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

Trendingnow

1

Bolt CEO says he let go of his entire HR team for creating problems that didn’t exist: ‘Those problems disappeared when I let them go’ 

2

Meet a 21-year-old community college student who's going to China as the first American woman welder in the trades Olympics

3

The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises

1

Bolt CEO says he let go of his entire HR team for creating problems that didn’t exist: ‘Those problems disappeared when I let them go’ 

2

Meet a 21-year-old community college student who's going to China as the first American woman welder in the trades Olympics

3

The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises
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

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

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
  • Pinterest icon

Latest in Commentary

trader
CommentarySoftware
The 50-year-old law that governed every software company just broke. Here’s what replaces it
By Martin Casado and Abhishek NagarajMay 20, 2026
7 hours ago
FJ Campbell, MD, is chief medical officer at Ardent Health.
CommentaryHealth
A doctor shortage is coming. AI could be the only realistic fix
By FJ CampbellMay 20, 2026
9 hours ago
trump
CommentaryCongress
Milken-Harris Poll: 80% of Americans want AI workforce programs now — and Washington hasn’t delivered
By Karen Kornbluh and Libby RodneyMay 20, 2026
9 hours ago
‘Change the World’ idealism is dying in Silicon Valley. We’ll miss it when it’s gone
CommentarySilicon Valley
‘Change the World’ idealism is dying in Silicon Valley. We’ll miss it when it’s gone
By Jonathan WeberMay 19, 2026
1 day ago
reorgs
CommentaryRestructuring
We found the real reason 70% of transformations fail
By Julia Dhar, Kristy R. Ellmer and Philip JamesonMay 19, 2026
1 day ago
joel
Commentarysaas
The SaaSpocalypse isn’t killing software. It’s exposing where software value really lives
By Joel HronMay 19, 2026
1 day ago

Most Popular

Bolt CEO says he let go of his entire HR team for creating problems that didn’t exist: ‘Those problems disappeared when I let them go’ 
Workplace Culture
Bolt CEO says he let go of his entire HR team for creating problems that didn’t exist: ‘Those problems disappeared when I let them go’ 
By Preston ForeMay 19, 2026
22 hours ago
Meet a 21-year-old community college student who's going to China as the first American woman welder in the trades Olympics
Future of Work
Meet a 21-year-old community college student who's going to China as the first American woman welder in the trades Olympics
By Mike Householder and The Associated PressMay 17, 2026
3 days ago
The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises
Politics
The Bezos family just donated $100 million to help achieve one of Mayor Zohran Mamdani’s top campaign promises
By Jake AngeloMay 12, 2026
8 days ago
Current price of oil as of May 19, 2026
Personal Finance
Current price of oil as of May 19, 2026
By Joseph HostetlerMay 19, 2026
1 day ago
Spirit Airlines apologizes to all the Americans who can't afford any summer vacation flights as it shuts down
Travel & Leisure
Spirit Airlines apologizes to all the Americans who can't afford any summer vacation flights as it shuts down
By Rio Yamat and The Associated PressMay 18, 2026
2 days ago
CNN analyst and 'The Morning Show' producer says Stephen Colbert is a role model for his ‘positive’ outlook on his show ending
Arts & Entertainment
CNN analyst and 'The Morning Show' producer says Stephen Colbert is a role model for his ‘positive’ outlook on his show ending
By Emma BurleighMay 19, 2026
1 day 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.