Despite Changes That Undermined ACA Enrollment, Marketplaces 'Remarkably Stable'

Two Californians wait to meet with an enrollment counselor to sign up for Affordable Care Act insurance in Sacramento. Nationwide enrollments are holding up despite uncertainties about the health law's future

Only 11 states plus Washington D.C. have their own exchanges, but the state-specific marketplaces spurred those states to level sign-ups a year ago.

The annual enrollment tally remains a relatively crude metric that doesn't account for what kind of consumers are signing up for coverage.

Sign-ups fell 5.3% in the 34 states that leave enrollment entirely to the federal exchange, healthcare.gov.

"Despite all that, enrollment in the marketplaces across the nation was remarkably stable", said Trish Riley, executive director of the academy, a nonprofit, non-partisan group.

Officials from states operating their own exchanges said their ability to make changes led to their gains. But it remained essentially flat in the 12 state-based marketplaces and in the five states that have their own exchanges, but outsource the enrollment process to healthcare.gov.

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While California and other states that operate their own marketplaces invested in marketing and outreach, the Trump administration took a number of steps that weakened enrollment.

Several states, including Alaska and Minnesota, already have reinsurance programs.

Trump also repeatedly referred to the health care system, also known as Obamacare after his predecessor, as "dead" and talked of allowing it to implode.

About 1.5 million Californians signed up for insurance through Covered California during the three-month open enrollment period that ended January 31st.

Korbulic credited the state's Republican governor, Brian Sandoval, with helping to stabilize a shaky market even as insurers stopped selling plans in the state and threatened to leave consumers in some rural areas with no choice of plans.

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An Associated Press count found that nationwide enrollment was about 3 percent lower than previous year. Overall, U.S. enrollment dropped by about half a million people, or 3.7 percent. Arizona relied on the federal government to operate its marketplace.

People who are eligible for health law subsidies would be shielded from such increases, but those who don't get financial assistance would face another round of premium hikes.

The difference, according to NASHP, was state-based exchanges used "effective communication"-since they didn't cut their advertising budgets like HHS-to reach out to key populations who may be eligible for larger subsidies, shielding them from the double-digit premium increases seen across the country".

But continued uncertainty about the markets and the disappearance in 2019 of a penalty for not having coverage could push up rates for consumers who don't qualify for aid.

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