Obamacare’s 2018 open enrollment period came to a close in most states on December 15. Roughly 8.8 million people signed up for health plans through Healthcare.gov, the federal exchange that operates in 39 states. That’s a 4 percent decline compared to last year’s total of 9.2 million sign ups through the federal marketplace that operates exchanges in 39 states. Enrollment in the 12 exchanges run by individual states and the District of Columbia also appears to have dipped.
The health law’s backers say that President Trump is to blame for these lower enrollment figures. They claim that the administration sabotaged open enrollment by slashing advertising budgets and shortening the sign-up period.
These accusations fall apart under scrutiny. The skyrocketing cost of insurance and diminishing plan choices have driven Americans away from the marketplaces — not presidential malfeasance.
Even before open enrollment started November 1, Obamacare’s proponents tried to lower the public’s expectations and shift blame for the coming drop in enrollees. They predicted that President Trump’s decision to cut Obamacare’s advertising and outreach budget from $100 million to $10 million — as well as his decision to shorten the open enrollment period from 12 to six weeks — would lead to lower enrollment.
Senate Minority Leader Charles Schumer, D-N.Y., accused the administration of “deliberately attempting to sabotage our health care system.” Sen. Ron Wyden, D-Ore., said, “The Trump administration is constantly doing somersaults to try to find ways to dissuade people from enrolling.”
The truth is, the administration’s gymnastics have little impact on whether people purchase coverage. Those decisions are dictated by simple things like the price of a plan and how much they value the benefits it provides.
Many Americans have decided that exchange coverage simply isn’t worth its high price tag.
Under President Obama, enrollment dropped from 12.7 million in 2016 to 12.2 million in 2017. In the years leading up to that dip, enrollment consistently disappointed expectations. In 2010, the Centers for Medicare and Medicaid Services projected that 17 million people would enroll in the exchanges in 2014. Fewer than half that number actually signed up.
Those lackluster enrollment numbers were the direct result of rising prices and dwindling choices on the marketplaces. Between 2016 and 2017, average premiums on the Healthcare.gov marketplace rose by 25 percent. One in five enrollees had a “choice” of plans from a single insurer.
The same is true for this year’s sign-up season. Premiums continued their rapid ascent in the 2018 enrollment period; the average silver plan is 34 percent more expensive. And nearly one in three customers had just one insurer to “choose” from.
It doesn’t help that, even after five years, the sign-up process remains plagued by technical glitches. For instance, in Illinois — a state that uses the federal Healthcare.gov exchange — some customers who applied for financial assistance on the website were alerted that no plans were available in their area.
That message was false — people in all U.S. counties have access to least one marketplace plan.
Which seems more likely: that current exchange customers abandoned the marketplaces in the face of outrageous price hikes, paltry plan selection, smaller networks of doctors and hospitals, and a frustrating user interface — as so many did during the Obama administration? Or that President Trump’s decision to spend only $10 million of taxpayer money promoting open enrollment “sabotaged” what would have been Obamacare’s first successful sign-up period?
On the contrary, the changes made to Obamacare by President Trump and Congress could make insurance coverage more accessible next year. The president’s October executive order directed federal agencies to expand access to cheaper, less comprehensive short-term health plans. Last year, 45 percent of people who went without insurance cited its cost as the reason why. Short-term plans could be appealing to this group.
Such plans could be even more appealing now that Congress has repealed the individual mandate. Short-term plans didn’t comply with the mandate; now, people who choose them won’t be subject to a fine.
If President Trump is guilty of anything, it’s giving his detractors a convenient, albeit inaccurate, excuse to lay Obamacare’s worst consequences at the feet of the administration. In condemning the president’s marketing and outreach cuts, Sen. Schumer warned that “when the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame.”
Nice try, Chuck. Soaring premiums and falling enrollment rates were the norm long before President Trump set foot in the White House. No amount of advertising can convince Americans to buy health plans they can’t afford. Next year’s open enrollment season will bring more of the same — unless Obamacare is repealed and replaced.