Open Enrollment 2020 Reflection

Open Enrollment 2020 Reflection

Open enrollment officially ended on December 18. The original closing date was December 15, but on this last day, the website glitched, preventing consumers from enrolling. This was the second time the site glitched during the enrollment period. During the first day of open enrollment on November 1, consumers also had trouble enrolling prompting members of Congress to write a letter to Administrator Seema Verma of Centers for Medicare and Medicaid Services (CMS).

Get America Covered, an advocacy group, estimates that as many as 100,000 fewer people could have signed up for coverage on the first day.

Despite the glitches, the final week of enrollment almost stayed pace with last year’s numbers. Approximately 8.3 million consumers selected a plan in the 38 states that depend on HealthCare.gov, down 2% from 2019’s open enrollment; 2 million of the 8.3 million were new consumers and 6.2 million renewed their coverage from last year. Enrollment of new consumers was up 3% relative to last year.

The data shows the marketplaces are alive well, and there is continued demand for the individual market coverage, despite arguments made to the contrary in the Texas v. United States case against the Affordable Care Act (ACA). That enrollment declined only slightly even with one fewer state—Nevada—depending on HealthCare.gov, is a testament to the marketplaces’ resilience.

The states have weathered the administration’s rollbacks on the ACA, including cuts on marketing and in-person assistance, a shortened enrollment period, a public charge policy for immigrants, the elimination of the subsidy program and the repeal of the individual mandate.

The fact remains the numbers likely would have been higher had the administration not undermined enrollment in the 38 states. Enrollment has declined every year since 2016 when about 9.6 million people out of almost 12.7 million consumers enrolled in coverage. The administration defends the decline by citing the stronger economy, but the uninsured rate rose 0.5% last year.

State-based marketplaces (SBMs) have been able to protect themselves from the administration’s unpredictability and attacks against the ACA. Since 2016, enrollment has been steady or grown in these exchanges.

For 2020, Maryland reported its highest sign-up in years. California reported new enrollment is up 16%. New York also reported an acceleration. Open enrollment in these states continued past December 18.

These numbers add to growing evidence that SBMs have fared better during Trump’s administration than states depending on HealthCare.gov. Premiums in SBMs have decreased or increases have been relatively muted. SBMs have also experienced greater autonomy and flexibility in being able to lengthen their open enrollment and increase advertising and outreach. Financially, SBMs have been able to save relatively more money by not having to fork over user fees to the federal government.

Many of the states transitioning to an SBM, including Nevada, New Jersey, New Mexico, Oregon and Pennsylvania, have cited the cost savings and greater autonomy as reasons for their switches.

Reversing its 2% decline in enrollment, HealthCare.gov could make similar gains in 2021’s open enrollment if it prevents technical glitches and increases marketing and in-person assistance. The administration could also lengthen the enrollment period, retract the public charge policy for immigrants, and reinstate the subsidy program and the individual mandate.

Sources:

  1. https://medium.com/get-america-covered/week-7-new-sign-ups-gain-ground-to-overcome-trump-administration-obstacles-77a3bde51b93
  2. https://www.fiercehealthcare.com/payer/democrats-demand-answers-from-cms-healthcare-gov-technical-problems
  3. https://www.healthaffairs.org/do/10.1377/hblog20191222.796617/full/
  4. https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-weekly-enrollment-snapshot-week-7
  5. https://www.npr.org/sections/health-shots/2019/12/16/788638889/government-extends-open-enrollment-for-aca-health-plans-but-only-for-36-hours
  6. https://www.softheon.com/2019/09/24/rising-uninsured-rate-and-how-states-can-respond/
  7. https://www.help.senate.gov/imo/media/doc/191121%20Letter-%20HHS%20CMS%20Healthcare.gov.pdf
  8. https://www.coveredca.com/news/pdfs/CA_MA_WA_2019_Open_Enrollment_observations-03-05-2019.pdf
  9. https://www.commonwealthfund.org/blog/2019/states-looking-to-run-their-own-health-insurance-marketplace-see-opportunity
  10. https://www.rwjf.org/en/library/research/2019/10/states-seek-greater-control-cost-savings-by-converting-to-state-based-marketplaces.html

 

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