Open enrollment: 7 ways Trump’s actions could impact uninsured rate

Despite the efforts of President Trump and many congressional Republications to repeal and replace the ACA in 2017, it is still the law of the land. Therefore, marketplace plans are again being offered for 2018.

However, the Trump administration did make some changes that could make it more difficult for consumers to sign up for healthcare coverage or deter them from doing so. This could result in fewer Americans being insured.

Here’s a look at seven specific steps the administration has taken.

1. Shortening the enrollment period. The open-enrollment period was reduced from three months to 45 days. It begins November 1 and ends December 15. “The shorter enrollment period could reduce enrollees’ abilities to optimize their plan selection or make a plan selection because this takes time and research,” says Adam E. Block, PhD, assistant professor of health policy and management, School of Health Sciences and Practice at New York Medical College in Valhalla, New York. “In the past, many enrollees signed up during the December holidays. They will no longer have this opportunity unless they reside in one of the few states that has extended the enrollment period.”

A shorter open-enrollment period will also reduce the length of time during which a medical diagnosis could encourage someone to enroll, notes Hector De La Torre, executive director, Transamerica Center for Health Studies, a nonprofit that provides health coverage and health and wellness information, based in Los Angeles, California.

2. Making changes to qualifying events. For individuals who fail to meet the December 15 deadline, the only way to enroll in a marketplace health plan is by qualifying for a special enrollment period, which is the 60-day period following certain life events that involve a change in family status (e.g., marriage or birth of a child) or loss of other healthcare coverage. “Individuals attempting to enroll during special enrollment periods must provide verification through documentation of a qualifying event,” says Altair Gobo, a certified finance planner and partner at U.S. Financial Services, a wealth management firm. “Previously, individuals merely had to attest to changing circumstances that made them eligible to apply during special enrollment periods.”

3. Decreasing the amount spent on advertising ACA plans. CMS cut ACA advertising from $100 million spent by the Obama administration for the 2017 open-enrollment season by 90%-to about $10 million for the 2018 open enrollment season, De La Torre reports.   

Consequently, Block says fewer existing enrollees will be reminded to re-enroll and fewer new enrollees will learn about the existence of health insurance exchanges along with the possibility of obtaining federal assistance when purchasing it.

4. Decreasing the number of navigators. CMS also cut navigator grants from $62.5 million in 2016 by about 40% to $36.8 million for 2017. “In addition to encouraging enrollment and helping consumers navigate the exchange, counselors also raise awareness of the availability of qualified health plans, and provide culturally appropriate information to populations served by the exchange,” De La Torre says.

5. Planning more maintenance outages on the exchanges. CMS plans to shut down the enrollment website for 12 hours every Sunday evening except one to perform maintenance throughout the open enrollment period. “The majority of exchange enrollees are people who generally work during the week and are unable to sign up during working hours,” Block says. “Therefore, they will be spending a significant amount of time on nights or weekends on the website. The maintenance periods will cut into this time; individuals who might otherwise join a health plan might not do so because of the inconvenience.”

6. Collecting unpaid premiums. Insurers are now permitted, but not required, to collect unpaid premiums for prior health insurance coverage before enrolling an applicant in a new health plan, reports Gobo. This could deter some people from signing up.

7. Canceling a subsidy to insurers that lowers consumer costs. Trump has indicated that the federal government will cease making cost-sharing reduction (CSR) payments to insurers to reimburse them for discounts they give policyholders with incomes under 250% of the federal poverty level, Gobo says. This could push premium prices even higher, and will specifically impact lower income exchange-covered consumers who qualified for the CSR subsidy that lowers the amount they have to pay for deductibles, copayments, and coinsurance.

“Faced with the potential of higher out-of-pocket costs, these individuals may forgo coverage,” De La Torre concludes.

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