As of the final enrollment tally released by the Centers for Medicare and Medicaid Services on March 15, about 12.2 million people had enrolled in a health insurance plan using Obamacare marketplaces this year. The final tally includes enrollment data from federal and state exchanges, and it represents a slight drop over the final figure for 2016. Then, enrollment topped 12.7 million people. This year’s total is about half a million short of that figure and over a million short of the Obama administration’s projected total of 13.8 million signups. Amid concerns over the Republican replacement bill, officially called the American Health Care Act and unofficially dubbed Trumpcare, the CMS report indicates that many Americans are hesitant to purchase health insurance in an uncertain climate.
The final tally represents data from all 50 states and the District of Columbia, generated from federal and state-based marketplaces. It does not include the number of people who bought health insurance outside of the exchanges. This year’s figure comes as somewhat of a surprise given steady enrollment in the early weeks of the 2017 signup period. Until President Trump took office, enrollment showed signs of surpassing last year’s total.
In January, Trump pulled about $5 million worth of advertising funding from HealthCare.gov, and it’s been suggested that this measure is partially responsible for lower-than-anticipated enrollment totals. But funding cuts aren’t completely to blame. Uncertainty about Republican efforts to repeal and replace Obamacare is also a likely motivating factor.
Over the last few months, vocal rightwing lawmakers, Speaker of the House Paul Ryan chief among them, have been adamant about upholding a key campaign promise to repeal and replace former President Obama’s signature healthcare law with something of their own design. The latest bill, the American Health Care Act (Trumpcare), was introduced on March 6.
The Affordable Care Act (Obamacare) made health insurance affordable for millions of people. In 2017, about 83 percent of marketplace enrollees received advance premium tax credits to offset the cost of insurance. Trumpcare would exchange income-based subsidies with age-based ones, leading some to worry that older, sicker enrollees would not be able to afford health insurance. Age-based subsidies are more beneficial to younger people who need less care.
This year’s enrollment tally suggests that healthcare is still a top priority for most Americans despite the lower final count. Of the 12.2 million people who got coverage during open enrollment, about 3.8 million were new customers, representing 31 percent of the total. Most enrollees were younger than 54, and 71 percent of those who signed up earned between 100 and 250 percent of the federal poverty level.
Even more telling this year is the number of people in rural areas who used a state exchange or HealthCare.gov to sign up for health insurance. Just 18 percent of the enrollment total came from rural areas. This year, major insurers like United Healthcare and Aetna withdrew from the exchanges, citing profit losses as the primary reason. Not enough young, healthy individuals signed up for coverage, forcing insurers to cut their losses and duck out early. It’s not clear how Trumpcare will address this problem and create competition again in the individual market, but Republicans assert that this is one of their primary goals with the AHCA.
Trumpcare has made its way through two House committees so far, but resistance from Democrats and moderate conservatives will slow things down. Whether the AHCA is a viable option to replace Obamacare remains to be seen. As written, it’s unlikely to make headway in the Senate. Signup numbers from the 2017 open enrollment period indicate a continued need for affordable health insurance, an issue that will need to be addressed in any replacement