Enrollment for health plans under the Affordable Care Act are running 26 percent higher, at the state and national levels, than they did last year, despite concern by advocates that White House attempts to repeal the law would discourage people from signing up. (Photo by Alex Proimos/Creative Commons)
WASHINGTON – Halfway into the Affordable Care Act’s open enrollment season, the number of people signing up per day is sharply higher than it was last year, with about 500 more Arizonans signing up every day this year.
The increase, at both the state and national levels, has come as a pleasant surprise to advocates who worried that a shortened enrollment period, cuts to advertising and outreach, and repeated Republican attempts to kill Obamacare would discourage people.
“One of the surprises across the country and in Arizona is that we continue to track ahead of last year, in spite of the federal government not spending the money on outreach and advertising,” said Allen Gjersvig, director of navigator and enrollment services for the Arizona Alliance for Community Health Centers.
While the numbers have been encouraging so far, however, not all advocates are convinced it will carry through to higher enrollment overall.
“We are very pleased of where we are at this point,” said Lori Lodes, co-founder of Get America Covered. “But we don’t believe as many people will sign up.”
But for now, the number of average daily enrollees at both the national and state level is up by 26 percent over the same time last year, according to the latest numbers from the Centers for Medicare and Medicaid Services (CMS).
CMS said that nationwide an average of 111,250 have been signing up every day for 2018 coverage, compared to an average of 82,220 per day at the same point last year. That brought overall enrollment nationally to just under 2.8 million as of Nov. 25. In Arizona, the number was 51,615, the CMS figures show.
Open enrollment began on Nov. 1 and continues through Dec. 15 – a 45-day enrollment window compared to 90 days in previous years.
Lodes attributes the increased enrollment this year to several factors, including a great deal of media attention, private efforts to get the word out about the open enrollment period and generally lower prices for insurance plans.
“The number one reason people don’t sign up is affordability,” Lodes said. “The reason why we think there’s a higher uptick in plan selection is because people aren’t getting scared off by the prices this year.”
She and Gjersvig agree that media attention has helped increase awareness.
“It’s also been very top-of-mind for a lot of people,” Lodes said. “It’s on the news every single day.”
That news had generally been bad for supporters of Obamacare, as Congress made several attempts to repeal and replace the program and the White House slashed funds for advertising and navigators, dropped a cost-sharing program for insurance and cut the enrollment period in half, among other changes.
And the GOP tax-reform plan the Senate is taking up this week includes a repeal of the individual mandate, the Affordable Care Act provision that requires people to pay a sliding-scale penalty with their taxes if they do not have health insurance.
If passed, “some people will choose not to buy. People dropping out will raise prices for those who choose to sign up,” Gjersvig said.
“That has no impact on this year, other than perception. It could affect their behavior,” he said of a possible mandate repeal. But until then, he noted, the requirement is “still the law.”
Last year saw the first drop in ACA enrollment since the law took effect in 2012, with numbers falling at both the state and national levels. Many advocates, including Lodes and Gjersvig, attribute the drop to a volatile presidential election, which spurred uncertainty in the health care debate.
Also last year, premiums in Arizona skyrocketed, rising an average of 116 percent over the year before, a statistic frequently cited by the president as proof the system was failing.
But this year, it’s a different story. Premiums in Arizona, for example, are expected to increase by only about 2 percent or less this year.
“Plans are cheaper than they ever have been before,” Lodes said, adding that many have been “very, very surprised at just how affordable it was.”
A study by the Kaiser Family Foundation found that 54 percent of people eligible for coverage under Obamacare – 5.9 million – could qualify for premiums this year that would cost less than the individual mandate penalty they would have to pay if they went without coverage. The penalty is set at 2.5 percent of a family’s income, or $695 per adult, whichever is higher.
About 4.5 million of those people could end up paying nothing for their coverage, Kaiser estimates, because of health care tax credits they could receive to offset the cost of coverage.
Kaiser estimated that individual mandate penalties for an uninsured 55-year-old couple in Arizona with a $40,000 income would be about $116 per month. The same couple could get tax credits that would bring the cost to the couple down to zero.
Lodes said there is one other factor that might be at work: The president’s decision to do away with cost-sharing reduction payments to insurance companies that help offset the cost of providing free or low-cost coverage to low-income individuals. The insurance companies are still required to offer the coverage, but are passing the cost on to customers, which in turn is making more taxpayers eligible for higher tax credits.
Gjersvig said enrollment numbers dipped slightly last week, but chalked that up to the holiday. Lodes agreed that “people aren’t really thinking about healthcare,” during Thanksgiving week.
In years past, there has been a surge as the enrollment period winds down, and advocates said they expect that again this year. But they conceded that, with all the changes that took effect this year, it’s largely uncharted territory.
“There’s a big question mark as to what’s going happen in those last few weeks,” Lodes said.