CMS on Tuesday released a final report for the 2018 open enrollment period, showing approximately 11.8 million individuals signed up for exchange plans—down 3.3% from the 2017 open enrollment period, when 12.2 million individuals signed up for exchange plans.
According to the Wall Street Journal, industry analysts had expected to see steeper declines in exchange sign-ups this year because of policy changes enacted under the Trump administration to shorten the open enrollment period from 90 days to 45 days and cut outreach spending.
CMS' report is based on data from the 39 states that use the federal exchange for enrollment and the 11 states as well as the District of Columbia that use state-based exchanges. The data include returning customers who were automatically re-enrolled in coverage as well as those who actively selected a new plan. According to the Journal, the data do not indicate whether individuals completed the enrollment process by paying their first month's premiums, meaning the number of people who actually enroll in exchange coverage is likely to be lower.
According to CMS, decreases in sign-ups primarily occurred in states that use the federal exchange. Those states accounted for 8.7 million sign-ups for the 2018 open enrollment period. Enrollment remained flat—at around 3 million—in states that run their own exchanges.
The data also show the number of first-time sign-ups dipped from 31% during the 2017 open enrollment period to 27% this year.
In terms of specific age groups, CMS found individuals ages:
- 55 and over accounted for 29% of exchange plan sign-ups;
- 35 to 54 accounted for 36% of exchange plan sign-ups;
- 18 to 34 accounted for 26% of exchange plan sign-ups; and
- 0 and 17 accounted for 9% of exchange plan sign-ups.
According to Politico's "Pulse," the share of exchange plan enrollees between 18 and 34 dropped for the first time since the exchanges launched. "Pulse" reports that such consumers, who are younger and typically healthier, are seen as vital to the exchange market, because they help balance out risk pool to offset set the cost of insuring those who are older and less healthy.
Of the 11.8 million individuals who signed up for exchange coverage:
- 63% selected a silver plan—down 9 percentage points from the 2017 open enrollment period;
- 29% selected bronze plans—up 6 percentage points from the 2017 open enrollment period; and
- 7% of selected gold plans.
While insurers increased 2018 exchange premium "list prices" by about 30% compared with 2017 coverage, consumers who qualify for federal subsidies—about 83% of all exchange sign-ups—saw their out-of-pocket premiums costs decline. For example, the average out-of-pocket premium cost for individuals who purchased coverage on the federal exchange and qualified for federal subsidies was $89 this year, down about 16% from $106 for 2017. According to CMS, federal subsidies covered about 86%, on average, of the premium's "list price." The subsidies are available to those with annual incomes between 100% and 400% of the federal poverty level.
However, individuals who did not qualify for federal subsidies paid the higher list price in full. CMS Administrator Seema Verma in a release called for more affordable coverage options for those individuals.
CMS in the report called the latest open enrollment "the agency's most cost-effective." According to the report, CMS spent $10 million on outreach and marketing—which is the equivalent to about $1 per HealthCare.gov enrollee. In comparison, CMS for the 2017 open enrollment period spent approximately $100 million on outreach and marketing—which is the equivalent of $11 per HealthCare.gov enrollee.
Several groups that support the ACA exchanges applauded the figures, saying they show U.S. residents support the health reform law despite Republican efforts to repeal it, the Journal reports.
Topher Spiro, the vice president for health policy and a senior fellow for economic policy at American Progress, in a tweet said, "In the face of repeated attempts to repeal the ACA and numerous acts of overt sabotage, ACA enrollment remains stable." Spiro said, "The people fought and saved health care for millions."
Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, said, "These numbers show for the first time how the Trump administration's termination of payments to insurers in a sense backfired." He added, "The result, which is a little bizarre, is that consumers eligible for government premium subsidies are actually paying less out of their own pockets for insurance on average than last year."
However, some experts said the administration's efforts curtailed enrollment. Josh Peck, co-founder of Get America Covered and who led federal exchange marketing efforts under former President Barack Obama's administration, said, "While enrollment remained steady because of high consumer satisfaction and more affordable premiums for those who qualify for tax credits, enrollment would have outpaced previous years' if the administration had focused on signing people up instead of derailing open-enrollment efforts" (Erman/Hunter, Reuters, 4/3; Morse, Healthcare Finance News, 4/3; Diamond, "Pulse," Politico, 4/4; AP/New York Times, 4/3; Goldstein, Washington Post, 4/3; Armour, Wall Street Journal, 4/3; Goodnough, New York Times, 4/3).
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