With three days remaining in most of the country to buy Affordable Care Act coverage for 2018, enrollment is ahead of the same time last year but is almost sure to fall short in the end because of a compressed enrollment season.
During each of the six weeks of this sign-up period, the number of consumers choosing plans through the federal HealthCare.gov website has outmatched that of 2017, according to a federal enrollment snapshot released Wednesday. The overall sign-ups of nearly 4.7 million Americans through last Saturday was about 650,000 higher than through the parallel week a year ago.
"If not for the pronouncements of its death, and steps taken to hobble it, the ACA marketplace would actually seem, well, alive," Larry Levitt, senior vice president of the Kaiser Family Foundation, tweeted in reference to repeated statements by President Trump and to cuts in funding for efforts to encourage Americans to get insurance.
A surge is expected in these last days before Friday's deadline in most states. The government will then automatically enroll perhaps 1 million to 2 million people — based on last year's experience — who have current ACA coverage but did not sign up again. Yet even the law's most ardent proponents are not expecting the ultimate tally to match the 9.2 million who got coverage last year in states using HealthCare.gov during an enrollment season that went twice as long.
Thirty-nine states are either in the federal insurance marketplace or rely on its computerized enrollment system. The deadline is later this month or in January in nine of the states, including Maryland as well as the District, that run their own marketplaces under the ACA.
On Tuesday, two senior Senate Democrats urged the Health and Human Services Department to extend the season to Jan. 31 as in the past three years. The Obama administration had proposed shortening the enrollment period, at the request of health insurers, starting next fall. The Trump administration decided in the spring tomake the change right away.
The truncated sign-up "poses further risks to the continued stability of the individual marketplace and puts the goal of affordable, comprehensive insurance for all further out of reach," Oregon Sen. Ron Wyden, the ranking Democrat on the Senate Finance Committee, and his counterpart on the Senate Health, Education, Labor and Pensions Committee, Sen. Patty Murray of Washington, wrote in a three-page letter. They said the shorter time frame especially harms people with existing medical issues and lowers the odds of enrollment by healthy young adults, who tend to wait until the last minute.
A spokesman for HHS's Centers for Medicare and Medicaid Services (CMS), speaking on the condition of anonymity since he did not have permission to discuss the letter, said officials "continue to encourage people to make plan selections by that deadline so that their coverage can begin on Jan. 1."
Unlike the fall of 2013, when HealthCare.gov debuted with serious computer defects that took months to overcome, enrollment this time has been comparatively smooth. The site has been closed every Sunday but one for a total of 21.5 hours, with about two hours of "unplanned down time" on Dec. 1.
Officials also said a sporadic problem, in which the site failed to show health plans available in certain areas, has been fixed.
An unknown number of people, however, are bumping up against a technical problem with HealthCare.gov when they try to complete an initial step of verifying their identity.
Jeffrey Reifman, 47, a tech entrepreneur who splits his time between Washington state and Oregon, has had ACA insurance for four years, and it has covered surgery to remove a benign but potentially dangerous brain tumor and the follow-up treatment. For the third time, he must find a different health plan because his insurer is pulling out of the marketplace. He browsed HealthCare.gov until he discovered one in Oregon with his neurosurgeon and endocrinologist in its network.
But on Saturday, when he tried to have the website "proof" his identity so he could select the PacificSource plan, he got a message saying it could not be verified. He was told to call the credit-rating agency Experian, with which the government contracts for that part of the process, and share a code. The computer screen did not provide a code, though.
Reifman suspects the problem might be that he had frozen his credit after a nationwide Equifax hack in September. CMS officials acknowledge that consumers cannot complete the online verification if their credit is frozen because that blocks Experian from getting access electronically to their information. The officials said the percentage of consumers encountering this problem is small but did not provide numbers.
The spokesman said people who need to phone Experian — or are instructed to mail documents — will be allowed extra time to finish after Friday. Experian did not respond to requests for information about the number of people affected.
Reifman said he eventually bought his coverage directly from the insurer — but he is anxious to receive confirmation that he has been accepted into the health plan before the deadline.