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ACA enrollment drops by half a million

Individual mandate is not the reason most consumers buy insurance, says insurer in New Jersey, which has its own individual mandate.

Susan Morse, Managing Editor

This year's open enrollment shows 500,000 fewer people signing up this year than last, as of December 8.

During week 6 between December 2-8, 934,269 people selected plans on compared to 1,073,921 during the same time last year.

In total, 4.1 million people have enrolled for individual insurance under the Affordable Care Act, compared to 4.6 million last year, a drop of 10.8 percent.


While numbers may change by the end of open enrollment on Saturday and it's too soon to predict what insurers will do in 2020, health plans are keeping a close watch, said Ryan McCostlin, head of healthcare financial planning at Bernard Health in Nashville.

"Insurers are going to be examining this closely throughout 2019," he said.


There's always a last-minute surge in enrollment. experienced its highest traffic on Monday since the start of open enrollment on November 1, according to the Centers for Medicare and Medicaid Services.

Horizon Blue Cross Blue Shield New Jersey typically sees 50 percent of enrollment come in during the last 10 days, according to Michael Considine, vice president of consumer, small group and mid-size markets.

But a 10.8 percent drop is still significant, McCostlin said.

Four reasons account for the decrease, he said.

First, the federal government cut its marketing budget by 90 percent, though this was also in effect for 2017.

Consumers are confused over whether the ACA still exists, given Republican efforts to repeal and replace the law.

The individual mandate to buy insurance is gone for 2019.

And the fourth reason, McCostlin said, is that the unemployment rate is 3.7 percent, compared to 4.1 percent last year at this time. Some people who formally got coverage through the individual market may now be insured under an employer plan, McCostlin said.


The market stabilized this year. Premiums or premium increases were lower, insurers jumped back in and a reinsurance program is helping plans mitigate their risk in the market.

But the loss of the federal mandate absolutely added to the tip of the scale towards lower numbers, Considine said. It eliminated the urgency to buy a plan, especially for the young and healthy.

New Jersey is among three states and the District of Columbia that has enacted its own individual mandate. The others are Massachusetts and Vermont, though Vermont's mandate begins in 2020, according to CheckUp by Seven other states are also considering an individual mandate.

However, most people in a Horizon BCBSNJ survey said the individual mandate, while important, was not the reason they purchased insurance, Considine said.

Horizon has no numbers as yet to release on enrollment.

The Centers for Medicare and Medicaid Services shows New Jersey ACA enrollment rates of 118,134, compared to 138,773 last year.

"I think we're doing a lot better than those numbers suggest," Considine said.

This is because the number of those who have actively enrolled doesn't tell the entire story.

Horizon BCBSNJ is among insurers that allow for passive renewal. As long as beneficiaries continue to pay their premium, they are considered enrolled for 2019, whether they actively signed up or not.

Horizon BCBSNJ has made a big push to make consumers aware of the December 15 deadline, to make it easy to enroll at retail locations and to extend the hours for sign-up.

"We have seen high volumes and tremendous activity at all of our retail locations," Considine said.

Horizon plans to stay in the market and is already working on 2020 open enrollment, Considine said.

CMS is extending the deadline for sign up, for those consumers who are asked to leave a leave a message with the marketplace call center. They'll likely get a call back after December 15 and will be allowed to enroll, CMS said.

Twitter: @SusanJMorse
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