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Affordable Care Act numbers stabilize at enrollment deadline

CMS gave consumers two extra days to sign up, as not all of the half a million people who wanted to enroll were able to do so by December 15.

Susan Morse, Managing Editor

The number of people signing up for Affordable Care Act plans on took a big jump over previous weeks at the deadline for open enrollment, leaving total numbers just 1.7% shy of 2018 figures.

Open enrollment this year started on November 1, but was extended for more than two more days through the early morning hours of December 18.

This year, a total of 8,303,850 individuals enrolled, compared to 8,454,882 in 2018, representing a 1.7% drop in the number of people enrolling.

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The preliminary data indicates enrollment continues to remain stable, CMS said.


Just two weeks ago during Week 5, enrollment was down 10% over last year. During Week 6, numbers were off by 6%.

On December 15, the last official day of open enrollment, over half a million consumers attempted to sign up, but some were asked to leave their names at the call center and did not sign up, CMS said. 

Out of "an abundance of caution," for those people who were unable to complete the enrollment process, CMS extended the deadline to enroll to 3 a.m., December 18. Consumers were able to come back to the website to complete their enrollment for January 1 coverage.

Consumers who enrolled in coverage between 12 and 3 a.m. on December 18, were not included in the Week 7 totals. Also, consumers who left their contact information at the call center due to high volume have not been counted. 

Similar to previous years, CMS plans to release an updated snapshot during the second week of January with the final enrollment data.

CMS said open enrollment is influenced by a number of factors. This year, the unemployment rate is at the lowest it has been in 50 years. In addition, states such as Maine have expanded Medicaid, so that an estimated 12,000 people are now eligible for Medicaid in that state instead of tax credits. 

Also this year Nevada transitioned to a state-based exchange so that the CMS report totals do not include those consumers.  At the end of open enrollment in 2018, about 84,000 consumers in Nevada selected a plan using

This year, CMS implemented upgrades to the exchange system by transitioning operations to the cloud. 

For the first time, CMS expanded the display of quality rating information for  consumers to compare health coverage choices using a five-star quality rating system similar to other CMS star rating programs. CMS said it also streamlined the application process. 

Also, Enhanced Direct Enrollment allowed consumers to complete the entire application and enrollment process directly with an approved insurance company or other online partner instead of going through


The numbers add stability to the ACA market.

Other stabilizing factors this year are a greater number of plans being offered on the exchanges, more insurers in the market, and lower premiums or premium increases.
Instability exists in the question of whether the ACA is constitutionally valid.

An appeals court this month upheld a lower court's ruling that the individual mandate of the ACA, which required individuals to get coverage or face a tax penalty, was unconstitutional. The court sent a decision on whether the ACA could stand without the individual mandate, back to a district court in Texas. 

Republicans and the Trump Administration have attempted to repeal the law.

Whatever decision comes out of the lower court could send the fate of the ACA to the Supreme Court, but for 2020, the market is set and is expected to remain stable.


"There are many factors that impact enrollment each year. These numbers continue to represent strong stable enrollment in light of the ongoing growth of the economy, improving employment conditions and rising wages that would otherwise reduce the demand for subsidized coverage on the exchange," CMS said.

"We are reporting that for the third year in a row enrollment in the Federal Exchange remained stable," said CMS Administrator Seema Verma. "Far from undermining the Affordable Care Act – as some hysterical and inaccurate claims would have it – the Trump Administration is making the very best of what remains a failed experiment. For all our successes, too many Americans who do not qualify for subsidies still cannot afford premiums that remain in the stratosphere – constituting a new class of uninsured. The Affordable Care Act remains fundamentally broken and nothing less than wholesale reforms can fix it."

Twitter: @SusanJMorse
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