Pace of sign-ups under Affordable Care Act blows past prior years


More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Donald Trump’s assertion that the marketplace was collapsing. 

In a report on the first four days of open enrollment, the Trump administration said Thursday, 601,462 people had selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange. 

“It’s the biggest start to open enrollment ever,” said Lori Lodes, an Obama administration official and co-founder of Get America Covered, a nonprofit group helping people get information about insurance options. “It shows that people really want to get health insurance and value it.” 

The surge in sign-ups came after Trump and Republicans in Congress had repeatedly tried to repeal the Affordable Care Act, warning that markets were imploding and rates exploding. 

“Obamacare is finished,” Trump said at a Cabinet meeting on Oct. 16. “It’s dead. It’s gone. It’s no longer — you shouldn’t even mention. It’s gone. There is no such thing as Obamacare anymore.” 

The numbers tell a different story. Sign-ups averaged more than 150,000 a day last week. By contrast, they averaged 66,000 a day in the first week of open enrollment in November 2014 and 77,600 a day in the first week of enrollment in November 2015. The Obama administration reported data every other week last fall, and the first report showed that sign-ups averaged 84,000 a day. 

Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that helps consumers, said he and his insurance counselors were seeing a huge demand for their services. 

“There’s a strong need among families in Utah for health insurance,” Slonaker said. “There’s been a threat to take away that option. People respond to threats. Perhaps there’s no such thing as bad publicity. All the talk about health care in the year since the election has been good advertising for the Affordable Care Act.” 

Lodes suggested that consumers, anxious and confused about coverage, visited HealthCare.gov last week and found that health plans were cheaper than they had expected. 

The Kaiser Family Foundation said Thursday that 4.5 million people could obtain insurance at essentially no cost next year because they are eligible for financial assistance that could pay the entire cost of a bronze plan, the minimum level of coverage that meets federal requirements. 

Insurers have raised the premiums for many health plans in 2018 because of Trump’s threat to cut off certain subsidies paid to insurers — a threat he carried out last month. Many consumers with low or moderate incomes are eligible for larger tax credits to help pay the premiums. As a result, many consumers can buy similar health plans or more generous plans for about the same price as last year. 

Republican attacks on the Affordable Care Act appear to be fortifying support for the law. 

The new report from the Trump administration came two days after voters in Maine approved a ballot measure to expand Medicaid under the health law and a Democrat swept to victory in Virginia in a governor’s election in which health care was a top issue. 

The sign-up period for the federal exchange ends Dec. 15 and is about half as long as the open enrollment season in each of the past three years. 

The number of new customers signing up for insurance is a closely watched indicator of public interest in the marketplace. The number of new customers selecting health plans on HealthCare.gov averaged 34,300 a day last week, up from 26,400 in the first week of open enrollment in 2015 and 20,500 last fall. 

The new report shows sign-ups by people in 39 states that use HealthCare.gov. It does not include activity in 11 states that operate their own insurance exchanges. Some people who sign up do not pay their share of premiums for the first month, so the coverage never takes effect. Others allow coverage to lapse during the year because they obtain insurance from another source or fail to pay premiums. 

Health policy experts said that unhealthy people with the greatest need for insurance tended to sign up in the first weeks of the open enrollment period while healthy people, who are needed to stabilize the market, were more likely to sign up near the final deadline. It is, they said, too early to predict total enrollment for 2018.


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