• Home
  • Latest
  • Fortune 500
  • Finance
  • Tech
  • Leadership
  • Lifestyle
  • Rankings
  • Multimedia

Trendingnow

1

College-educated women are snapping up the highest-earning men without college degrees, leaving the rest further behind

2

An 11-year-old is cleaning his neighbors' trash cans for $10 each—he now has 100K followers as teens face the worst summer job market since 1948

3

The millennial generation is split in 2: an older crowd with boomer-style comfort, a younger set going 'back to the early 1900s'

1

College-educated women are snapping up the highest-earning men without college degrees, leaving the rest further behind

2

An 11-year-old is cleaning his neighbors' trash cans for $10 each—he now has 100K followers as teens face the worst summer job market since 1948

3

The millennial generation is split in 2: an older crowd with boomer-style comfort, a younger set going 'back to the early 1900s'
Commentary

Commentary: Don’t Blame Trump for Lower Health Insurance Signups. Blame Obamacare.

By
Sally C. Pipes
Sally C. Pipes
and
Bethany Cianciolo
Bethany Cianciolo
Down Arrow Button Icon
By
Sally C. Pipes
Sally C. Pipes
and
Bethany Cianciolo
Bethany Cianciolo
Down Arrow Button Icon
December 19, 2017, 2:51 PM ET
Add Fortune on Google for similar content.

Obamacare’s fifth open enrollment period ended Friday. In the 39 states using the federal HealthCare.gov insurance exchange, 4.7 million people signed up for 2018 coverage, as of Dec. 9. At this point, that’s about 4.5 million fewer people who signed up than last year.

This year’s lower numbers shouldn’t be surprising. Those who logged onto HealthCare.gov found fewer options and higher premiums. Obamacare’s incoherent mandates—not the Trump administration—deserve the blame for this year’s stunted enrollment.

Obamacare’s proponents allege that President Trump “sabotaged” the exchanges. They’re referring to the Trump administration’s decision to shorten the open enrollment period—from three months last year to 45 days this year—and cut Obamacare’s advertising budget from $100 million to $10 million.

Accusations of sabotage don’t hold up under scrutiny. For starters, Obamacare’s advertising budget was a waste of money.

Consider one marketing initiative from last year’s open enrollment period, the Enrollment Assistance Program. Despite spending $22.4 million encouraging patients to sign up for coverage, the program enrolled just 14,500 people. That amounts to $1,545 per enrollee.

Further, the shorter open enrollment period has actually accelerated the pace of signups. Through mid-December 2017, more people had enrolled compared to the same period last year.

Look at California, one of the few states that operates its own exchange. This month, Covered California reported more than 100,000 new enrollees and 1.2 million renewals within the first month of open enrollment. Compared to last year, that’s a 28% increase.

The people motivated to get exchange coverage are clearly doing so. But that number is smaller than it was last year. And that’s because exchange coverage has grown costlier each and every year, thanks to Obamacare.

For an ever greater number of people, exchange coverage just isn’t worth the price. Premiums for mid-level “silver” plans have risen by an average of 34% nationwide, according to an analysis from the consulting firm Avalere.

Enrollees in many states faced even larger increases. Iowans are paying 69% more for silver plans in 2018. Shoppers in Wyoming, Utah, and Virginia who picked silver plans are paying 65%, 64%, and 61% more, respectively.

The 2018 open enrollment season was not the first time shoppers encountered steep rate hikes. Average rates rose 25% in 2017. Since 2013, the price of an individual plan has almost doubled.

Two of Obamacare’s mandates in particular deserve blame. “Guaranteed issue” prohibits insurers from denying coverage to enrollees based on their health status or history. “Community rating” bars insurers from charging sick enrollees more than healthy ones or from charging old people any more than three times what they charge the young.

These mandates create a perverse incentive for people to wait until they get sick to purchase coverage and ensure that the exchange pool will be disproportionately composed of high-cost individuals.

 

So insurers have hemorrhaged cash. Aetna (AET) lost $700 million between 2014 and 2016. The company expects to lose another $200 million by the end of the year. In October, CareFirst BlueCross BlueShield projected that it would lose more than $600 million by the end of 2017 on its exchange business. Nineteen of the 23 non-profit “co-op” insurers established by Obamacare have collapsed.

All those losses have driven insurers from the marketplaces. UnitedHealth Group (UNH), the nation’s largest private insurer, only sold exchange plans in 2017 in three states, down from 34 in 2016. Humana offered coverage in 11 state exchanges last July. In 2018, it pulled out of the exchanges entirely.

These exits left patients with fewer coverage options. Nearly half of all counties nationwide had only a single exchange insurer to choose from for 2018.

