Obamacare enrollment declines in first four weeks

Nov. 28--Open enrollment for 2019 health insurance under the Affordable Care Act is about to enter its final two-week stretch, with new applications down both statewide and nationally.

Enrollment on the federal health care exchange is off about 13 percent so far nationally, at 2.42 million, down from 2.78 million last year, according to the federal Centers for Medicare and Medicaid Services, which released the figures Wednesday for the first four weeks of the open enrollment period that began Nov. 1 and runs through Dec. 15.

Statewide, enrollment is down about 7 percent, at 311,489 compared with 334,328 after the first four weeks last year.

A variety of factors could be driving the trend -- including the lack of a financial penalty next year for people who opt to forgo health insurance. Republicans in Congress opposed to the Affordable Care Act have failed in their efforts to repeal the health care law, but they succeeded in removing the fine beginning in 2019.

Still, the sign-up numbers through the first four weeks don't include people opting for automatic re-enrollment in Affordable Care Act plans, so it's possible total enrollment won't appear as soft compared with last year once those figures are added when open enrollment ends. In addition, the four-week period measured this year contained one fewer day of open enrollment than last year.

But health care advocates also said enrollment this year could be suffering from low consumer awareness.

The Trump administration has cut funding for advertising and enrollment support for the second year in a row. Meanwhile, the fate of the Affordable Care Act -- commonly known as Obamacare -- was heatedly debated through much of 2017, increasing its profile ahead of last year's open enrollment period and potentially spurring sign-ups.

The GOP-controlled Congress "spent the entire year trying to repeal the Affordable Care Act" in 2017, said Stacey Pogue, a senior policy analyst for the Austin-based Center for Public Policy Priorities, a left-leaning think tank. "It's possible that a lot of the attention given to the ACA raised awareness" and fueled enrollment.

Pogue said there was "much more tumult" in the insurance markets overall last year as well because of the political wrangling, which might have forced more consumers to focus on their health plans rather than simply opt for automatic re-enrollment.

County-level enrollment data for the first four weeks of the sign-up period hasn't been released by the Centers for Medicare and Medicaid Services. But some local organizations that have been helping people sign up for health coverage are reporting softer numbers compared with last year, albeit not quite as soft as the state and national figures.

"The last two weeks were slow, and in total we are down about 5 percent," said Kori Hattemer, director of financial programs for local nonprofit Foundation Communities. "Over the last two weeks especially, we have seen a decline in the number (of people) coming in."

Hattemer said there has been a notable drop in Spanish-speaking consumers compared with last year. She also said the strong local and state economies could be contributing to softer enrollment, because more people could be accessing health insurance through their employers.

Regardless, Hattemer said Foundation Communities is preparing for a busy final two weeks of open enrollment. The sign-up period typically is cyclical, she said, and her organization's enrollment was up about 13 percent through the initial two weeks this year before slipping.

"Pretty much what we have seen every year is that a lot of people come in at the very beginning, and a lot of people come in at the very end," Hattemer said.

The United Way for Greater Austin, with support from Travis County's health district, is providing a call center for information and assistance during the enrollment period for people who want coverage or want to research their options. To access the service, area residents can dial 211 on their telephones.

Hattemer said people also can call Foundation Communities at (737) 717-4000.

Elizabeth Krause, senior program officer in charge of health insurance enrollment at St. David's Foundation, said multiple factors are likely contributing to the slower sign-ups so far this year. But she said she's optimistic enrollment will be strong over the final two weeks.

St. David's Foundation, a philanthropic entity funded through its co-ownership of the hospital, has been publicizing the open enrollment period, and it has provided grants to groups that help people sign up.

"There have definitely been challenges this year," Krause said. "But we are still seeing a good response and a steady stream of folks coming in. We are staying laser-focused over the next two weeks in getting the word out."

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