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Despite Obstacles, Affordable Care Act Enrollment Remains Resilient

Today, the Centers for Medicare and Medicaid Services (CMS) released preliminary Affordable Care Act (ACA) enrollment numbers, which showed that 8.3 million people made plan selections in the 38 states during the ACA’s seventh annual enrollment period.

A total of 8.5 million people enrolled during last year’s open enrollment period. However, taking into account states that have newly expanded Medicaid and Nevada’s transition to a state-based marketplace, this year’s enrollment total remained very similar to the previous year. 

In response to today’s ruling, Erin Hemlin, Director of Health Policy and Advocacy for Young Invincibles, issued the following statement:

“It’s incredibly frustrating to see overall enrollment isn’t growing given that the ACA marketplace is strong, more plans are being offered, and plans are more affordable for shoppers than ever before. We know that this year millions of people qualified for zero dollar premium plans and two in three returning shoppers could have found a plan for $10 or less. But thanks to the deep cuts to outreach, advertising, and in-person help, awareness among consumers who need coverage remains very low.

In addition to the Trump Administration’s 90 percent cut in outreach and advertising funding, consumers faced numerous challenges this year that made it harder for young people to enroll. The administration expanded short-term “junk” plans — which cover virtually nothing and are heavily targeted to a “young and healthy” audience — and those plans flooded the market. The public charge rule, a thinly-veiled attempt to dissuade low-income and disproportionately black and brown immigrants from using health care programs that they are legally eligible for, also had a chilling effect for customers. And of course the Trump Administration’s continued effort to repeal the ACA through the courts added to the confusion consumers feel about their enrollment options and about the future of the Affordable Care Act.

If this landscape isn’t bleak enough, the administration failed to properly support the website, resulting in an estimated 100,000 people unable to enroll in coverage. While CMS offered a short extension, it’s clear that it came too late and didn’t go far enough.  

We know this administration will stop at nothing to repeal the Affordable Care Act. But this refusal to follow existing federal law should frustrate every young adult who relies on the ACA for affordable, quality health coverage.”

While about 8.5 million people made plan selections by the end of the sixth open enrollment period, comparing this year’s enrollment to last year’s is not quite an apples-to-apples comparison. For instance, Nevada transitioned to run its own state-based marketplace and some states expanded their Medicaid programs, moving people off of the market. A more accurate point of comparison for last year’s enrollment figures would be closer to 8.34 million, which subtracts total marketplace enrollment in Nevada, and those marketplace enrollees in Maine and Virginia who transitioned to Medicaid after both states implemented expansion.

The preliminary numbers released by CMS also do not include the final three hours of the extension from midnight to 3 a.m. ET, or those who left their contact information with the call center before the deadline and will still have an opportunity to complete enrollment. The final enrollment total will differ slightly from today’s preliminary release. 

In addition to the numerous challenges and lack of funding for outreach from the Trump Administration, some of this decline is likely due to glitch issues with during high surge days on November 1 and the December 15 deadline.