Health and Science

Obamacare enrollment blows away expectations at nearly 9 million, despite short sign-up window

Key Points
  • The final tally for sign-ups during open enrollment on the federal Obamacare exchange was 8.8 million.
  • The Trump administration slashed advertising and outreach budgets for Obamacare.
Obamacare enrollment numbers blow away expectations at nearly 9 million
Obamacare enrollment numbers blow away expectations at nearly 9 million

Final open enrollment numbers for the Obamacare federal marketplace were surprisingly strong, with 8.8 million customers selecting a plan by the sign-up deadline, officials said Thursday.'

In the final week of enrollment, 4.1 million people signed up on, with 1 million of those being new customers, according to snapshot figures published by the Center for Medicare and Medicaid Services on Thursday.

CMS said, however, that these figures are not final because they do not include those who signed up after midnight Friday, Eastern Time. These numbers also do not account for people who were in line to enroll and left their callback number.

The high level of demand came despite fears that an enrollment season cut in half and a sharp reduction in outreach budgets would depress the number of sign-ups. The sign-up season, the first full one under the Trump administration, ran from Nov. 1 through last Friday — but many customers were unaware of the deadline.

The number of people who enrolled in the plans sold on, the federal marketplace that serves 39 states, was just about 400,000 fewer than the number that signed up during the prior enrollment season.

@SeemaCMS: Exchange open enrollment for 2018 coverage ended w/ approx 8.8M people enrolling in coverage. Great job to the @CMSGov team for the work you did to make this the smoothest experience for consumers to date. We take pride in providing great customer service.

Lori Lodes, co-founder of the Get America Covered campaign, said these enrollment numbers are "huge." She said the sign-up totals from the final week of enrollment were "likely the biggest in the history of the marketplaces."

Lodes, who served as a top health care official in the Obama administration, said these figures are an "incredible indicator of just how much people want quality, affordable coverage."

"No wonder the administration scuttled their plans to release the enrollment numbers yesterday. Despite [President Donald] Trump declaring Obamacare dead just yesterday and all of his administration's efforts to undermine enrollment this year, we saw record demand and enrollments," she said.

Larry Levitt, senior vice president of special initiatives at the Kaiser Family Foundation, tweeted that he was "very surprised" that enrollment was only down slightly year over year.

"That didn't seem possible with a 90% reduction in outreach, an enrollment period cut in half, and a constant refrain that the program is dead," Levitt said on Twitter.

@larry_levitt: I confess to being very surprised that ACA marketplace enrollment is down only slightly. That didn't seem possible with a 90% reduction in outreach, an enrollment period cut in half, and a constant refrain that the program is dead.

There is now a chance that the final enrollment tally for all of the United States could match or exceed the 12.2 million people who signed up throughout the country in the last sign-up period.

Nine state-run Obamacare marketplaces are still selling individual health plans that take effect in 2018. Officials at a number of those exchanges have reported higher enrollment this season than last season.

Washington state's Obamacare marketplace said enrollment so far this year is 35 percent higher than the same time period last year. California's exchange, the nation's largest state-run marketplace, said sign-ups are 10 percent higher.

Also, people in a number of states — including all of Florida, Georgia, South Carolina and more than 50 counties in Texas — are still allowed to enroll in Obamacare plans because of a waiver given to those affected by hurricanes this year.

Charles Gaba, who runs the Obamacare tracking site, said Wednesday that about 161 million people, or "almost precisely 50 percent of the total population" in the United States, live in areas with state-based Obamacare markets whose deadlines have yet to pass, or live in areas where they qualify for a special exemption that allows them to sign up for coverage through New Year's Eve.

The final national tally for Obamacare sign-ups for 2018 coverage will only become known in early February, after the deadlines for the special enrollment and for the state-based exchanges.

Last season, about 12.2 million people signed up for Obamacare plans that were in effect for 2017. The actual number of people who paid their first month's premiums, which is required for enrollment to be official was about 9.9 million as of June.

Congress gave final approval Wednesday to a tax bill that effectively eliminated Obamacare's individual mandate starting in 2019. Trump has said he will sign the bill.

That mandate currently requires most Americans to have some form of health coverage during the year or pay a tax penalty. That coverage can be through an employer, Medicare, Medicaid, an individual Obamacare plan, or other coverage that meets minimum standards established by the Affordable Care Act.

That fine this year is the higher of 2.5 percent of household income or $695 per adult. The tax bill that Trump will sign will eliminate the penalty for not having coverage.

The Congressional Budget Office has estimated that eliminating the mandate will lead to 13 million more people lacking health insurance by 2027 than had earlier been projected when assuming the mandate remained in effect.

The non-partisan CBO also has estimated that eliminating the mandate will cause prices of individual health plans to be 10 percent higher than they otherwise would have been.

Despite elimination of the mandate, Obamacare overall will remain in effect.

The law provides federal funds to subsidize the purchase of plans sold on government-run exchanges such as for low and middle-income customers. Many of those customers also qualify for discounts in their out-of-pocket health costs, which include deductibles, co-payments and co-insurance.

Obamacare also obligates the federal government to pick up no less than 90 percent of the costs for low-income adults who become newly eligible for Medicaid because their states have expanded that health coverage program under the Affordable Care Act.

Obamacare advocates have accused the Trump adminstration of actively sabotaging enrollment this season.

Those advocates likewise last January accused the administration of undercutting the final days of the prior open-enrollment season — on the heels of President Donald Trump's inauguration — by pulling back on customer outreach.

Trump's actions led to a 500,000-customer shortfall of enrollment for 2017 plans compared to 2016, according to a former top health official in the Obama administration.

In turn, Trump officials have said shortfalls in enrollment are due to inherent problems with the law and unsustainable premium prices.