Affordable Care Act Sign-Ups Dip Amid Uncertainty and Trump Attacks

By ROBERT PEAR
FEB. 3, 2017 - The New York Times

WASHINGTON — The number of people who signed up for health insurance in the federal marketplace that serves most states dipped this year to 9.2 million, the Trump administration said Friday, as consumers struggled with confusion over the future of the Affordable Care Act.

That represents a decline of more than 4 percent from the total of 9.63 million people who signed up through HealthCare.gov at this time last year.

The numbers do not include activity in the 11 states that run their own online marketplaces under the Affordable Care Act, former President Barack Obama’s signature health care law. State reports suggest that they have signed up about three million people.

Veterans of the Obama administration said President Trump’s opposition to the health law and his efforts to undermine it had taken a toll. People may also have been influenced by signals from Congress that the law would soon be repealed. And some consumers may have been put off by the termination of their health plans, which was caused by an exodus of major insurers from the market in many states.

Just before leaving office, the Obama administration reported that sign-ups through HealthCare.gov were running slightly ahead of the number at the same time last year, with 8.8 million as of Jan. 14.

“Trump’s sabotage worked,” said Ben Wakana, who was a spokesman for Sylvia Mathews Burwell, the secretary of health and human services under Mr. Obama. “We were on track to exceed last year’s total. We expected a million people to sign up on the federal exchange in the final week of the open enrollment period.”

Still, the numbers present a challenge to Republicans who are struggling to repeal the law that allowed those millions to purchase insurance plans — and who have promised not to displace anyone covered by it.

The fourth annual open enrollment season began Nov. 1 and ended Tuesday, 11 days after Mr. Trump took office.

The Trump administration scaled back publicity and advertising in the final days of the open enrollment period. Mr. Trump also issued a broadly worded executive order that directed federal officials to waive or delay any provision of the Affordable Care Act that would impose “a cost, fee, tax, penalty or regulatory burden on individuals.”

The order, issued within hours of Mr. Trump’s inauguration on Jan. 20, did not specify what actions would be taken. But lawyers and health policy experts read it as an indication that the government might not enforce the federal requirement for people to have health insurance or pay a tax penalty.

Mr. Trump has described the Affordable Care Act as “a complete and total disaster” and has said he wants to replace it with better, cheaper coverage “for everybody,” but he has not offered a plan to achieve that goal.

Senator Orrin G. Hatch, Republican of Utah and chairman of the Finance Committee, who is trying to draft a replacement for the law, said that “today’s numbers failed to keep pace with last year’s.” In addition, he suggested, some people who signed up will not pay their premiums and will therefore not have coverage this year.

“Either way,” Mr. Hatch said, “enrollment numbers are down, and costs are up.”

That response was predicted by Representative Nancy Pelosi of California, the House minority leader and an architect of the law.

“Now, Republicans will cynically point to the dip in enrollment they caused, declare the Affordable Care Act broken and move to steal the affordable health coverage of every American,” she said. “Meanwhile, in states committed to delivering affordable health coverage to their residents, enrollment in the Affordable Care Act’s marketplaces has surged.”

“Democrats will continue to stand our ground to ensure that every American has access to affordable health coverage,” she added.

Enrollment reports from the Obama administration were invariably upbeat, saying the numbers showed that people needed and wanted insurance under the Affordable Care Act.

The first report from the Trump administration struck a different tone.

“Obamacare has failed the American people, with one broken promise after another,” Matt Lloyd, a spokesman for the Department of Health and Human Services, said Friday. “Premiums in the A.C.A. marketplace have increased 25 percent while the number of insurers has declined 28 percent over the past year.”

Of the 9.2 million people who signed up through HealthCare.gov, one-third were new to the federal marketplace, and two-thirds were returning customers. The individual insurance market is in constant flux. With changes in income and employment, consumers may gain or lose coverage from Medicaid, employers and other sources of insurance.

The Obama administration predicted in October that 13.8 million people would sign up for coverage in the enrollment period that ended this week. The total appears likely to fall short of that goal.

Leslie Dach, a former Obama administration official who is trying to preserve the health law as a leader of the Protect Our Care Coalition, said, “Enrollment was a success, and it would have been even higher without the Trump administration’s efforts to suppress enrollment.” Despite those efforts, he said, “Americans continued to enroll in the final weeks, proving that there is considerable demand for quality and affordable coverage.”

Several states that run their own insurance exchanges appear to have done better than the federal marketplace. In New York, 908,200 people signed up through the state marketplace for either a qualified health plan or the “basic health program” authorized by the Affordable Care Act for low-income people. That represents an increase of 39 percent.

Under the Obama administration, enrollment in marketplace insurance plans was consistently lower than the levels originally projected by the Congressional Budget Office, in part because consumers were more likely to get and keep employer-sponsored insurance.