Those figures capture only part of the nation’s overall ACA enrollment, because they encompass only states that use the federal health-care marketplace or rely on its website for their consumers to sign up for coverage. Roughly a dozen states and the District of Columbia run their own programs and do not use HealthCare.gov.
Several state exchange officials — including in New York, Connecticut, Colorado, Idaho and Washington — said Tuesday that they have seen upticks.
An official at the Centers for Medicare and Medicaid Services said it would release data regularly throughout enrollment but did not give any schedule.
Many ACA advocates have been concerned that consumers wouldn’t sign up for coverage because Congress has repeatedly tried to repeal the 2010 law this year and President Trump has described it as “failing” and “virtually dead.”
Despite this criticism, and despite steep cuts to federal advertising and enrollment-assistance budgets, Americans appear to be signing up for coverage at a faster rate compared with last year. It is unclear whether the extensive media coverage of efforts to roll back the law or consumers’ concerns about its viability may be helping fuel the increase.
Grace-Marie Turner, president of the conservative Galen Institute, said some of the changes the administration has made may have helped boost enrollment, such as the fact that “private brokers are actually being engaged” to provide assistance through the federal website and some cheaper plans are now available.
Liz Hagan, associate director of policy at the National Association of Health Assisters, said in an email that she and other ACA supporters are “encouraged by what we’ve seen thus far. Thankfully, people sharing the facts about coverage and open enrollment have cut through the noise and rhetoric by the Trump administration.”
The chief marketing officer for the Washington (state) Health Benefit Exchange, Michael Marchand, believes the mixed messages and doomsday forecasts leading up to Nov. 1 may have actually helped increase marketplace visitation — which is up 20 percent — because it forced people to ask themselves how the changes will affect them personally.
But Peter Lee, executive director of Covered California, said that many of the people who tend to sign up for coverage as enrollment starts tend to need insurance the most, and the critical question is how many young, healthy Americans will sign up some weeks from now. Federal enrollment this year lasts 45 days, half as long as it has in the past, while several states are allowing residents to sign up for ACA plans into January.
“The real test for open enrollment isn’t day one. Federally, it’s day forty-five,” Lee said. “Young, healthy people need to be reminded, told, nudged and cajoled dozens of times to take the act of signing up for coverage.”
Roughly 5,900 Californians selected plans last Wednesday, a 25 percent over last year.
In New York, according to Department of Health spokeswoman Erin Silk, more than 140,000 people visited the state’s website and 73,000 placed calls to its customer service line “in just the first three days.”
In Rhode Island, enrollment this year is five times higher in the first week than it was last year, said Zach Sherman, the director of HealthSource R.I. An early outreach campaign by the state seems to have paid off with more than 500 people enrolling, compared to 109 people in the first week last year.
“We felt very strongly that we had to get out there earlier than in previous years,” Sherman said.
The District’s marketplace has seen the highest volume of first-week activity since the first year of enrollment. On just the first day last week, nearly 9,300 people visited the DC Health Link website to shop for plans, compared to 6,727 last year and just over 2,000 in years two and three.
Mila Kofman, executive director of the DC Health Benefit Exchange Authority, credits the uptick in interest to a concentrated effort by the District to publicize open enrollment as a way to pushback against the confusion that has swirled around the law.
And in Montgomery County, Maryland, one navigator group even had to stay open two hours late last Sunday because of demand.
The steady and consistent stream of insurance-seeking individuals are a mix of new applicants and re-enrollees, said Alma Luna, who has worked as an in-person navigator for all five enrollment seasons. “I’ve seen a lot of people who didn’t apply in previous years and are trying to apply now,” she said. “A lot of people already have enrollments, but they want to be reassured that nothing has changed considering what they’ve been hearing around the community.”
Statewide, in fact, growth is up 100 percent since last year, according to Betsy Plunkett, a deputy director for the Maryland Health Benefit Exchange. First-time enrollment is up 15 percent, with changes to existing plans up 270 percent. Overall, 10,420 people enrolled in the first week compared to 5,212 in 2016, she said.
The picture is similar elsewhere around the country.
Connect for Health Colorado spokesman Luke Clarke said state officials had expected that 2,700 residents would call exchange operators on the first day, which would have been on par with 2016, but 3,406 did. “It’s way ahead of where we were last year, and a big surprise,” he said.
That same day in Connecticut, 1,596 residents enrolled in qualified health plans on the state exchange while another 2,293 people either completed Medicaid applications or determined that they were eligible for that program. Access Health CT CEO Jim Wadleigh said in a statement that the state’s call center and website experienced a 15 percent increase in volume compared to opening day last year.
MNsure Chief Executive Allison O’Toole said in a statement that enrollment there has been “brisk,” in part because the state received federal approval for a reinsurance program that means premiums will either stay level or decline for 2018.
“Last year, 40 percent of our enrollees were new, and we’re on pace to match that again,” O’Toole said.
Though this year’s enrollment process has gone relatively smoothly, Hagan said there is less assistance in rural areas, “creating an unequal playing field that harms consumers.”
And while Lee expects many state-run exchanges, including his own, will maintain the same number of insured residents by the time open enrollment ends, he thinks states relying on the federal exchange will see a drop-off.
“We’re very likely to see fewer people enrolled in federal marketplace states, which is going to lead directly to higher premiums in 2019 because you’re going to have a sicker pool,” he said. “It’s bad math.”