By Sy Mukherjee
April 4, 2018

Last fall, President Donald Trump declared Obamacare “dead” and “gone.” During his first State of the Union address in February, Trump said that Congress had “repealed the core of disastrous Obamacare,” citing the nixing of the health law’s individual mandate (which requires Americans to either carry insurance or pay a tax penalty) that passed alongside the recent GOP tax overhaul.

But a pretty hefty number of Americans seem to signed up this year for a program that’s ostensibly dead and rotting—about 11.8 million, in fact, according to final government numbers released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday. That’s about 400,000 fewer than in 2017, or about a 3% year-over-year drop. But it’s a strikingly high number given the continuous havoc surrounding it and efforts to undermine the Affordable Care Act (ACA) by the Trump administration and Congressional Republicans in 2017. What’s more, the open enrollment period this year for the federal Healthcare.gov site was cut in half by the Trump administration compared with previous years, making the signup numbers even more impressive.

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Health insurance premiums rose, in some cases heftily, in many Obamacare markets as insurers prepared for Trump to end critical federal subsidies that help pay for consumers’ out-of-pocket medical costs (a move the president eventually made) and the repeal of the individual mandate. That’s likely part of the reason that enrollment dropped, as Americans making more than 400% of the Federal Poverty Level (about $48,000 for an individual or $98,000 for a family of four) wouldn’t be shielded from those rising premiums because they don’t qualify for federal subsidies that lower-income citizens do. Some of these people may have decided paying the Obamacare penalty for this tax year was a more cost-effective move. Beginning next year, the mandate to carry insurance will no longer be the law of the land, which may lead to more middle class Obamacare dropouts.

But CMS’ latest report also underscores the importance of marketing and official promotion in getting people to sign up for health coverage. Nearly the entire 3% drop in enrollment came from the 39 states that rely on the federal Healthcare.gov website. In the other states, plus the District of Columbia, which set up their own state-based Obamacare exchanges, many had longer enrollment periods than the curtailed federal signup window. They also reached out to residents about the health law and enrollment stayed flat at 3 million.

That may not be too surprising given that the Trump administration decided to cut off millions of dollars meant to promote the federal Obamacare open enrollment period. CMS Administrator Seema Verma took to Twitter on Tuesday to tout the signup numbers (while continuing to slam the very health law she’s tasked with administering). She was far more quiet during the actual open enrollment season, largely staying mum about Obamacare until the last few days of signups.

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