A total of 11.8 million Americans signed up for Affordable Care Act health insurance for 2018, a drop of just 400,000 from the previous year despite widespread predictions that enrollment would plummet amid political and insurance industry turbulence surrounding the law.
The final figures, released Tuesday by the Centers for Medicare and Medicaid Services, show that the proportion of first-time customers for this year dipped slightly, from 31 percent to 27 percent, while the high proportion qualifying for government subsidies that help consumers afford their insurance premiums stayed level at 83 percent.
The enrollment total in the new federal report is identical to that from a compilation issued in February by an outside group, the National Academy for State Health Policy.
In an uncharacteristic move, CMS Administrator Seema Verma announced the fifth-year tally in a series of tweets shortly before the report was issued late Tuesday afternoon. The tweets were a blend of praise for what she called “the most cost-effective and successful open enrollment to date” and the Trump administration’s characteristic naysaying about the marketplaces that were created by the sprawling 2010 health-care law it has been seeking to dismantle.
Verma noted that, without taking subsidies into account, the average monthly premium for 2018 health plans was $621, or 30 percent more than last year’s average of $476. But the data show that customers with incomes too high to be eligible for a subsidy tended to choose less expensive health plans, averaging $522 per month.
A greater share of the 2018 customers picked the lowest tier of coverage, known as bronze plans, compared with the year before.
The federal report also shows that 70 percent of customers had incomes between the federal poverty level and 250 percent of that — roughly the same as a year ago. This is the group that previously qualified for less expensive deductibles and other lower out-of-pocket expenses because of cost-sharing reduction subsidies to ACA insurers — payments that President Trump ended last fall.
The report makes clear that all of the enrollment drop occurred in the 39 states that rely on the federal insurance marketplace and HealthCare.gov. In states operating their own marketplaces under the law, enrollment was flat.
ACA proponents reacted to Tuesday’s statistics by saying they provide fresh evidence that Americans want the insurance the law’s marketplaces offer, which is intended for people who cannot get access to affordable health benefits through a job.
Josh Peck, co-founder of the pro-ACA group Get America Covered, said, “While enrollment remained steady because of high consumer satisfaction and more affordable premiums for those who qualify for tax credits, enrollment would have outpaced previous years’ if the administration had focused on signing people up instead of derailing open-enrollment efforts.”