Another year of Health Insurance Marketplace enrollment has passed and once again, there has been a decline in the exchange enrollment. Centers for Medicare and Medicaid Services (CMS) recently released preliminary data on the number of individuals who have enrolled in the federal exchange and the number is down from 8.5 million enrollees last year to 8.3 million this year. This comes despite the fact the actual cost of insurance has stabilized with average premiums falling by about 4% according to the government; and the fact that the 12 state-based exchanges (SBEs) have remained flat relative to 2018.

Looking back, enrollment in the state and federal exchanges hit a high back in 2016, with nearly 13 million enrolled overall with 9.6 million on the federal exchange and another 3.1 million on the state-based exchanges, heading into coverage for 2017. However, a combination of factors has caused meaningful regression in federal exchange enrollment for the last three years.

Thoughts from Adam Okun

The primary factor has been the active effort of the new administration to repeal the Affordable Care Act (ACA). In addition to the market confusion the new administration created for carriers and consumers, there was a dramatic reduction in advertising dollars and federal grants for healthcare navigators earmarked by the new administration.

Additionally, the administration chose to stop paying cost-sharing reduction payments to insurers who were previously providing richer plan designs for individuals who qualified for this further subsidy. Finally, many carriers simply felt that the exchanges were no longer a compelling business interest – with losses piling up in many markets and a lot of adverse risk overall.

One thing has become abundantly evident – while the exchanges have played a role in reducing the uninsured population, it has by no means been a panacea with more than 27 million Americans remaining uninsured and the exchanges largely flatlining, if not outright declining over recent years. And their introduction came at great political and financial cost.

I try not to get too pessimistic but if the “largest reshaping of healthcare in over 50 years” has just slightly moved the needle of our healthcare system are there really any greater pragmatic solutions out there? For the sake of our clients, our country and the people who remain uninsured, I certainly hope so.

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Adam Okun

Co-President, EPIC New York