ACA sign-ups lag by half-million as open enrollment ends

Written on Dec 20, 2018

As open enrollment ended on Dec. 15 for federally facilitated Affordable Care Act (ACA) exchange plans, the number of sign-ups through the HealthCare.gov platform is lagged behind last year's numbers.

About 934,000 people selected plans using the HealthCare.gov platform last week, bringing the cumulative total for the first six weeks of the 2019 open-enrollment period to about 4,132,000 plans selected, according to the Centers for Medicare & Medicaid Services (CMS).

By contrast, there were 546,000 more sign-ups at the same point in last year's open-enrollment period, when the cumulative number of plans selected reached about 4,678,000 at the end of the sixth week.

Comparing this year to last year, however, should come with a bit of a caveat: The cumulative total for the first six weeks of the 2019 open-enrollment period (Nov. 1, 2018, through Dec. 8, 2018) is a day shorter than the first six week of the 2018 open-enrollment period (Nov. 1, 2017, through Dec. 9, 2017) because each week is measured Sunday through Saturday, CMS noted.

Counting the seventh week, the open-enrollment periods for this year and last year are 45 days apiece.

Even so, the apparent dip in ACA plan selection follows a year of efforts by the Trump administration to remove some of the Obama-era law's teeth.

A year ago, Congress zeroed out the ACA's individual mandate penalty, effective Jan. 1, 2019. Since then, the administration has slashed funding for the "navigators" who help consumers sign up for coverage, touted skimpy alternatives to ACA-compliant plans, and sided against key provisions of the ACA in a lawsuit brought by Republican state attorneys general seeking to have the entire law overturned.

More recently, the administration has reinterpreted some of the terminology in the ACA's "guardrails" for Section 1332 waivers, giving states more leeway to sidestep certain requirements in the law—a move critics warn could lead eventually to the collapse of ACA-compliant markets.

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