The Trump administration may make for a convenient scapegoat for the exchanges’ declining enrollment. In reality, fewer people are buying insurance because it’s too expensive. And Obamacare itself brought about that outcome.

Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The Way Out of Obamacare (Encounter 2016). Follow her on Twitter @sallypipes.

About the Authors
By Sally C. Pipes
See full bioRight Arrow Button Icon
By Bethany Cianciolo
See full bioRight Arrow Button Icon
Add Fortune on Google for similar content.

Latest in Commentary

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025

Most Popular

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Fortune Secondary Logo
Rankings
  • 100 Best Companies
  • Fortune 500
  • Global 500
  • Fortune 500 Europe
  • Most Powerful Women
  • World's Most Admired Companies
  • See All Rankings
  • Lists Calendar
Sections
  • Finance
  • Fortune Crypto
  • Features
  • Leadership
  • Health
  • Commentary
  • Success
  • Retail
  • Mpw
  • Tech
  • Lifestyle
  • CEO Initiative
  • Asia
  • Politics
  • Conferences
  • Europe
  • Newsletters
  • Personal Finance
  • Environment
  • Magazine
  • Education
Customer Support
  • Frequently Asked Questions
  • Customer Service Portal
  • Privacy Policy
  • Terms Of Use
  • Single Issues For Purchase
  • International Print
Commercial Services
  • Advertising
  • Fortune Brand Studio
  • Fortune Analytics
  • Fortune Conferences
  • Business Development
  • Group Subscriptions
About Us
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • Facebook icon
  • Twitter icon
  • LinkedIn icon
  • Instagram icon
  • TikTok icon
  • YouTube icon

Latest in Commentary

trump
CommentaryMarkets
In the Age of Big Players, $100,000 buys you a head start on Trump’s mood
By Steve H. Hanke and Roger KopplJuly 27, 2026
8 hours ago
Europe has an electrification target. Here’s how it can become a competitive advantage
Commentaryclean energy
Europe has an electrification target. Here’s how it can become a competitive advantage
By Andreas SchierenbeckJuly 27, 2026
8 hours ago
raikes
CommentaryMicrosoft
Jeff Raikes: The talent debt I warned about is now showing up in the data
By Jeff RaikesJuly 26, 2026
1 day ago
beatles
CommentaryLeadership
George Martin never out-wrote the Beatles. That’s exactly why he’s the AI leadership lesson we need now
By Jeff DeGraffJuly 26, 2026
1 day ago
students
CommentaryEducation
I’ve been teaching college students for decades. Most of them can no longer finish a book
By Austin SaratJuly 26, 2026
1 day ago
katty
CommentaryLeadership
Katty Kay: confidence is the skill that turns thoughts into action—and companies need to start teaching it
By Katty KayJuly 26, 2026
1 day ago

Most Popular

College-educated women are snapping up the highest-earning men without college degrees, leaving the rest further behind
Economy
College-educated women are snapping up the highest-earning men without college degrees, leaving the rest further behind
By Mia OsmonbekovJuly 26, 2026
1 day ago
An 11-year-old is cleaning his neighbors' trash cans for $10 each—he now has 100K followers as teens face the worst summer job market since 1948
Success
An 11-year-old is cleaning his neighbors' trash cans for $10 each—he now has 100K followers as teens face the worst summer job market since 1948
By Orianna Rosa RoyleJuly 25, 2026
2 days ago
The millennial generation is split in 2: an older crowd with boomer-style comfort, a younger set going 'back to the early 1900s'
Real Estate
The millennial generation is split in 2: an older crowd with boomer-style comfort, a younger set going 'back to the early 1900s'
By Nick LichtenbergJuly 25, 2026
2 days ago
New York City women are making up to $30,000 per month by renting out their closets to strangers
Retail
New York City women are making up to $30,000 per month by renting out their closets to strangers
By Sarah GlodekJuly 27, 2026
13 hours ago
I've been teaching college students for decades. Most of them can no longer finish a book
Commentary
I've been teaching college students for decades. Most of them can no longer finish a book
By Austin SaratJuly 26, 2026
1 day ago
The Pete behind Jersey Mike’s was only 17 years old when he borrowed $125,000 to buy the chain—with some help from his high school football coach
Success
The Pete behind Jersey Mike’s was only 17 years old when he borrowed $125,000 to buy the chain—with some help from his high school football coach
By Marco Quiroz-GutierrezJuly 26, 2026
2 days ago

© 2026 Fortune Media IP Limited. All Rights Reserved. Use of this site constitutes acceptance of our Terms of Use and Privacy Policy | CA Notice at Collection and Privacy Notice | Do Not Sell/Share My Personal Information
FORTUNE is a trademark of Fortune Media IP Limited, registered in the U.S. and other countries. FORTUNE may receive compensation for some links to products and services on this website. Offers may be subject to change without notice.