Best Case Scenario Is Keeping Exchange Enrollment at '18 Level

By Judy Packer-Tursman

Similar to a year ago, the open enrollment period for Affordable Care Act exchange plans began Nov. 1 surrounded by political "noise." Industry experts tell AIS Health they don't see any factors that are likely to significantly boost or reduce the current national exchange enrollment figure of nearly 12 million.

Premiums are generally flat or declining and the marketplace seems calmer, leading some carriers to enter or re-enter markets or add products for 2019. But new Trump administration rules are forcing qualified health plans (QHPs) on exchanges to compete against short-term plans and other non-ACA-compliant options that navigators must promote to get federal dollars. Moreover, the individual mandate penalty is being eliminated for 2019, and political rhetoric, heating up before the Nov. 6 midterm elections, is creating confusion about what it all means — and thrusting formerly esoteric insurance terms such as "pre-existing conditions" into the public spotlight.

So what will happen during this sign-up season? "I think the best-case scenario is maintaining [ACA exchange] enrollment at the levels we had last year," says industry consultant Rosemarie Day, founder and president of Day Health Strategies LLC. In all likelihood, she tells AIS Health, she expects to see a decline in enrollment for federal facilitated marketplaces, "and I think the state-based exchanges will work hard to maintain what they had last year."

Day and others note that the vast majority of enrollees in exchange plans receive federal subsidies, "so most are sheltered from premium increases." But, for unsubsidized individuals, there was a big spike in exchange plan premiums last year, she says.

Yet she recalls better-than-anticipated enrollment results in fall 2017. She posits that state-based exchanges outperformed federally facilitated marketplaces on sign-ups because of their strong investment in marketing and outreach.

Chris Sloan, a director at Avalere Health, is encouraged that exchange "premiums in many places are going down and enrollment is going up." 

"But this is still not a market with much choice and there are wide swaths of the country with only one option — and the participation in this market is still nowhere close to what it was" a few years ago, he says.

From Health Plan Weekly