Congress eliminated the tax penalty for individuals without coverage for 2019. “Individuals who wanted to avoid the health insurance tax penalty and didn’t feel they needed health insurance will likely drop their coverage this year,” says De La Torre. However, a November 2018 Kaiser Foundation survey showed that a surprising 38% of respondents were unaware that Congress removed the tax penalty for individuals without health coverage. “So eliminating the tax penalty may have had less of an impact on open enrollment than anticipated,” he says.

• Medicaid was expanded. In November 2018, Idaho, Nebraska, and Utah approved Medicaid expansion ballot measures, but they haven’t been implemented yet. In Virginia, enrollment for Medicaid expansion began on November 1, 2018, for coverage effective January 1, 2019. Simultaneously, Virginia marketplace enrollment was down 66.5% compared to last year- the biggest drop of any state, De La Torre says. The opposite dynamic may soon occur in Montana where Medicaid expansion is currently being implemented, but is slated to end in June 2019.

• A judge ruled that the ACA mandate was unconstitutional. One day before open enrollment for ACA plans ended on December 15, Judge Reed O’Connor, a Texas federal judge, ruled that the ACA’s individual coverage mandate was unconstitutional and invalidated the entire law. “The ruling likely had little impact on the last day of marketplace open enrollment,” says Philo D. Hall, attorney with Epstein Becker Green, a national healthcare law firm. “National media highlighted the uncertainty and risk under the decision, but this must be balanced against health plans immediately issuing statements that the decision had no present impact on the availability of coverage in 2019.” Further, Verma released a statement the same day that the ruling was not meant to impact coverage for 2019 plans.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.