Week 7: Demand for quality, comprehensive health coverage once again overcomes Trump Administration
CMS released its Week 7 snapshot for the 2018 Open Enrollment period announcing the near final enrollment total for the 39 HealthCare.gov states of 8,454,882. While overall enrollment is down 4% compared to last year and new enrollment is down by 15%, this year’s Open Enrollment proves once again the resiliency of the ACA marketplaces.
Given stable premiums, more insurers and the wide availability of ultra low cost $0 plans, there should have seen at least modest growth this year. These factors, along with the fact people really value having comprehensive health coverage, are likely the key reasons behind the consumer demand that fueled the highest retention rate in Marketplace history. Unfortunately, new enrollment declined once again.
The decline in new enrollment is most concerning. New enrollment in Week 7 this year outpaced enrollment during the same week last year likely due to a major push from those outside of the administration. Nevertheless, new enrollment dropped yet again on the Trump administration’s watch — down 15.4% this year and 50.3% since 2016. New enrollment is especially important for the Marketplaces because new enrollees tend to be younger and healthier. Advertising and outreach, which the administration significantly cut, play an especially important role in bringing new people into the Marketplaces.
People who shopped were more likely to find a plan they liked this year. CMS did not release data on how many people actively renewed their coverage this year through Week 7. But people who visited the website or called the call center through Week 6 of this year vs last year, were 11.6% more likely to select a plan. This, in conjunction with anecdotal evidence from across the country, also demonstrates that demand for marketplace coverage remains high.
Multiple factors contributed to the decline in new and active enrollment this year. In our analysis yesterday of headwinds and tailwinds, we pointed to the 90% cut to advertising, lack of promotion by the Trump administration, 80% cut to local help since 2016, the zeroing out of the individual mandate, the introduction of short-term plans, and the decision not to extend the deadline due to a lower court ruling striking down the Affordable Care Act as major contributing factors.
The total number of people renewing their coverage is higher this year, despite the fact that, at this point, over 400,000 FEWER people signed up than last year. People getting their coverage through HealthCare.gov are more likely to keep their coverage at a higher rate than we have ever seen. The administration did not release the number of people who actively renewed their coverage in the Week 7 snapshot. But through Week 6, the number of people actively renewing their coverage was down 8.4%. Despite this impressive retention rate, all signs point to the first ever drop in people actively renewing their coverage in Marketplace history. This is a significant shift in Marketplace enrollment behavior. The final enrollment totals do not reflect this decline, because most of these people saw their coverage automatically renewed. But, we also know the number of people who cancel their coverage after being automatically renewed historically has been far higher. Early next year, we expect to see the impact of this shift when the number of people who pay premiums or effectuate their enrollment is reported.
In contrast, State-Based Marketplaces facing similar tailwinds and some of the same headwinds, are on track to break records. Massachusetts, the state with the lowest uninsured rate in the country, has already surpassed its enrollment peak — with a month to go. Specifically, Massachusetts enrolled more people than it did through January 23rd of 2018 as of December 16th. So far 6 out 10 states that have released enrollment numbers are on track to enroll more people this year than last year (Colorado, Maryland, Massachusetts, Minnesota, New York, Rhode Island), California and Connecticut are on track to break even or be close. This State-Based Marketplace enrollment is even more impressive when viewed over a multi-year time frame. While enrollment through HealthCare.gov has been continuously contracting, it has been stable or growing in State-Based Marketplaces.
Remember: Open Enrollment is still happening in California, Connecticut, Colorado, District of Columbia, Massachusetts, Minnesota, New York and Rhode Island. People in Alaska who live in areas affected by the earthquake can also still enroll.
On December 15, 2016, just 35 days before Trump took office, HealthCare.gov saw the biggest day of enrollment in its history — the Marketplace was on track to enroll more people that year than ever before. Once the Trump administration took over, Federal enrollment began a continuous decline that stands in stark contrast to enrollment in State-Based Marketplaces. The demand for health coverage continues to thwart this administration’s efforts to undermine Open Enrollment, but it is clear that the actions taken by CMS are continuing to cause clear and direct harm to the American people and their access to quality, comprehensive, and affordable coverage.
Final enrollment numbers are likely to shift slightly, so we’ll update these figures when the final numbers are released.
This year 5 HealthCare.gov states grew: Oklahoma, Mississippi, Florida, Hawaii, Wyoming. Enrollment in 20 HealthCare.gov states shrunk by more than 5%: West Virginia, Virginia (due to the state expanding Medicaid), Louisiana, Indiana, New Hampshire, New Mexico, Ohio, Missouri, Wisconsin, Delaware, Kansas, Nevada, New Jersey, Iowa, Michigan, Illinois, Pennsylvania, Maine, Oregon, Montana, and Kentucky.