ACA enrollment down 12.8 percent over last year

Affordable Care Act open enrollment for week four, from November 18-24, is 500,437, only 3,744 behind numbers from last year at the same time when 504,181 consumers selected plans on Healthcare.gov.

But since November 1 when open enrollment began, there's been a 12.8 percent drop in the number of people signing up for Obamacare.

So far this year, 2.42 million people have enrolled, compared to 2.78 million last year, a 356,347 difference.

One caveat to the lower numbers is that enrollment weeks are measured Sunday through Saturday.  Consequently, the cumulative totals reported in this year's figures reflect one fewer day than last year.

Open enrollment ends December 15.

WHY THIS MATTERS

The decrease is significant compared to past years and the reasons may include the lack of an individual mandate to buy coverage and consumer confusion over whether the insurance even still exists, given recent Republican efforts to repeal and replace the law.

But insurers this year were looking at a more stable market for 2019 despite the lack of an individual mandate. Many reentered the business or expanded their footprint and kept premiums lower than in the past.

While there are no current plans to repeal the law, the Trump Administration on Thursday announced a proposed policy to allow states to apply for 1332 waivers that would let them use ACA subsidies for other types of plans, such as catastrophic insurance. The money would be placed in defined-contribution, consumer-directed accounts for individuals to pay for premiums.

In a letter to Health and Human Services Secretary Alex Azar and other officials, Democrats called the move an effort to sabotage the ACA.

The drop in enrollment numbers and destabilization of the market through federal policy could cause insurers to rethink their ACA business plans for next year.

WHAT ELSE YOU NEED TO KNOW

CMS also released effectuated enrollment numbers, reflecting the numbers of people who not only signed up, but activated their plans and paid their ACA premiums.

As of September 15, an average of 10.3 million individuals had effectuated their coverage through June 2018, a 1 percent increase over the same time period in 2017, CMS said.

The number of people who pay for coverage is always lower than figures for those who sign-up for a plan. However, in 2018, that difference was markedly below that of 2017, 1.5 million people compared to 2.1 million, respectively.

THE TREND

The data released by CMS show that the average monthly premium per enrollee for the first six months of 2018 was $595.89, an increase of 26 percent compared to the first six months of 2017.

The average monthly amount of advanced premium tax credits per enrollee also rose 39 percent to $519.18 when compared with the first six months of 2017.

The proportion of enrollees who received a tax credit in the first six months of the year was 87 percent, up from 84 percent in the first half of 2017.

The average premium and average advanced premium tax credit amounts have been relatively stable since the start of the 2018 plan year, CMS said.

ON THE RECORD

"Millions of Americans are served by this market, and our industry is committed to delivering affordable choices for them," America's Health Insurance Plans said. "We'll continue to encourage people to sign up for coverage, because it is essential to ensuring their health and financial stability."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com