The decision by the Trump administration to drastically cut the budget for promoting the upcoming enrollment period for health plans sold on Affordable Care Act (ACA) exchanges could reduce the number of people who sign up, healthcare policy analysts at the nonpartisan Kaiser Family Foundation (KFF) said yesterday.
The policy analysts said in a news briefing that the White House, which labels the ACA a failing law, has created other obstacles for individuals and families to obtain coverage in 2018, such as shortening the enrollment period from 12 weeks to 6 weeks. It begins on November 1 and ends December 15 for residents of the 39 states that shop for a plan on the healthcare.gov website as well as three states that run their own exchanges.
A recent KFF survey found that a majority of uninsured Americans as well as those currently enrolled in an exchange plan don’t know the stop and start dates. That’s all the more reason to get the word out, said Jennifer Tolbert, the director of state health reform at KFF.
“Consumers need to hear this information over and over and over again,” said Tolbert. She noted that when the Trump administration pulled television and radio ads for the previous enrollment period in late January 2017, there was a marked dip in sign-ups.
“The uncertainty and lack of awareness suggest that there could be a drop in enrollment [for 2018],” added KFF Senior Fellow Karen Pollitz.
Roughly 12.2 million Americans signed up for health plans sold on state insurance exchanges for 2017.
In August, the Centers for Medicare & Medicaid Services (CMS) announced that it would spend $10 million to advertise ACA enrollment for 2018 through “digital media, email, and text messages.” The ad budget for the previous enrollment drive was $100 million.
In addition, CMS will spend 41% less on ACA “navigators,” who personally help individuals obtain coverage on the exchanges. That cutback is another setback, said Pollitz. “What we found is that people who go to navigators don’t have the confidence to go through this process alone.”
Shorter Enrollment Time, More Last-Minute Shoppers?
Other decisions by the Trump administration could complicate ACA enrollment this fall, according to the KFF policy analysts. The healthcare.gov website will shut down for maintenance every Sunday from midnight to noon EST, cutting into screen time. And the truncated period to sign up in most states could increase the volume of last-minute insurance shoppers on the federal website when December 15 nears. A surge of visitors to the website could cause it to slow down.
Pollitz told reporters that it’s not clear whether someone who is “in line” to enroll on a balky healthcare.gov but can’t do so by the December 15 deadline will be permitted to do so afterwards.
“Don’t wait until the last minute,” she said.
The shorter time for enrollment presents yet another potential problem. Individuals already covered by an ACA exchange plan can automatically renew it, but if their insurer has left the exchange, they could be assigned to a new insurer ― and new provider network ― that they may not like. But they won’t have the opportunity to change plans in January as they did in previous enrollment periods.
Confusion and Uncertainty
The KFF policy analysts reviewed other actions by the Trump administration that they said created confusion and uncertainty about the ACA.
Last week President Donald Trump announced that he would immediately stop reimbursing private insurers for reducing copays and deductibles for exchange plan enrollees. By law, most of them are entitled to lower out-of-pocket expenses because of their income, and they’ll continue to receive this benefit despite the cutoff of so-called cost-sharing reduction (CSR) payments to insurers, said Larry Levitt, senior vice president for special initiatives at KFF.
Insurers generally jacked up their premiums for 2018 in anticipation of this revenue loss, but most enrollees receive premium subsidies that keep pace with the cost, so they’ll be held harmless, Levitt noted.
Bipartisan legislation is brewing in the Senate to temporarily restore CSR payments to insurers. It faces opposition from Trump, who just the day before spoke favorably about it.
Trump also issued an executive order last week calling for new regulations to expand association health plans and short-term policies that would cost less but offer fewer benefits than ACA-compliant plans and that would lack their consumer protections. This new policy direction won’t have a direct bearing on ACA enrollment for 2018, said Levitt, but it could have an “indirect affect by creating confusion for consumers.”
A recording of the KFF news briefing is available on the group’s website.
Follow Robert Lowes on Twitter @LowesRobert
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