ObamaCare enrollment tells tale of two systems

ObamaCare enrollment tells tale of two systems

Most states that operate their own ObamaCare exchanges saw more people sign up in 2018 than last year, while 29 of the 34 states that rely on the federal government to promote enrollment saw their sign-ups fall.

Of the 17 state-based marketplaces, 11 saw enrollment increases: Colorado, Connecticut, Washington, D.C., Massachusetts, Minnesota, New York, Rhode Island, Nevada, Washington, Kentucky and Oregon while California, Idaho, Maryland, Vermont, Arkansas and New Mexico saw decreases.

The 34 states using the federal marketplace, in contrast, saw a 5.3 percent drop in enrollment, according to data released Wednesday by the National Academy of State Health Policy (NASHP).


Louisiana, one of those states, saw a 23 percent drop in enrollment — a difference of about 33,700 people. 

Overall, total enrollment in ObamaCare dropped about 4 percent, or by 500,000 people, as the increases in the state-based exchanges did not increase enough to offset the losses on the federal exchange.

The different enrollment numbers suggest the Trump administration’s decision to cut off advertising and other services intended to get people signed up for ObamaCare plans had an effect on the federal exchange. 

“It’s a tale of two approaches to the marketplaces,” said Josh Peck, founder of Get America Covered and a former Obama official who ran marketing for the health care law. 

“The state-based marketplaces generally are much more supportive and want to see them succeed. The federal marketplace under the Trump administration — Trump has specifically said ObamaCare is dead. That is their approach.” 

The Trump administration cut the advertising budget for the exchanges from $100 million to $10 million, and cut grants to local organizations that help people sign up for coverage, known as navigators, by 40 percent.

The administration also kept a relatively short period for enrollment this year, which ended on Dec. 15.

Washington, D.C. and the 16 states running their own exchanges have the ability to make their open enrollment periods longer, and some opted to stay open for through January.

Washington state’s marketplace saw a 7 percent increase in enrollment from last year, a difference of about 20,000 people.

Washington’s state legislature approved more funding for marketing and outreach, which appeared to be a factor. 

“We think marketing, outreach, and our customer support network made all the difference,” said Pam MacEwan, chief executive officer of the Washington Health Benefit Exchange. 

State-based exchanges have generally been more stable than states using the federal exchange. 

From 2016 to 2018, state-based exchanges saw a 1.5 percent growth in enrollment. The federal exchange saw a 10.5 percent decrease in that same time period. 

Minnesota’s state-based exchange saw a 6 percent enrollment increase, and 30 percent of its enrollees were new customers. 

“We had the best open enrollment period we’ve ever had,” said Allison O’Toole, chief executive officer of MNsure. 

Rhode Island’s state-based exchange saw a 12 percent enrollment increase, with 8,000 new customers. 

Zachary Sherman, director of the state’s exchange, said it’s control of the program has never been more critical than it was in the recent open enrollment period. 

“Our ability to extend our open enrollment period, our ability to control our marketing and outreach budget, our ability to quickly and nimbly mitigate the impact of defunding CSRs right before open enrollment started and our ability to serve our customers in their communities led to a very successful open enrollment period,” Sherman said. 

While the overall ObamaCare numbers fell, supporters of the law said the expected enrollment to drop much more given the cuts by the Trump administration.

“Enrollment in 2018 was much better than was expected, given all the headwinds,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

But further reductions in enrollment are possible, particularly given the end of the individual mandate.  

Peter Lee, executive director of Covered California, said the end of the mandate combined with other factors could cause “premiums will go up anywhere from 15 percent to 30 percent or more, depending on the state.”