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News | Healthcare Reform

Enrollment largely stable in ACA marketplaces

News | Healthcare Reform

Enrollment largely stable in ACA marketplaces

  • Enrollments in the federal and state-operated insurance marketplaces are either slightly lower or higher than last year.
  • Either the loss of the federal mandate or creation of state mandates appear to have had no effect.
  • California enrollments are lagging despite numerous new provisions to boost enrollment, including subsidies.

Sign-ups in the latest enrollment period for federal- and state-run marketplaces of health plans compliant with the federal coverage mandates were largely consistent with last year.

Enrollment in the 38 federally operated marketplaces reached 8.3 million during its recently concluded open enrollment. That was 2% fewer than the 8.5 million who enrolled in the 2018 open enrollment period, according to a release by the Centers for Medicare & Medicaid Services.

Among the mitigating factors that might explain the slight decrease was that this year’s totals do not include Nevada, which transitioned to a state-operated marketplace this year and enrolled 84,000 as part of the federal marketplace last year.

The federal figures also are preliminary, not final, open-enrollment figures.

The enrollment totals were similar for the 12 state-operated marketplaces — some of which are still accepting sign-ups — including:

  • California with 1.38 million plan selections, or 50,000 fewer at the same point in 2018
  • Colorado with 170,000, or about 14,000 fewer than at the same point in 2018
  • Connecticut with 104,000, or about 6,000 less than 2018-2019 total (enrollment continues to Jan. 15)
  • Maryland with both on and off-exchange enrollment of 215,150, or 1% more than a year ago
  • Washington with 210,000, or 11,000 fewer than the 2018-2019 total (enrollment continues to Dec. 30)

The state-released totals generally do not include the ACA-compliant individual coverage plans sold off the government-operated marketplaces, and such figures generally are not available until many months after open enrollment ends.

Mandate effect?

This year’s open enrollment on the government-operated marketplaces is being closely watched to see the effect — or lack thereof, of health insurance mandates. The 2017 federal tax reform law reduced the federal mandate penalty to $0, despite warnings that millions would drop their insurance without it. Meanwhile, several states aimed to bolster their marketplaces by instituting their own coverage mandates and tax penalties including:

  • Massachusetts
  • New Jersey
  • Vermont
  • District of Columbia
  • California
  • Rhode Island

Similar stability in enrollment totals does not lend much weight to the belief that the mandate is a large driver of enrollments in individual coverage.

Other policy effects on enrollment?

Enrollment also was expected to be affected by differing approaches of federal and state governments advertising and educating the public about the availability of individual insurance coverage on the government-run marketplaces.

Specifically, the Trump administration slashed the outreach budget for the marketplaces to $10 million from the $100 million spent by the Obama administration.

And some states operating their own marketplaces aimed to make up for the reduced federal outreach by funding their own, including the $121 million 2019 outreach and education budget of the California marketplace.

California also was betting that providing $295 million this year to bolster subsidies for those already receiving federal subsidies and to create new subsidies to households with incomes of up to 600% of the federal poverty level (FPL) would help many more get coverage. The federal government limits subsidies to those earning up to 400% of FPL.

However, only of 540,000 of the projected 799,000 have enrolled to get those new subsidies nine weeks into the 15-week enrollment, according to a state press release.


About the Author

Rich Daly, HFMA senior writer and editor,

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare


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