In Texas and nationally, Obamacare enrollment slips but averts big decline

Dec. 21--Enrollment for health insurance under the Affordable Care Act slipped from last year but has bucked forecasts for a big decline, providing ammunition to proponents and critics alike just as the debate over health care is set to take center stage in 2019.

About 8.45 million people in the 39 states, including Texas, that use the federal HealthCare.gov marketplace signed up for 2019 coverage by the Dec. 15 deadline, according to preliminary federal data, off from about 8.82 million during open enrollment last year. Still, the 4.2 percent slide marked an improvement after a sluggish start this year that saw signups down by double digits at one point on a percentage basis from the comparable period of 2017.

In Texas, about 1.09 million people signed up for 2019 coverage under the Affordable Care Act -- commonly known as Obamacare -- a decline of about 3.6 percent from 1.13 million who signed up last year for 2018 coverage.

Some health care advocates had feared a more significant drop this year, based on what they viewed as continued attempts to undermine the law by the Trump administration and Republicans in Congress, who are opposed to it.

"The numbers are not bad," said Kay Ghahremani, chief executive of the Texas Association of Community Health Plans. "They are actually better, really, than what we were thinking after the first couple of weeks of the enrollment period."

Ghahremani said the enrollment numbers show the importance that people place on access to health insurance and medical care.

But critics of the law say the decline in overall signups, despite being relatively small, is the latest evidence that the Affordable Care Act is failing and has made premiums for people who buy their own health insurance on the marketplace too expensive if they aren't eligible for federal subsidies.

"Outside of a government-provided health care scheme for those at a certain level of poverty, there hasn't been growth" in enrollment, said Rob Henneke, general counsel for the conservative Texas Public Policy Foundation. "People (who aren't eligible for subsidies) today have worse access to care at higher cost than they did before."

The fate of the Affordable Care Act will be hotly debated in the coming year after a federal judge in Fort Worth ruled last week -- on the eve of the final day of open enrollment -- that the entire federal law is unconstitutional. Texas led a coalition of 20 states that sued to throw out the law, and Henneke is a lawyer on the legal team that successfully argued the case.

Proponents of the law have said they will appeal the ruling, and 2019 coverage under it won't be affected. But the move has put pressure on Republicans in Congress and elsewhere who have opposed the Affordable Care Act to come up with alternatives in the event that the ruling is upheld.

Gov. Greg Abbott, a long-time critic of the Affordable Care Act, said in the wake of the ruling that Texas "will begin the process of reforming state regulations and proposing changes to (state) laws" -- ensuring health care will be a major issue during the upcoming session of the state Legislature that begins next month.

"Texas will be ready with replacement health care insurance that includes coverage for preexisting conditions" if the ruling stands, said Abbott, a Republican.

His announcement has won him praise in many corners of the health care debate, with even supporters of the Affordable Care Act saying that waiting to see what happens in the court case would be a bad idea.

"I'm encouraged (Abbott) is willing to engage and develop options for coverage," Ghahremani said. "He took a proactive stance in what otherwise could be causing people a lot of angst."

County-level data for 2019 coverage under the Affordable Care Act hasn't been released yet by the federal Centers for Medicare and Medicaid Services. But local health care advocates said enrollment was solid in the Austin metro area, albeit down slightly from last year.

Kori Hattemer, director of financial programs for local nonprofit Foundation Communities, said her organization met its target of helping about 5,000 people enroll this year. Still, she said she thinks reductions by the Trump administration in federal promotion of the signup period likely crimped turnout.

"It felt like there was a lot less awareness" of open enrollment this year, Hattemer said. "There is only so much we can do (to get the word out) in our capacity as a nonprofit."

Other factors that might have reduced turnout include the lack of a financial penalty in 2019 for people who opt to go without health insurance. Republicans in Congress opposed to the Affordable Care Act removed the fine beginning next year, after failing to repeal the health care law.

The Trump administration also has increased the availability of short-term health plans that don't have to comply with the ACA's coverage requirements, which might have siphoned some enrollees as well. In addition, the strong economy nationally may have enabled more people to access employer-provided health insurance.

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