It's looking like Trump's Obamacare meddling could cause serious problems for the healthcare market
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- Enrollment on the federally run Affordable Care Act exchanges is outpacing 2016.
- But it's projected to fall short overall because of a shorter time window for people to enroll.
- Other actions from the Trump administration will likely lead to fewer Americans signing up for coverage.
- Experts say this will likely lead to higher insurance premiums.
Sign-ups for next year on the federally run Affordable Care Act insurance markets are crushing their pace from last year. But darker clouds loom on the horizon.
According to the Centers for Medicare and Medicaid Services (CMS), about 3.6 million plans have been selected on the federally run Healthcare.gov exchanges through December 2 — about 2.6 million people renewing coverage and just under 1 million new customers.
The overall number is above last year's pace, with nearly 600,000 more plans selected than at this time last year.
That's the positive news for the healthcare law. The not-so-good news: The open enrollment period for 2017 is significantly shorter this year compared to last. The Trump administration shrunk the sign-up stretch to six weeks instead of three months.
With the December 15 deadline fast approaching, the number of plan selections is well short of the more than 9 million people who signed up on the federal exchange last year.
Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan healthcare policy organization, said there will likely be a significant kick of sign-ups near the finish — since auto-enrollments will be added onto the final numbers. But it will likely not make up for the shortfall.
"It seems pretty clear at this point that the combination of a shorter sign-up period and massive reductions in outreach will lead to lower enrollment and more people uninsured," Levitt told Business Insider.
Obamacare markets could see big problems
Levitt hinted at another reason experts say there has been a drop in enrollments. The Trump administration cut its advertising budget by around 90%. Money to in-person navigators, who help people find plans, dropped by just over 40%.
Matthew Fiedler, a fellow at the Brookings Institution's Center for Health Policy, said there are a lot of reasons for the enrollment drop-off — but not one that stands out above others.
"My view is that various administration actions — including the shorter enrollment period, the reduction in outreach funding, higher premiums for unsubsidized consumers due to policy uncertainty, and consumer confusion about the ACA’s future — have weighed on enrollment, but the size of each of those effects is uncertain," Fiedler told Business Insider.
Fiedler said that the decrease in enrollment will likely be detrimental to people enrolled on the exchanges.
"In terms of what the effects of lower enrollment will be, a lower uninsured population will be damaging. The additional uninsured will have worse access to care and be less financially secure," Fiedler told Business Insider. "Similarly, other individual market enrollees will face higher premiums since the lost enrollees are likely healthier than average, and health care providers will face higher uncompensated care costs."
Levitt, on the other hand, argued that there are "countervailing forces" in the market due to the shorter enrollment period.
"A shorter period means less chance that someone who wasn’t planning to sign up gets sick and then enrolls," Levitt said. "That may only be a handful of people, but they could have very expensive health conditions."
Given this factor, he said, the actual effect on premiums is "unclear."
Fiedler said that the Obamacare markets could still "muddle through" even with lower enrollment.
"While bad, enrollment declines are not an existential threat to the individual market," he said. "The impact of enrollment declines on the risk pool are smaller than sometimes thought. Furthermore, the rate increases insurers implemented for 2018 appear to be large enough to accommodate the deterioration in the risk pool we are likely to see."