In its final report on the 2018 open enrollment period on the Affordable Care Act (AC) exchanges, CMS said 11.8 million people selected or were re-enrolled in a plan. While the final tally combining enrollment from the federal and state exchanges represents a 3 percent decline from the prior year, supporters of the ACA painted it as a positive considering cuts in outreach and advertising and the push to repeal the law by the Trump administration.
CMS Administrator Seema Verma, MPH, said the 2018 enrollment period was “the most cost-effective and successful” to date, but criticized the ACA’s individual market for rising premiums and fewer choices, pointing out many U.S. counties had only one insurer offering exchange coverage.
“Taken together these data suggest that more affordable healthcare options are needed. Especially for those forgotten women and men who are not eligible to have their premiums reduced by tax credits,” Verma said in a statement.
Without a subsidy, the average monthly premium increased by 30 percent in 2018 to $621, according to CMS, though 83 percent of customers qualified for subsidies. There was a noticeable shift in what plans consumers selected—while silver plans remained the most popular, being chosen by 63 percent of exchange customers, Verma said this represented a decrease of 9 percentage points. Bronze plans’ share of ACA enrollees went up 6 percentage points.
That’s a result of President Trump’s decision to cut off cost-sharing reduction subsidies, or CSRs, which are based on silver plan premiums, leading customers to switch to either bronze or more generous gold-level plans. It also increased federal spending as the government had to award greater subsidies to cover the cost of the premium hikes, meaning funding the CSRs would’ve ultimately been less expensive.
Exchange premiums could be in for another double digit hike after Congress failed to agree on a stabilization package which would’ve restored the CSRs and added billions in reinsurance for 2019, which will also be the first year without the ACA’s individual mandate penalty. This could further weaken the risk pool on the exchanges, which CMS found continues to skew towards older customers.
For groups that had defended the ACA during the 2017 efforts to repeal it, the slight decrease in enrollment was seen as a victory over the “sabotage” efforts from CMS, HHS and President Trump.
“This success is a testament to the incredible work of so many people to defend the Affordable Care Act from the Trump administration’s attacks and help the public get signed up for coverage,” said Sam Berger, senior adviser for the liberal think tank the Center for American Progress. “Without their persistence and determination, millions of families would be left without coverage and at risk of financial catastrophe.”
Seven months out from the next open enrollment period, however, there have more moves by the Trump administration to expand options for insurance coverage outside the exchanges. Proposed rules would expand the availability of short-term insurance and association health plans, both of which wouldn’t be subject to the ACA’s insurance standards like its required benefits and accepting customers regardless of pre-existing conditions. The result would likely be a sicker, more expensive risk pool left on exchanges and gaps in coverage for those who choose the cheaper, skimpier plans.
Additionally, defenders of the ACA are facing pressure from Republican states. Idaho had moved to allow “state-based plans” which don’t comply with ACA regulations before CMS suggested aligning the policies with their proposed rules. Iowa went a step further, with its governor recently signing a law allowing non-ACA-compliant plans to be sold through the Iowa Farm Bureau.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.