Health and Science

Here are some places where Obamacare enrollment actually has gone UP this year

People sit with insurance agents as they discuss plans available under the Affordable Care Act.
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The "state" of Obamacare depends on where you look.

Obamacare enrollment on marketplaces run by individual states is on track to rise this year, in contrast to the decrease seen in sign-ups on the federally run exchange, data shows.

That data suggests that sign-ups on the 12 exchanges operated by states and the District of Columbia will increase by at least 2 percent compared with last year, according to the leading Obamacare tracking site

In contrast, the federal marketplace, which serves residents of 39 states, had about 4 percent fewer sign-ups, as of the close of open enrollment Jan. 31.

The uptick in enrollment on the state-run exchanges provides evidence that the Trump administration's last-minute decision to gut advertising and outreach efforts for the federal marketplace dampened sign-ups there.

State-run marketplaces, which do their own marketing, were not apt to be affected by that pullback for

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And despite the fact that enrollment nationally will decrease as a result of's decline, the increase on state marketplaces also could provide ammunition to supporters of Obamacare as they pressure lawmakers to retain all or most of the Affordable Care Act.

"Absolutely," said operator Charles Gaba when asked if enrollment growth on so-called state-based marketplaces complicates Republican plans to repeal and replace Obamacare. Republicans already have hedged on when those plans would go into effect as individual members of Congress have voiced fears about changes that could lead to losses in coverage for millions of people.

"The fact that enrollment in the state-based marketplaces does appear to have increased a little bit ... suggests that there may not be huge room for growth, but it appears [the market is] fairly stable on the SBM side, at least," Gaba said.

"I think it's a good thing," he said.

Since they began being generated in late 2013, when the government-run exchanges opened for business, Obamacare enrollment numbers have been used by both proponents and opponents of the ACA to make their respective arguments.

Obamacare supporters have pointed to the millions of people who have signed up for coverage on the exchanges, particularly when enrollment exceeded the prior year's tally, as evidence the law is a success. But Obamacare foes have pointed to the millions of Americans who remain uninsured, as well as shortfalls in enrollment compared with initial predictions, as evidence that the law is not working.

Right before President Barack Obama left office in January, federal health officials were expecting national enrollment in Obamacare plans to top 13 million, which would represent an increase, albeit a slight one, from 2016's sign-up tally of 12.7 million.

Those expectations were dashed in the final week of enrollment when the Trump administration canceled ads and outreach programs for Although the administration soon afterward allowed email and Twitter reminders about to resume, former Obama administration officials called the pullback "sabotage" that was expressly designed to depress enrollment.

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Last Friday, federal health officials revealed that total sign-ups on were at 9.2 million — 400,000 or so fewer than last year's tally.

It was the first time a drop was seen in enrollment on, and the first time that a dip will be seen nationally for Obamacare sign-ups. Because of's drop, national enrollment, after factoring in the 3 million or so state-based exchange enrollees, likely will be around 12.2 million or so.

The decline on the federal exchange was cited by a spokesman for the U.S. Health and Human Services Department as evidence that Obamacare isn't working. HHS runs

"Obamacare has failed the American people, with one broken promise after another," that spokesman said as the numbers were released.

But state-run marketplaces have released numbers that could tell a different story, at least when looked at cumulatively.

Washington state reported that enrollment was up more than 12 percent over last year. Colorado's tally jumped by more than 14 percent.

And enrollment in Massachusetts surged by nearly a whopping 24 percent. That rise is stunning, particularly because Massachusetts for years has had a relatively high percentage of residents covered by health insurance.

New York's exchange reported a nearly 11 percent drop in sign-ups. But that decline was more than offset by a 75 percent increase in the number of residents enrolled in basic health plans, which are not counted toward Obamacare enrollment. Maryland's site dropped 2.8 percent.

Connecticut on Tuesday reported that enrollment on its exchange was down by almost 4 percent. But the District of Columbia's exchange, which covers far fewer people than Connecticut's, grew by more than 4 percent, DC announced Tuesday.

On Monday, California's exchange released a statement sayings sign-ups would be more than 1.5 million. On Tuesday, the exchange told CNBC that the actual tally was 1.56 million — a 1.2 percent drop in sign-ups compared to last year. An exchange spokesman said the number was "no surprise" given that the head of the marketplace last spring said it had reached "a cruising altitude."

Other states have yet to report their final tallies, although Minnesota's exchange three weeks ago already was nearly 28 percent ahead of last year's sign-up tally.'s tracking of previously disclosed numbers and newly disclosed numbers by the 12 state-based markets shows that enrollment is already up 2 percent over last year, with 3.02 million sign-ups.

Larry Levitt, an Obamacare expert with the Kaiser Family Foundation, said the difference in outcomes on and the state marketplaces likely reflect the effects of messaging around enrollment.

"While the Trump administration pulled outreach ads as the open-enrollment period ended, state marketplaces were continuing to market to potential new enrollees," Levitt said. "With so much churn in the insurance market as people's circumstances change, constant outreach is necessary to keep enrollment up."

Levitt also said, "There has been enormous uncertainty about the future of the ACA following the election. The messages out of Washington were that the law will be repealed quickly and replaced."

"State-based marketplaces were able to communicate with potential enrollees in a clearer and more nuanced way about their options with the law's benefits and requirements still in place."

Timothy Jost, a health law professor at the Washington & Lee School of Law, also believes the differences in outreach strategies in the final days of enrollment made a difference.

But, "A larger factor might be the overall environment," Jost said.

"The states tend to be favorable to the ACA generally. My impression is that the largest enrollment drops were in very red states such as Texas where hostility to the ACA is more widespread," he said.

Jost also that the executive order signed by President Donald Trump on his first day in office, which authorized federal officials to scale back Obamacare rules, might have played a role.

"The executive order was interpreted, incorrectly, by some to mean that the individual mandate would no longer be enforced," Jost said, referring to the Obamacare requirement that most Americans have some form of health coverage or pay a tax penalty.

"I wonder if these reports were more widespread, or more widely believed in more conservative states?" Jost said. "Indeed, repeal, either by the Trump administration or Congress, may well have seemed more of a certainty, and more likely to occur quickly, in redder states. Why enroll if there was no legal requirement and the law would disappear quickly in any event?"

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