Key Factors Impacting Open Enrollment 6

As we await the final numbers for the 2019 Open Enrollment through HealthCare.gov, it’s important to put this year’s figures into the proper context. Given stable prices, more issuers, more uninsured people, and the availability of ultra low cost $0 bronze plans, we should have seen modest growth this year at the very least. But in practice we faced severe headwinds because of a number of decisions made by the Trump administrations, as well as the calamitous Texas ruling on the eve of the final day of enrollment.

Positive Trends

• Healthy Marketplaces, Stable Premiums: The marketplaces remained healthy this year, with new insurers offering coverage in 608 counties. In addition, premiums, on average, were stable. According to the Kaiser Family Foundation, average premiums for lowest cost plans actually decreased slightly across all medal levels. According to a recent Department of Health and Human Services analysis, 8 out of 10 people shopping at HealthCare.gov can qualify for a plan that costs less than $75 each month.
• Wide Availability of Zero-Dollar Plans: This year, zero-dollar bronze plans were available in 33 of 39 HealthCare.gov states. Avalere released an analysis that found 95 percent of counties with exchanges operated by HealthCare.gov have free plan options for low-income users.The Kaiser Family Foundation estimates that 4.2 million uninsured people, including about a million in Texas and more than 620,000 in Florida, could obtain comprehensive coverage for free.
  - In fact, in 2 out of 3 counties in America a 40-year-old making $25,000/year could’ve found a bronze plan with monthly premiums of zero dollars.
  - Zero-dollar gold plans were also much more widely available this year. 40-year-old individual making $25,000 can find a gold plan with zero dollar premiums in 153 counties this year, compared to only 33 counties last year.
• Increase in the Number of Uninsured: While it’s definitely not a positive trend, more uninsured people creates a larger market of potential enrollees. According to the Kaiser Family Foundation, the number of people without health coverage increased by 700,000 in 2017 — the first time such an increase had been recorded since the passage of the Affordable Care Act.
• Consumer Interest: As this election and the 2017 debate over health repeal demonstrated, consumers are intensely concerned about the availability of quality, comprehensive, and affordable coverage for themselves and their families. Of the consumers who visited the website or called the call center through Week 6 of this year, we can see that people were 12% more likely to select a plan than through Week 6 of last year.

Severe Headwinds

• Lack of Media Coverage: Television news coverage was virtually non-existent. According to a Media Matters analysis, just 16.5 minutes of coverage were devoted to Open Enrollment between October 3 to December 3, with fully 14 minutes of the total coming from Fox News. MSNBC and CNN covered it for approximately two minutes over the course of the two months. CBS devoted one minute of coverage. NBC and ABC ignored it entirely.
• Low Awareness: In the November KFF poll, almost 4 out of 5 people who are uninsured or buy their own insurance either didn’t know that the December 15 deadline was around the corner or thought it was a different day or refused to answer. The number who simply said they didn’t know the deadline increased from 53 percent in October 2017 to 61 percent last month.
• Calamitous Texas Ruling: The ruling declaring the entire Affordable Care Act to be unconstitutional came on the eve of the final day of Open Enrollment. We know that the final day of Open Enrollment is the largest, with more than 620,000 signing up in a typical year, so the impact of any confusion caused by the ruling could have been very significant. And we know the administration was concerned about this, too. That’s why in September they asked the judge to delay any ruling until after Open Enrollment, a request he unfortunately did not honor. Most unfortunately, the administration’s decision to refuse to defend the law in court compounded the harm done by the actions of the conservative attorneys generals who filed the lawsuit in the first place.
• Trump Administration Decisions: Multiple factors under their control undermined Open Enrollment again this year.
  - Outreach cut by 90%: Fewer than 1 in 4 people buying insurance for themselves knew when the marketplace deadline was.
  - Admin Officials did not promote OE: Administration officials did not promote Open Enrollment in the media or send staff out to promote it locally. This was a major contributing factor to the extremely limited media coverage of Open Enrollment this year.
  - 80% cut to Local Help since 2016: The administration drastically scaled back in person assistance for low income populations.
  - Short-Term, Limited-Duration Insurance (Junk Plans): The dramatic expansion and promotion of Short Term Limited Duration plans created consumer confusion and funneled some consumers into plans without basic protections.
  - No deadline extension from CMS: Citing the court ruling, Connecticut and California extended their December 15th deadlines. Washington State also extended their December 15th deadline citing “other barriers.” Only two out of twelve states outside the federal Marketplace, Idaho and Maryland, had a final deadline for enrollment on December 15th.
  - Shortened OE period: Once again this year, Open Enrollment was shortened to just a six-week period, including two weeks that were significantly overshadowed by the midterm election.
• Zeroing Out the Mandate Penalty: In addition to precipitating the Texas lawsuit, this action likely contributed to some decline in enrollment. That being said, most Americans — almost 7 in 10 — are unaware that the penalty for not having insurance was zeroed out by Congress in 2017, so this policy change is not likely to account for a large portion of the decline in enrollment.

Meanwhile, state-based marketplaces have remained stable or growing, showing the difference that proper management, effective outreach and promotion, and policy support (e.g reinsurance programs that significantly lowered premiums in some states) can make compared to the administration’s active efforts to undermine both the marketplaces themselves as well as the Open Enrollment period.

We are expecting a significant drop in the final enrollment figures set to be released tomorrow. We will provide further analysis soon after they become available.