Despite Early Low Enrollment, Federal Exchange Enrollment Steady

The 2020 federal exchange enrollment remained steady at around 8.4 million enrollees, CMS announced.

However, CMS Administrator Seema Verma expressed dissatisfaction with enrollment. Her dissatisfaction was not because of the perceived steadiness but rather because of the persistent coverage gap for low-income individuals who do not qualify for subsidies. To Verma, this year’s enrollment numbers were further evidence of a flawed system that must be replaced.

“Far from undermining the Affordable Care Act – as some hysterical and inaccurate claims would have it – the Trump Administration is making the very best of what remains a failed experiment,” Verma said. “For all our successes, too many Americans who do not qualify for subsidies still cannot afford premiums that remain in the stratosphere – constituting a new class of uninsured. The Affordable Care Act remains fundamentally broken and nothing less than wholesale reforms can fix it.”

Earlier in the enrollment season, some experts shared their concerns that enrollment would take a dive. In the first two weeks of enrollment, approximately 20 percent fewer Americans enrolled in the federal health insurance marketplace than that time period the previous year, CNBC reported.

Experts and policymakers feared that technical challenges encountered in the first couple of days of the open enrollment season may have deterred potential enrollees and could result in higher uninsurance.

By the sixth week, however, the scene had improved. 

The agency’s snapshot of the penultimate week’s enrollment showed 3.8 million cumulative plan selections, which, while still 330,000 less than last year’s sixth week of enrollment, was better than the 20 percent drop in November.

In response to Congress’s concerns regarding the technical difficulties, CMS extended the open enrollment period by two days so that enrollment closed in the early morning of December 18.

At the end of week seven—including the extra two days—8.4 million are estimated to have enrolled or automatically re-enrolled in HealthCare.gov plans. That is more than 150,000 enrollees behind 2019 enrollment, a less than 2 percent decrease.

In the overall scope of enrollment across the last three years, this number represents a continuation of the enrollment creeping downward. Including state health insurance marketplaces, enrollment hit a high of over 12.6 million in 2016 and has been dropping since then.

While state-based exchanges have hovered around three million since 2015, HealthCare.gov states went from 9.6 million enrolled in 2016 to 8.4 million this year and in 2019 open enrollment season, according to last year’s report. That means 1.2 million Americans left the exchange in the past three years.

Similar to Medicare open enrollment, navigators and call centers were swamped with the demand for information and assistance. CMS reported that the call center’s consumer satisfaction response was high again this year, with an average of over 90 percent satisfaction rate.

To help ease the process, CMS added new features to the website, including quality star ratings on the exchange plans and a more streamlined website experience. 

The agency also expanded Enhanced Direct Enrollment to enable individuals to enroll through approved third-party websites. These private sector partners were intended to lessen the traffic on HealthCare.gov to prevent a crash.

While the concerned predictions arising from the 20 percent lower enrollment earlier in the season proved false, one prediction that has not changed is the marketplace premium rate for 2020. For the second year in a row, the average premium on HealthCare.gov declined. CMS also noted that 20 payers entered the marketplace.

But across all of the positive press, CMS and HHS officials continue to remind the public that one of their top priorities is to repeal the Affordable Care Act and, ostensibly, erase the marketplaces, although no replacement has been proposed.

CMS is expected to release a complete enrollment snapshot next week.