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December 20, 2018

Federal exchange enrollment has ended, and the signup total is in

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    CMS on Wednesday announced that 8.5 million U.S. residents signed up for federal exchange plans this year, down by about 4% from the approximately 8.8 million who signed up during last year's open enrollment period.

    The federal open enrollment period for the 2019 coverage year ran from Nov. 1 through Dec. 15. Some state-based exchanges have longer open enrollment periods.

    In keeping with a practice established last year, CMS did not project in advance how many U.S. residents would enroll in exchange coverage. However, some experts predicted that the number of enrollees will stay about the same as 2018, when a total of 11.8 million people signed up for or were automatically re-enrolled in exchange plans through both the federal and state-run exchanges. Others suspected the total could drop slightly, largely because of policy changes that expanded access to short-term and association health plans and zeroed out the ACA's individual mandate penalty for remaining uninsured.

    Signups reach 8.5M

    CMS data released Wednesday include signups in the 39 states that use the federal exchange for enrollment that occurred from Nov. 1 to Dec. 15. The data do not indicate whether individuals paid their first month's premiums, a step that effectively completes the enrollment process. The data also do not include individuals who signed up for exchange plans in states that did not use the federal exchange for enrollment.

    CMS said 4,322,450 people selected federal exchange plans during the seventh week of the open enrollment period, which spanned from Dec. 9 to Dec. 15. CMS said that figure included:

    • 3,403,802 returning customers; and
    • 918,648 new customers.

    CMS said, "Similar to previous years, there was a surge in the number of consumers contacting the exchange call center and visiting HealthCare.gov during the final days of open enrollment." CMS said the federal exchange enrollment call center during the open enrollment period received a total of about 5.2 million calls, including 1,783,333 calls during week seven. HealthCare.gov during the open enrollment period saw more than 15 million visitors, including more than five million visitors during the seventh week of open enrollment, according to CMS.

    CMS said as of Dec. 15, about 8.5 million U.S. residents had selected federal exchange plans since the open enrollment period launched Nov. 1. CMS said that total includes the number of U.S. residents who signed up for a federal exchange plan as of 11:59 p.m. EST on Dec. 15. As such, the total could increase, because U.S. residents in other time zones had until 3:00 a.m. EST on Dec. 16, at the latest, to sign up for federal exchange plans. In addition, U.S. residents who left their contact information with the federal enrollment call center will be contacted and have extra time to sign up for a federal exchange plan. CMS said it already has begun reaching out to such individuals.

    Signups so far down by 4% when compared with last year

    According to Reuters, the 8.5 million total is down by about 4% from the 8.8 million who signed up for federal exchange plans during last year's open enrollment period.

    CMS cautioned that the 8.5 million total is "preliminary and [does] not represent final 2019 exchange open enrollment figures."

    Reasons for the decrease

    CMS Administrator Seema Verma said the Trump administration "has taken strong steps to promote a more competitive, stable health insurance market and these steady enrollment numbers are yet another sign that the administration's efforts are working."

    Verma in a release suggested the lower exchange enrollment figure could be attributed to the stronger economy. "With the lowest unemployment rate in 50 years, it's possible that more Americans have employer-based coverage, and don't need exchange plans," Verma said.

    Further, Verma in a call with reporters noted that about 100,000 Virginia residents who had been enrolled in exchange plans became eligible for Medicaid this year under the state's expansion of the program.

    Analysts also have pointed to cuts in ACA outreach funding and the elimination of the ACA's individual mandate penalty as reasons why total enrollment might decline when compared with last year. However, Verma suggested those changes did not affect signups. "We see no correlation between what we are seeing on advertising and effectuated enrollment," she said.

    Politico's "Pulse" reports that federal exchange enrollment has declined by nearly 750,000 over the past two open enrollment periods, "and it's not clear if those [U.S. residents] got coverage elsewhere, or what they're paying if they did." "Pulse" reports, "That data relies on other surveys and is still months away" (Humer, Reuters, 12/19; CMS release, 12/19; CMS fact sheet, 12/19; Owens, "Vitals," Axios, 12/20; Armour, Wall Street Journal, 12/19; Diamond, "Pulse," Politico, 12/20).

    Cheat sheet: What you need to know about the ACA


    The Patient Protection and Affordable Care Act, otherwise known as the ACA, is the comprehensive health care reform bill passed by Congress in March, 2010. The law reshapes the way health care is delivered and financed by transitioning providers from a volume-based fee-for-service system toward value-based care.

    Download the ACA cheat sheet to get a quick overview of this significant U.S. health care legislation.

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