January 2, 2020

CMS recently announced that 8.3 million U.S. residents signed up for federal exchange plans for the 2020 coverage year during the Affordable Care Act's (ACA) latest open enrollment period, with total signups down slightly when compared with the previous open enrollment period.

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Details on open enrollment data

The ACA's federal open enrollment period for the 2020 coverage year launched Nov. 1, 2019, and was scheduled to end on Dec. 15, 2019. However, in response to reports of technical glitches on HealthCare.gov that occurred during the first and final days of the open enrollment period, CMS relaunched open enrollment at 3:00 PM EST on Dec. 16, 2019, and allowed U.S. residents to sign up for federal exchange plans through 3:00 AM EST on Dec. 18, 2019. CMS said the extension would give U.S. residents who experienced difficulty signing up for a federal exchange plan because of the glitches additional time to do so.

CMS on Dec. 20, 2019, released preliminary data on federal exchange signups that occurred from the open enrollment period's launch on Nov. 1, 2019, through Dec. 17, 2019. The data also included specific details on signups that occurred during the last week of the ACA's latest open enrollment period, which spanned from Dec. 8, 2019, to Dec. 17, 2019.

The data included signups in the 38 states that use the federal exchange for enrollment. The data did not indicate whether individuals paid their first month's premiums, a step that effectively completes the enrollment process.

The data also did not include signups that occurred on Dec. 18, 2019, during the final three hours of the open enrollment period. In addition, the data did not include signups from people who left their contact information with representatives from the federal exchange's call center because the call center was experiencing high call volume. Such individuals can sign up for coverage at a later date, Modern Healthcare reports.

8.3M signed up for or were automatically re-enrolled in federal exchange plans, CMS says

CMS said about 8.3 million individuals selected or were automatically re-enrolled in federal exchange plans as of Dec. 17, 2019.  That total included about 4,421,179 individuals who selected or were automatically re-enrolled in federal exchange plans during the last week of the ACA's latest open enrollment period.

According to CMS, the 8.3 million individuals who selected or were automatically re-enrolled in federal exchange plans included:

  • 2,062,474 new customers; and
  • 6,241,376 returning customers.

Signups down less than 2% from last year

Overall, the preliminary number of total signups that occurred during the ACA's latest open enrollment period were down by about 1.8% when compared with the nearly 8.5 million signups that occurred during the open enrollment period for the 2019 coverage year:

According to Modern Healthcare, the number of people who renewed their federal exchange coverage during the latest open enrollment period was down by about 3% when compared with the previous open enrollment period, but the number of new customers who signed up for federal exchange plans increased by about 2%.

Why are signups lower?

Get America Covered Co-Founder Josh Peck in a blog post wrote that the Trump administration's "lack of effort" to promote the ACA's latest open enrollment period likely contributed to the comparatively lower signups. "There [was] an acute lack of awareness that enrollment [was] happening, a huge perception gap between how much people think HealthCare.gov plans cost and how much they actually cost, aggressive marketing campaigns for short-term plans, as well as continued uncertainty about the future of the [ACA] among the uninsured," he wrote.

In addition, observers have noted that the technical glitches with HealthCare.gov, new Medicaid expansions in a number of states, the administration's expansion of short-term health plans, and lower unemployment rates could have contributed to the comparatively lower signups.

Further, David Anderson, a research associate at the Duke-Margolis Center for Health Policy at Duke University, noted that average federal exchange plan premiums are lower for the 2020 coverage year than they were for the 2019 coverage year. Those lower premiums mean average subsidies for exchange plans also are lower, which could have contributed to lower signups, Anderson said. He explained, "[A] lot of people will be seeing slightly higher [out-of-pocket] premiums in 2020 than they were seeing in 2019. That might be worth a couple percentage points of enrollment."

Reaction

Administration officials said the preliminary data on the latest open enrollment period show total federal exchange signups have remained relatively stable.

For example, CMS Administrator Seema Verma said, "We are reporting that for the third year in a row enrollment in the federal exchange remained stable. Far from undermining the [ACA], as some hysterical and inaccurate claims would have it, the … administration is making the very best of what remains a failed experiment."

But Larry Levitt, EVP for health policy at the Kaiser Family Foundation, said, "What you don't see in these numbers are the big declines in recent years in individual insurance enrollment among people not eligible for subsidies who buy outside the exchange as premiums increased significantly."

For her part, Verma also acknowledged that U.S. residents who do not qualify for ACA subsidies are facing rising premiums. "For all our successes, too many Americans who do not qualify for subsidies still cannot afford premiums that remain in the stratosphere—constituting a new class of uninsured. The ACA remains fundamentally broken and nothing less than wholesale reforms can fix it," she said (Livingston, Modern Healthcare, 12/20/19; CMS fact sheet, 12/20/19; Goldstein, Washington Post, 12/20/19; Sullivan, The Hill, 12/20/19; Maddipatla, Reuters, 12/20/19; CMS release, 12/16/19; Peck, Medium, 11/20/19).

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