About 8.2 million people signed up for health plans for the coming year through the Affordable Care Act’s federal insurance marketplaces, driven largely by soaring unemployment and other effects of the coronavirus pandemic.
During the final six-week enrollment window of the administration, Americans demonstrated that turbulence surrounding the decade-old ACA did not dampen their interest in the health plans it offered.
Nearly one-fourth, or 1.8 million, of the participants signed up for the first time, according to federal figures released Friday from the enrollment period from Nov. 1 to Dec. 15. The other 6.4 million were returning customers who selected a health plan or were re-enrolled automatically if they had not chosen one.
“People are clearly finding the coverage they need at this critical time,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services, who has been one of the administration’s most vocal critics of the ACA but who has vowed to run orderly annual sign-ups.
She pointed out that the Trump administration has “focused on delivering more choices,” apparently referring to both an expansion of ACA health plans being sold as well as easier access to inexpensive insurance that does not always meet the law’s standards for benefits and consumer protections.
In various regions of the country, demand for mostly virtual appointments to discuss insurance options and get enrollment help was higher than in the past and often reflected the economic fallout from the pandemic, according to leaders of grass-roots nonprofit groups called “navigators,” which help consumers use the marketplaces.
“This was a really exhausting and stressful open enrollment,” said Jodi Ray, program director for Florida Covering Kids & Families, the nation’s largest navigator organization. Ray said she and other enrollment helpers heard “over and over and over again” that people needed to recalculate how much they qualified for in federal subsidies for the ACA health plans because their incomes had dropped, making them eligible for more government help with their monthly premium payments.
Ray said she helped a lot of clients in the performing arts — musicians, actors and choreographers from New York or Los Angeles, where the pandemic shut down live performances, so they no longer had enough income to qualify for their unions’ health benefits. Many had migrated to Florida, where living costs are lower.
“We saw quite a demand” for help in enrolling this year, said Mark Van Arnam, director of the NC Navigator Consortium in North Carolina. On Dec. 7, about a week before the enrollment period ended, he and others from the consortium appeared on a 2½ -hour call-in show on a Raleigh television station that airs across eastern North Carolina, answering questions and making appointments for individual help. More than 1,000 people called in, and 400 more left phone messages because they couldn’t get through, he said.
Van Arnam noticed another change this year: More young adults, who typically have the lowest rates of insurance coverage, signed up for plans. Many of them, he said, “were looking seriously at making sure they had coverage in case, God forbid, they got sick” with covid-19, the illness caused by the coronavirus.
“In this pandemic, they understood the importance of having coverage,” Van Arman said. Some told enrollment helpers of relatives who had lingering symptoms of covid-19 for months.
Sign-ups had been slumping — though less than some predicted — during President Trump’s tenure. His administration shortened the yearly sign-up period from three months to six weeks, sharply cut federal aid for outreach activities and navigator activities, collaborated with congressonal Republicans on an unsuccessful attempt to dismantle large sections of the law, and joined with a coalition of GOP state attorneys general in a lawsuit, now before the Supreme Court, seeking to have the entire law overturned.
The figures released Friday reflect 32 states that rely on the federal insurance exchange, known as Healthcare.gov, plus a few others that run their own state marketplaces under the law but depend on the federal online sign-up system. The insurance starts in January if consumers begin paying for it.
Excluded are sign-ups from 14 states, plus the District of Columbia, that operate state-based insurance marketplaces. They include California and New York, among the largest. In all but one of those, the sign-up for 2021 health plans continues into later this month or January.
For the first time, New Jersey and Pennsylvania used their own sign-up systems; last year they enrolled nearly 600,000 people. Even without them this year, the federal marketplaces signed up just 100,000 fewer than a year ago.
The only state-based marketplace that closed this week was Maryland’s, though it may allow later sign-ups in some form. Gov. Larry Hogan (R) announced Thursday that 166,000 state residents had enrolled in health plans — the most in the eight years since Marylanders could buy such coverage and a 45 percent increase from a year ago. Sign-ups increased in every county, state data shows.
President-elect Joe Biden said during his campaign that he favored opening the federal insurance marketplaces outside the usual enrollment period to help provide a cushion for some of the millions of Americans who have lost coverage as the pandemic has caused them to be furloughed from their jobs or laid off.
The Biden transition team is considering the idea, as well as restoring millions of dollars that the Trump administration cut from advertising and other outreach activities to encourage people to sign up.
It is unclear how many people who have lost jobs this year can afford ACA health plans, even with subsidies — or exactly how many have joined their state’s Medicaid programs.
In the days leading up to Tuesday’s enrollment deadline, officials in at least four states called for the Department of Health and Human Services to allow more time to sign up because of the pandemic.
“These extraordinary times call for leadership and action in the face of the pandemic,” Peter V. Lee, executive director of California’s health exchange, wrote to HHS leaders. His state’s exchange remains open until Jan. 31.
Even before the pandemic, Lee pointed out, an estimated 9.2 million uninsured people nationwide were eligible for ACA health plans with federal subsidies, according to an analysis by Get Covered 2021, a coalition trying to foster ACA sign-ups. “Keeping the doors open as long as possible to meet consumers’ needs is the right policy for Americans in these difficult times,” Lee wrote.
He said he did not receive a reply.
Asked how many such requests it has received or whether the agency had considered extending the enrollment time, a spokeswoman for the Centers for Medicare and Medicaid Services, the part of HHS that oversees the sign-ups, did not respond to the questions.
In North Carolina, “it would have been fantastic to have open enrollment extended this year,” Van Arnam said. In the last few days before the deadline, he said, the navigator coalition ran out of appointments.
ACA marketplaces have sold private health plans to individuals and families who cannot get affordable health coverage through a job each fall since 2013.
The authors of the law, which was adopted by a Democratic Congress in 2010, designed the marketplaces for people without access to job-based insurance — the nation’s most common source of coverage. Before then, many of them had relied on the individual insurance market, where health plans were expensive and especially prone to deny coverage to people with existing medical problems.
When the law was passed early during Barack Obama’s presidency, government forecasters estimated that about 24 million people would be getting health plans through these marketplaces, most with federal subsidies for the monthly premiums. The number never has reached that high. More than 10 million others have gained insurance through an expansion of Medicaid for those with relatively low incomes.
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