Shorter Obamacare enrollment period: Sabotage or savior?

Yet, despite the changes that the Trump administration has made and Democrats have decried, premiums have gone down slightly heading into 2019, helped along by federal dollars in the form of reinsurance programs, and more insurers are offering coverage. Enrollment, too, could hold up.

The deadline for Obamacare customers, a group that doesn’t get coverage through work or a government program, is just days ahead, on Dec. 15, and so far enrollment has lagged behind last year. Still, the numbers may catch up. The final days of open enrollment tend to bring a surge of visitors and applicants to healthcare.gov and onto call lines. Current customers who do nothing by the end of open enrollment won’t lose coverage, but will be automatically placed into the same plan or a similar one.

The later deadline gave customers more time to sign up, and it allowed them to change their healthcare plan if they were automatically enrolled into one they didn’t like. Customers may want more time to evaluate their options and sit down with an expert who might help them.

But obligating people to sign up by Dec. 15 has its own benefits. It means that coverage will begin Jan. 1, ensuring that beneficiaries don’t face a coverage gap.

It also means that insurers can count on data from a full year’s-worth of claims, which allows them to price their plans better. The earlier deadline reduces the likelihood that people will try to get out of paying a full year of claims or that they will wait a little longer, or until they are sick, to enroll in coverage.

Reducing the enrollment period to six weeks was one of the requests that America’s Health Insurance Plans, which represents insurers, had when Trump took office. The Obama administration had proposed shortening it to six weeks beginning in 2018, but the Trump administration moved that decision up by a year.

“You want to get people in for 12 months of coverage, unless you have one of those major life events like having a baby or getting married,” said Kelley Turek, executive director of employer and commercial policy at AHIP. “If you’re in coverage from Jan. 1 to Dec. 31, that creates more stability in the risk pool and the claims experience that you’re getting. That helps kind of steady premiums for everybody.”

But what insurers hadn’t expected were other actions taken by the Trump administration, including slashing funds for ads about open enrollment. Funding for navigators, or nonprofits that receive federal grants to help people enroll in coverage, fell from $100 million during Obama’s last year to $10 million this year.

“One thing that we had talked about when we initially advocated for [six weeks of enrollment] is that it needs to be coupled with really good education and outreach to consumers, and that’s something that didn’t happen” this year and last year, Turek said.

“That is something that was concerning for us last year, and it’s still something we’re keeping an eye on,” she added.

Cori Uccello, senior health fellow at the American Academy of Actuaries, said that the other factors make it difficult to tease out the impact of trimming open enrollment.

“Because this is the sixth year, its impact may be less than if it were a shorter period from the get go,” Uccello said. “Presumably people are more aware of it these days so it doesn’t change things much.”

But certain behavior could impact the market. People who are sicker and cannot get by without medical care are likely to sign up early, and healthier people are more likely to put off getting covered, and perhaps miss the deadline, she said.

A series of other actions could contribute to enrollment. Congressional Republicans zeroed out the individual mandate beginning in 2019, which means that people who go uninsured won’t be fined, and so fewer people might enroll. The Trump administration is also allowing people to buy coverage that doesn’t contain all of Obamacare’s rules on pre-existing illnesses, which could result in healthier people leaving the market for them.

Outside groups and lawmakers refer to these other factors when they slam the Trump administration over its Obamacare actions. Andy Slavitt, the Centers for Medicare and Medicaid administrator under Obama who now works to defend the healthcare law, recently lamented on Twitter that people didn’t know about the open enrollment period because of the Trump administration’s lack of outreach.

Sen. Patty Murray, a top Democrat in the upper chamber, recently said in a statement that the president’s healthcare strategy centered on “sabotage.”

“He has slashed investments, shortened enrollment windows, expanded junk plans, undermined protections for people with pre-existing conditions, and more,” she said.

Asked to comment for this story, the Trump administration in a statement stressed the importance of having a full year of coverage, and said it changed the open enrollment period so that it would match up better with the one for Medicare. Seema Verma, the current CMS administrator, has often touted the approach her agency took toward marketing and outreach as cost-effective.

“We remain committed to continuing to work to bring stability to the market and ensure that individuals who want coverage on the exchange can find a plan that best meets their needs,” a CMS spokesperson said in an email.

There is another factor adding to the complexity of evaluating the impact of Trump’s actions: Just because enrollment in the exchange falls doesn’t mean that the number of uninsured rises. People who don’t receive subsidies tend to enroll in coverage not on the Obamacare marketplaces but directly from an insurer because they might have more options and also find premiums to be less expensive. Further, the booming economy could mean that people who were on Obamacare plans previously are now getting coverage through a job instead.

California, which spent $110 million raising awareness about its open enrollment last year, and allowed for a three-month signup period, used that explanation after its enrollment at the time fell by 2.3 percent. New Jersey is similarly invested in the law, spending $825,000 on promotions and reinstating the fine on the uninsured after congressional Republicans zeroed it out. Still, its enrollment is behind, leaving officials to point to the possibility of off-marketplace enrollment.

A spokesperson from the National Association of Insurance Commissioners said that the group didn’t have data on what a six-week enrollment period does to the stability of the market. The spokesperson noted that a handful of states had longer enrollment periods.

“We would not want to imply that they are causing instability,” the spokesperson said.