TAMPA, Florida ― The Affordable Care Act clearly isn’t “dead,” as President Donald Trump declared a month ago.
But despite some surprisingly large sign-up numbers for the first two weeks of open enrollment, it’s way too early to tell just how big a toll Trump’s war on the program has taken ― or how many people will end up with insurance by Dec. 15, the deadline for obtaining 2018 coverage.
That’s what you’ll hear from most experts who follow the issue closely. It’s also what you’ll hear from people like Jodi Ray, who is the project director for Florida Covering Kids and Families, a nonprofit that has spearheaded state efforts to get residents health insurance under “Obamacare.”
Ray has been there since the program’s beginning, going back to late 2013, when the website didn’t work, and when a combination of plan cancellations and sudden rate hikes sparked an uproar. For a while, it looked like the whole system might just fall apart. It didn’t, of course, and Florida would go on to have some of the largest signup numbers of any state in the country.
This year, Ray says, interest in plans seems even stronger.
She says she’s seen it at her office and at walk-in enrollment events, like one at the University of South Florida on Wednesday, where a group of “navigators” (the Affordable Care Act’s official enrollment advisors) kept busy with a steady stream of consumers all morning long.
Ray has heard similar accounts from her contacts around the state ― including enrollment counselors in the small, rural counties that are traditionally the hardest for organizations like hers to reach. “They said this year, they have been busier than they have ever been, which astonishes me.”
The numbers tell a similar story. Through the first two weeks, 1.5 million people signed up for private insurance through HealthCare.gov, the Department of Health and Human Services reported on Wednesday. That’s roughly 50 percent more than last year’s sign-ups after two weeks.
States that run their own online marketplaces, such as California and Minnesota, are reporting similar surges. Charles Gaba, the analyst who runs ACAsignups.net, says that he expects sign-ups on HealthCare.gov to pass 2 million over the weekend, with enrollments from state-run marketplaces bringing the national total to around 4 million.
But “nobody is calling trends yet,” Ray warns, and it’s easy to see why she is wary. In the past, open enrollment has extended into January. With the much shorter period, accelerated sign-ups are necessary just to hit last year’s mark.
Meanwhile, organizations like hers are operating with fewer financial resources, because the Trump administration decided to slash federal support. (Florida’s Covering Kids took a cut of about $900,000, out of a total $5.8 million budget, according to Ray.) Nor can they can count on the usual barrage of national advertising to promote enrollment, because the Trump administration pulled way back on that spending, too.
The scaled-back outreach seems especially troubling because Republican efforts to repeal the program appear to have created a great deal of confusion over its status. “We’ve got people calling us and saying they stopped paying their premiums, because they thought it was all gone,” Ray said.
Still, the Affordable Care Act has proven surprisingly resilient in the past -– and it may be doing so again, sometimes for reasons that are surprising a lot of experts. A case in point is the way Trump’s most well-publicized effort at sabotage has played out.
In October, Trump finally carried out his threat to stop a set of vital payments to insurance companies. By that time, several insurers had already left the market, in no small part because they feared such a move was coming. Those that remained jacked up their premiums. But in most states they did so in a way that shielded some or all of their customers ― and, for a variety of complicated reasons, it means that lower-income consumers are actually getting even more assistance than they would have otherwise.
It’s a clumsy solution that hasn’t worked for everybody. The number of upper-middle-class consumers facing high, sometimes unaffordable premiums is going up. And it was already pretty high, for reasons that have as much to do with the program’s design as anything the Trump administration did.
But people who make a little less money, and thus qualify for the law’s financial assistance, are generally getting a better deal this year. Either they can spend the same amount of money and get a better plan, or they can keep the same plan and just spend less on it.
Online brokers, like HealthSherpa, have noticed a shift ― with average lower premiums coming down and interest in “gold” plans, the more generous alternative to traditional “silver” plans, ticking up. And although its sample is not necessarily representative of the whole, officials at Covered California, that state’s marketplace, reported last week they are seeing the same two trends among their consumers.
Strange as it may sound, all the turmoil may be helping too ― or, at least, having more of a mixed effect than everybody was expecting as recently as last month. At another open enrollment on Wednesday, sponsored by the Health Council of South Florida and held in northwest Miami, Jesse Miro, one of the Health Council’s navigators, told HuffPost that confusion over news reports may be prompting more people to ask questions ― and, ultimately, to check out their coverage options online, where they are discovering the deep discounts.
Like Ray, Miro said he’s heard of people dropping coverage because they thought the program had ended. But now he’s wondering if the prospect of repeal is having the opposite effect on at least some consumers ― prodding them to sign up, or at least investigate their options, because they think that once they have some insurance it will be easier to hold onto it. “Some seem to think that if they get in now, they’ll get locked in ― end up grandfathered somehow.”
Still, the people who work in outreach say that, with less publicity and less funding from Washington, they will have less capacity to help people who are hardest to reach, or whose circumstances are the most complicated.
“I have a woman, she and her kids were all uninsured ― one college aged, one high school, she’s a waitress in a restaurant,” Ray said on Wednesday, describing a family with a particularly complex income situation. “We enrolled them yesterday, for first time in years. All she could talk about is scheduling her first appointment for a checkup. She was ecstatic. But analyzing health insurance for her was very involved.”