President Donald Trump’s administration has already had a massive effect on the Affordable Care Act, the healthcare better known as Obamacare.
In an press release, the Centres for Medicare and Medicaid Services (CMS) — which oversee the ACA’s public insurance exchanges — provided their typical biweekly update on the end of Obamacare’s open enrollment period, which ran from November 1 through January 31.
The period in which people without insurance through an employer or Medicare/Medicaid could sign up for coverage ended with 9.2 million people signed up for plans through the Healthcare.gov platform, not including state-based exchanges.
What’s most startling, however, is just how much the plan selections slowed after Trump took office.
According to the previous bi-weekly update from the Obama administration, 8.8 million had signed up through January 14, meaning that roughly 800,000 people were enrolling on a weekly basis. Based on the updated figures from Trump’s CMS, only 200,000 Americans signed up for coverage in each of the final two weeks.
The slow end pace could be potentially crippling to the law’s health. The late sign-up period is critical, as the percentage of young people obtaining coverage usually increases, leading to help balancing risk pools for the exchanges.
So far in the previous three years of the exchanges, the population that has signed up through the exchanges has been older and sicker than expected. This phenomenon has led to higher costs for insurers, which then get passed on to consumers.
The Obama administration was hoping to have more young people sign up through outreach, especially as the sign-up period came to a close. Instead, communication regarding the open enrollment period came to a screeching halt after the Obama administration turned the keys over to Trump and his team. The effect on enrollment is clear.
The Twitter account for the Department of Health and Human Services ceased tweeting about signing up for coverage, and Trump’s team rolled back significant amounts of TV advertisements touting Healthcare.gov.
Obama’s HHS officials also reported a higher number of concerned calls regarding the repeal of the law, and independent enrollment advocates reported a lower-than-average number of appointments for assistance in signing up for a plan.
In addition to a serious drop-off in enrollments, the CMS update it also signalled a tonal shift in how the government will talk about the ACA.
Typically, the CMS releases have conveyed not only data but also general support for the law, touting what it has portrayed as an increase in plan selections from the previous year and the ability for people to gain access to health coverage easily. For example, previous emails frequently noted the percentage of people that could get covered for less than $75 or $100 a month.
But in the first communication about the sign-ups from the Trump administration, the tone was drastically different. After first providing the number of sign-ups for plans on Healthcare.gov, the email immediately pointed to increased premiums associated with many of the exchange-based plans.
“On January 31, 2017, Open Enrollment for 2017 coverage ended with more than 9.2 million plan selections in states that use the Healthcare.gov eligibility and enrollment platform,” said the press release from CMS.
It continued: “Those selections were made from a market that experienced a 25 per cent increase over the previous year in the average premium for the benchmark second-lowest cost silver plan as well as a 28 per cent decline in the number of issuers participating over the past year.”
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