Signups for Obamacare in states that had later deadlines for open enrollment appear to be outpacing previous years, despite consumer confusion about the law and federal cutbacks to advertising and outreach.
As of Jan. 29, nearly 11.8 million people had enrolled in Obamacare coverage in the federal and state exchanges, according to data collected by the pro-Obamacare group Get America Covered. The numbers appear to be headed toward outrunning the end of the previous open enrollment during President Barack Obama's last year in office, when 12.2 million had signed up.
The estimates come as every state, other than the District of Columbia, has closed its open enrollment period. The Trump administration's healthcare.gov deadline ended Dec. 15, six weeks earlier than under the Obama administration.
But the 11 states and D.C. that created their own exchanges could set their own deadlines. Nine had deadlines that were later than healthcare.gov's, excluding Maryland, whose officials later decided to provide a five-day extension. California and New York ended open enrollment this week.
State governments that were more supportive of Obamacare had later deadlines and spent more on getting the word out.
California spent $110 million on advertising and outreach, saying it was necessary because of consumer confusion about the law. The amount dwarfs the $10 million that the federal government spent on advertising, down from $100 million spent during the previous year. The Trump administration also reduced spending on navigators, who help people sign up for plans, from $62 million to $36 million.
"Getting press coverage to complement our advertising is actually what has made us so effective," said Peter Lee, executive director of Covered California. Research that the agency commissioned showed that people were more likely to go to the state website or encourage people they know to sign up for coverage when they read about it in the media.
Data from Jan. 21 indicated that 342,000 new California consumers had signed up for health insurance, and 1.2 million had stayed on. New customers are showing higher volumes than last year, when these sign-ups hadn't passed 320,000 until Jan. 23.
Republicans failed in 2017 to repeal most of Obamacare, formally called the Affordable Care Act, but did repeal the law's penalty against people who were uninsured in the tax overhaul legislation. The penalty will be lifted beginning in 2019, but state officials say the back and forth on Capitol Hill caused confusion among customers.
The efforts in Congress and from the Trump administration led to Democratic charges of "sabotage," but the changes the Trump administration made did not appear to significantly affect enrollment. At the close of the federal exchange's deadline, about 8.7 million people signed up for coverage, a slight decrease from the 9.2 million the year before. Much of that was thanks to a system that automatically enrolled previous customers in the same plan they had or in a similar plan if their insurer stopped participating in Obamacare.
The Trump administration said it had used resources more efficiently and effectively, focusing on strategies such as emailing people directly about the deadline. Seema Verma, administrator for the Centers for Medicare and Medicaid Services, also credited her agency's work in launching a website that didn't face the technical challenges that plagued earlier years.
But officials at the local and state levels said they observed confusion, and surveys parallel their experiences. One poll from YouGov suggested a third of the public believes Obamacare has been repealed, and another poll indicated that the public was confused about the status of the Obamacare fine. An eHealth survey found more than half of consumers didn't know when the Obamacare deadline was.
The District of Columbia extended its deadline for DC Health Link to Feb. 5 from Jan. 31.
"We know anecdotally that there has been real confusion about whether the marketplace was open for enrollment after Dec. 15," said Linda Wharton-Boyd, spokeswoman for DC Health Link. "We also know from a recent national survey that up to a third of Americans believe the ACA was already repealed. We want to cover as many people as we can and that’s why we did this extension."
As of Jan. 8, the latest day for which data are available, 93,335 people had signed up for coverage. The totals are in line with the previous open enrollment and include the SHOP exchange, which covers small businesses and members of Congress and their staffs.
In New York, more than 1.36 million people signed up for coverage, an increase from 1.1 million the year before. State officials held more than 470 events to promote open enrollment and released a range of ads, as it had in previous years.
"Since the start of the 2018 open enrollment period, N.Y. State of Health worked to get its message out and counter consumer confusion about coverage and enrollment deadlines," said Jill Montag, spokeswoman for the state's health department.
Cost also may have had an impact on enrollment. A larger proportion of states were able to offer their customers lower-cost health insurance than the previous year. The Trump administration ended payments to insurers known as cost-sharing reduction subsidies, and as a result, some states raised premiums only on certain types of plans, shifting costs to the federal government. That curbed premiums for customers who otherwise would have faced higher costs and allowed other customers to obtain coverage without any cost to them.
Rate increases varied widely by state but increased by an average of 34 percent nationwide for mid-level plans that weren't subsidized. The increase was felt most by healthier, older enrollees who are middle-class.
Lee noted that people who were unsubsidized at a certain income level might be hardest to bring along. The group also tended to be healthier, he noted, which would continue to raise the cost of premiums in future years as they exit plans.
"There is a small slice that is absolutely not going to buy no matter what you do, but there are a lot of people for whom marketing gets them across the finish line," Lee said. "They need to be sold and cajoled."
States are considering various responses for 2019, whether by buckling down on Obamacare by imposing their own mandates for coverage or asking the federal government to allow changes to the law.
California plans to continue to try to make Obamacare successful there.
"We will make it work for consumers with whatever cards we are dealt," Lee said.