ObamaCare's latest open enrollment period ended Saturday with the future of the law facing uncertainty after a federal judge in Texas struck it down.
Sign-ups for ObamaCare plans at healthcare.gov, the federal platform used by 39 states, had already lagged behind previous years, putting enrollment on track to drop for the second year in a row under the Trump administration.
“There’s a decent chance this will be the largest drop the federal marketplace has ever seen,” said Joshua Peck, co-founder of Get America Covered, a website that tries to spread the word about open enrollment. “It would be shocking to me if more than 8.8 million people were enrolled at the end of this period.”
Enrollment on the federal exchange is unlikely to top the 8.8 million who signed up last year, or the 9.2 million people who signed up in former President Obama’s final year.
In a late twist, a federal judge in Texas on Friday also issued a ruling finding core provisions of ObamaCare unconstitutional, making the whole law invalid.
While the decision will almost certainly be appealed, experts worried that it would cause confusion on the last day of open enrollment, which is usually the busiest day of the entire season.
Still, the law is still in effect and officials said the decision will not affect the 2019 plan year.
“The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment,” Centers for Medicare and Medicaid Services Administrator Seema Verma tweeted Friday night.
“There is no impact to current coverage or coverage in a 2019 plan.”
A decline in enrollment next year doesn’t mean the law is imploding, experts say. But a drop in enrollment is certain to intensify the partisan fighting over the health-care law.
Democrats have repeatedly accused President TrumpDonald TrumpOvernight Defense & National Security — The Pentagon's deadly mistake Overnight Energy & Environment — Presented by Climate Power — Interior returns BLM HQ to Washington France pulls ambassadors to US, Australia in protest of submarine deal MORE of “sabotaging” the 2010 law, pointing to the Trump administration's decision not to defend ObamaCare against the lawsuit filed by Republican attorneys general. Republicans call the law a failure.
An enrollment drop would carry more risks for the administration next year as Democrats retake the House majority. The party has already vowed to conduct oversight hearings on the what they see as administration efforts to undercut the law.
Many indications have pointed to a drop in numbers. Enrollment numbers released for the first six weeks of this sign up period show a lag over previous years, and a 12 percent decline over last year.
More than 4.1 million people had signed up for coverage as of Dec. 8, compared to the 4.7 million who had signed up during the same time period last year.
Thousands more are expected to have signed up during the final days of open enrollment, as is typically the case, but those numbers won’t be released until this week.
It’s unclear if that surge will be enough to overcome the decline in signups seen since open enrollment began Nov. 1.
The number of new customers is down 20 percent compared to last year, in addition to the drop in people renewing their coverage.
“The gap there is so significant, that it is almost a certainty that there’s no chance we’ll catch up,” said Peck, who was responsible for marketing open enrollment under Obama.
Still, more than 4 million people signed up for coverage in the last week of open enrollment last year — nearly double the number of people who had signed up in the six weeks preceding.
More than 4.6 million people would need to sign up this week to match last year’s healthcare.gov enrollment numbers.
“In years past, there’s always been a last-minute surge,” said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University.
“People do procrastinate on this stuff, it’s a busy time of year. It may more people this year than in year’s past who are not actively renewing and are waiting to be auto-enrolled. Those numbers won’t show up until the end.”
Many factors could play into this year's lag in enrollment.
Next year is the first year since 2014 where consumers who don't have health insurance won’t have to pay a penalty. Congress repealed the penalty last year, and it takes effect Jan. 1.
The Trump administration also expanded non-ObamaCare plans that are sold off the exchange and are cheaper but cover fewer benefits.
Unemployment in the U.S. is the lowest it’s been in nearly 50 years. That suggests fewer people could be purchasing their own insurance because they now get it through work.
The administration also cut funding for enrollment assistance this year, and is spending less on advertising.
Cynthia Cox, a health care expert with the Kaiser Family Foundation, said fewer people appear to be aware of open enrollment and their options.
The ACA received a lot of attention from media outlets and celebrities last year when Congressional Republicans were trying to repeal and replace the law, she said.
That could have encouraged people to sign up.
“This year, the ACA hasn’t been in the news as much, and hasn’t been getting as much attention,” she said.
That's despite the fact that, on average, premiums are stable compared to last year. But they are still high for those who earn too much to qualify for subsidies.
However, at least 4.2 million people who are uninsured qualify for free bronze plans due to financial assistance, according to a KFF analysis.
Another indicator of a lack of awareness is the dwindling number of visits to healthcare.gov.
While 14 million people visited healthcare.gov through week six of open enrollment last year, only 11 million have so far this year.
“Not only are sign ups dropping, but the number of people actually getting to the website are dropping even more,” she said.