Healthcare.gov enrollment down from 2018 as exchanges fail to attract new customers
By Shelby Livingston
January 3, 2019 - Modern Healthcare
The CMS published its final snapshot of
HealthCare.gov sign-ups on Thursday, showing that 8.4 million people selected or
were automatically enrolled in a 2019 health plan during the open enrollment
period that ended Dec. 15.
Sign-ups fell about 3.8% from open
enrollment for 2018 coverage, when more than 8.7 million people chose a plan
during open enrollment. The final tally does not include people who signed up
for health coverage in states that operate their own insurance exchanges. The
CMS said it plans to release a report in March with that data.
The CMS
data shows that the 39 states using HealthCare.gov failed to attract new
customers, which drove the decrease in enrollment. A little less than 2.1
million people who enrolled in a health plan were new customers who didn't have
an exchange plan the year before—about 15.8% fewer than the 2018 total.
Meanwhile, customers that previously enrolled through HealthCare.gov and came
back to do so again for 2019 totaled 6.3 million, up 0.9% over the number of
customers who renewed coverage in 2018.
Larry Levitt, a senior vice
president at the Kaiser Family Foundation who has tracked open enrollment over
the years, said the big drop in new customers is "troubling." As people move in
and out of the individual insurance market after gaining or losing job-based
insurance, an influx of new customers is necessary to keep enrollment stable, he
said.
The drop in sign-ups was less drastic than some observers had
anticipated. The zeroed-out individual mandate penalty, expanded access to
association and short-term health plans, and gutted federal budget for ACA
advertising and outreach were expected to dampen enrollment this year.
At
the same time, unemployment is down, more insurers are selling health plans on
the exchanges this year and premiums for benchmark silver plan premiums
decreased by about 1.5% on average after years of sharp increases—all factors
which could positively affect enrollment.
At the state-level, almost all
HealthCare.gov states experienced a decrease in enrollment compared with 2018
sign-ups.
Virginia experienced the largest drop at 18%. The state's decision to
expand Medicaid starting in January 2019, extending coverage to 400,000 newly
eligible residents, likely explains the drop in its exchange enrollment. People
who enrolled in HealthCare.gov previously may have become eligible to enroll in
Medicaid.
Florida, Hawaii, Mississippi, Oklahoma, Utah and Wyoming
experienced an increase in sign-ups.
The final enrollment count is
about 43,000 people below the CMS' preliminary enrollment total, released Dec.
19. The final figure is lower because people who were automatically enrolled or
who actively enrolled canceled their health plans before the deadline.