When ObamaCare’s open enrollment period begins Friday, many people can expect to find lower premiums and more plan options on healthcare.gov.
But experts and advocates are projecting the number of enrollees for 2020 will decrease for a fourth consecutive year, in large part because of actions taken by the Trump administration.
“I expect to see a decline in enrollment because of the long list of things working against it,” said Josh Peck, who oversaw ObamaCare enrollment efforts from 2014 to 2017.
Enrollment has slipped in recent years, from a high of 12.7 million in 2016 to 11.4 million in 2019.
Democrats have accused President Trump and his administration of “sabotaging” the 2010 health care law by backing a lawsuit that seeks to overturn it, loosening regulations on the sale of non-ObamaCare plans, cutting federal funds for marketing and outreach efforts, and ending payments to insurers that go toward reducing costs for low-income customers.
Still, there are signs the Affordable Care Act (ACA) marketplaces are holding steady. Health insurance premiums have decreased, on average, from last year, and increased insurer participation means consumers will have more plan options.
“Generally speaking, the markets have proven to be more resilient than many would have given it credit for, and I think there are several positive trends for the market and the people signing up for it,” said Cynthia Cox, director of the Kaiser Family Foundation’s ACA program. “The market is still relatively stable despite the policy changes that have been put in place over the last few years.”
An analysis by Peck’s group, Get America Covered, found 67 percent of consumers shopping for coverage on healthcare.gov this year can find an ObamaCare plan for $10 or less after subsidies.
Peck said he would highlight that dollar amount if he were still running marketing for ObamaCare.
“That is not something they’re broadcasting,” he said of the Trump administration.
While the administration has noted premiums are down this year, and insurer participation is up, Trump officials have also said ObamaCare “simply doesn’t work” and is “unaffordable” for too many people.
That messaging, combined with the administration’s decision in 2017 to slash the marketing budget from $90 million to $10 million, can dampen enrollment, Peck said.
“Telling people prices are unaffordable leads to fewer people seeing if they qualify for coverage,” he said. “There’s a need to make sure consumers are aware there are affordable prices out there.”
Open enrollment begins Friday and ends Dec. 15 for the 28 states that use healthcare.gov, the enrollment platform managed by the federal government. The remaining states manage their own platforms, like California’s coveredca.com. Seven states also have enrollment deadlines that extend into January.
The open enrollment period comes as Democratic presidential candidates argue over the next steps for ObamaCare. White House hopefuls like former Vice President Joe Biden want to build on ObamaCare, while progressive candidates like Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) favor a national health care program referred to as “Medicare for All,” where everyone would receive coverage.
In the meantime, one of the biggest concerns to advocates this open enrollment season is the proliferation of loosely regulated “short-term” plans that have been expanded by the Trump administration. The plans, which are sold by some health insurance companies, agents and brokers, typically cost less than ObamaCare but provide fewer benefits.
Short-term plans were originally designed to fill gaps in insurance coverage for consumers, but the administration finalized rules last year allowing the plans to be renewed for up to three years, much longer than the previous three-month limit.
House Democrats are investigating what they see as “deceptive” and “misleading” marketing tactics used by some companies to attract customers who might not know their plans don’t cover all of the same benefits ObamaCare does, like prescription drugs or mental health care.
Experts expect those marketing efforts to intensify as open enrollment begins and consumers start thinking about their health insurance options for the coming year.
“There’s definitely some efforts out there to sell skimpier plans, and it’s not clear to people necessarily know what they’re buying,” Cox said.
A study conducted last year by the Urban Institute found that Google searches for “ObamaCare plans” and “ACA enroll” mostly yielded results for websites selling short-term plans. Those plans aren’t sold on healthcare.gov or other state-based marketplaces, but are instead found on third-party websites run by brokers, agents and insurance companies.
The plans are also available year-round, while sign-ups for ACA plans are limited to six weeks at the end of the calendar year.
“Even if you type in ‘ACA plans’ or ‘ObamaCare plans,’ the first page of results is mostly junk insurance,” said Sabrina Corlette, a research professor and founder of Georgetown University’s Center on Health Insurance Reforms who co-authored the Urban Institute report.
These plans are being “aggressively and deceptively marketed to consumers,” she said.
The Trump administration lifted restrictions on short-term plans to offer an alternative for customers who can’t afford ObamaCare plans, particularly those who make too much money to qualify for subsidies.
Seema Verma, who oversees ObamaCare as director of the Centers for Medicare and Medicaid Services, said the Trump administration has tried to protect consumers by requiring companies selling short-term plans to include language in their contracts and applications clearly stating they don’t comply with ACA standards.
“These plans are not for everybody, and so we want to make sure that people understand exactly what they’re getting and what they’re not getting,” Verma told The Hill on Tuesday. “And that’s why we focused on strengthening the consumer protection regulations.”
Senate Democrats are also raising alarms over what they see as a lack of oversight by the administration, noting that brokers often get higher commissions for signing up customers for short-term plans compared to ObamaCare plans.
“There are other websites out there that may not be looking for consumers’ best interests,” Sen. Bob Casey Jr. (D-Pa.) told reporters Tuesday. “We have a lot of scam artists who are trying to rip people off that we’re trying to warn them about.”
Also hanging over the open enrollment period is a pending 5th Circuit ruling on the constitutionality of ObamaCare that could come any day now.
The Trump administration is supporting a lawsuit brought by a coalition of Republican-led states that argue the law has been unconstitutional ever since Congress in 2017 repealed the fine for not having insurance.
While the lawsuit won’t have a direct impact on enrollment, it could cause confusion among consumers about the future of the ACA, especially if the court declares the law, or parts of it, unconstitutional.
Whichever side loses is expected to appeal the case to the Supreme Court.
“I think the important thing for a consumer to keep in mind is that you just have to make your health insurance decisions based on the current law and based on what’s currently available to you what you can afford and what your options are,” Cox said.
“There’s no way that you can plan for what’s going to happen because no one knows.”