So far, a heady pace for Obamacare enrollment
The test is expected to come near the end of a narrow window
Fans and foes of the Affordable Care Act expected that political confusion and budget cuts would splash cold water on the willingness of Americans to sign up for health care coverage in this year’s shortened open enrollment period.
But so far it appears that both sides underestimated the vital importance that access to health care holds for individuals who cannot obtain it any other way.
More than two weeks into an abbreviated enrollment period that ends Dec. 15, the daily average of people purchasing policies through the federal website HealthCare.gov is higher by 60 percent than in 2015 — at a rate of more than 134,000 a day, compared to about 77,000. Despite a lower number of insurance carriers, generally higher premium costs and slashed federal spending on promotion and assistance, the numbers of new and returning customers are both up sharply.
Data at the local and state levels are not yet available, said Jodi A. Ray, director of Florida Covering Kids & Families at the University of South Florida’s Chiles Center. Ray has led the coalition of organizations responsible for helping Floridians enroll in this part of the state since 2013, at the beginning of what has come to be known as Obamacare. But from what she is seeing so far, Ray is guardedly optimistic.
“I’m not going to tell you whether there’s a trend,” she said. “But the results that I’m getting from the field are really positive. We really put forth an aggressive effort to reach out to customers that we’ve worked with over the past four years. The appointments are filling up, which is great.”
This is happening despite a determined effort to reduce the amount of reliable information reaching consumers, observed Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation, which researches health care issues.
“For the fifth open enrollment, the period was shortened to six weeks, with a 90 percent reduction in federal funding for advertising and a 41 percent reduction in navigator grants,” she said, referring to the hiring budget for the trained advisers who help people sign up online. The foundation’s research showed, she said, that going into the enrollment period, “Nearly 30 percent of the general public and 40 percent of the uninsured don’t know whether the health care law is still in effect.”
Funding for navigator funding in Florida is higher than the national average, with only a 30 percent reduction in spending from 2016, a drop from almost $9.5 million to about $6.6 million. Some states are responding by concentrating their outreach and education in urban areas, where it is most effective, and leaving rural consumers to find their own way.
But Ray’s group adopted a different strategy, hiring as many navigators as possible for the enrollment period and laying them off later.
“Regardless of the cuts that we took, we weren’t going to eliminate vulnerable populations that we were serving already,” she said. “We find that the people who need the assistance of navigators come in with more complex situations. We have been calling for months to let them know about the shortened enrollment period and encouraging them to come in.”
In Sarasota and Manatee counties, only about 7 percent of the population enrolled in Obamacare in 2017 — just over 54,000 residents. Several factors are in play here, including an unusually high number of Medicare beneficiaries, and the fact that Floridians do not have access to the Medicaid expansion program that makes more low-income Americans eligible for coverage. About 384,000 people in this state fell into that coverage gap last year, making too much money to qualify for traditional Medicaid coverage and too little to receive insurance subsidies under the federal plan.
But it is also likely that many young and healthy county residents, mostly holding jobs in the service economy, are opting to pay the tax penalty of $695 or more rather than seeking out health care coverage. This is the population that worries health care policy experts, because their participation is necessary to make the “risk pool” math work for insurance providers.
“It’s important to keep in mind that the impact of the Trump administration’s decision to significantly cut outreach will primarily be felt in the final weeks of open enrollment,” said Lori Lodes, co-founder of the nonprofit Get America Covered, and a former outreach staffer for HealthCare.gov. “The young and healthy tend to sign up when it’s close to the deadline, and need the extra reminders that advertising provides. That’s why we need to do even more during the final four weeks before the final Dec. 15 deadline to make sure people understand that coverage for most people is more affordable than they think.”
Ray emphasized that these younger consumers should at least find out what their options are, and whether they qualify for premium assistance.
“You want to make sure that people remember that there is a mandate, and they may get penalized financially,” she said. “You’re going to pay this huge penalty and not get anything for it. Most of the people who are applying, they’re getting the subsidy.”
She added that her navigators are encountering confusion about whether the Affordable Care Act is still in place.
“The early response is great and promising, but I’m not ready to call it a win,” she said. “We spent four years educating people, and we really made headway. I remember the first year, people didn’t know anything. And now we’re kind of almost starting over.”
On the other hand, she said, the pace of enrollments so far makes sense to her: “People need insurance. Florida every year has led the nation in enrollment. From my vantage point, we have seen the need, and we have witnessed the real desire to have coverage.”
Obamacare: what you need to know
• Deadlines: This year’s enrollment period runs until Dec. 15. Due to a special exception for states affected by hurricanes Harvey, Irma and Maria, Floridians can apply for an extension until Dec. 31. But this option is not recommended, because of uncertainty about how it would affect the start date of insurance coverage.
• How to enroll: Florida has no state exchange, so the federal website, HealthCare.gov, is the portal for enrollment. The site also has answers to most general questions.
• If you need help: Navigators are available in this area through the enrollment period, by appointment. You can find one by going to CoveringFlorida.org. Click on “enroll and renew coverage” and enter your ZIP code.