Obamacare enrollment opens, but fate remains uncertain
Updated 10:49 am, Wednesday, November 1, 2017
The fifth enrollment period for Affordable Care Act health insurance opens Wednesday under a cloud of uncertainty and political rancor as bad, if not worse, than in the earliest days of the law.
More than three of four in the country do not know when enrollment begins and nearly 20 percent think the health care law known as Obamacare is no longer in effect, according to a survey released this week by Policygenius, a national online insurance brokerage.
Similarly, one in four in the country think the law has been at least partially repealed, according to a separate Morning Consult/Politico survey from last week.
For the record, Obamacare remains the law of the land even as the White House and most Republicans in Congress have declared it a disaster and vowed for months to kill it. So far, multiple congressional efforts to repeal and replace it have been unsuccessful.
Still, this year's enrollment season will see significant changes. The time period for people to sign up for coverage was cut in half. Enrollment will run 45 days rather than 90, ending Dec. 15.
In addition, the federal healthcare.gov website where people can sign up for plans will be shut down from midnight to noon every Sunday except Dec. 10 and also overnight on Wednesday, the first night of enrollment. At the same time the advertising budget to promote enrollment has been cut by 90 percent and the number of people available to help with enrollment questions or prod those reluctant to sign up will be far fewer.
The Trump administration has called the changes necessary to streamline the process and make it more financially sustainable.
Others, though, see internal sabotage to guarantee failure, not only from the president but also from the U.S. Department of Health and Human Services, the very federal agency that oversees the law.
"I've never seen anything like it," said Katy Caldwell, CEO of Houston's Legacy Community Health, the largest community-based health care system in Texas.
Obamacare: By the numbers
76 percent of Americans don't know open enrollment begins Wednesday.
22 percent don't know kids can stay on parents' plan until age 26.
18 percent don't know that Obamacare is still the law of the land.
45 percent of Democrats vs. 35 percent of Republicans and 37 percent of independents are more likely to know key provisions of the law.
Source: Policygenius online poll of 1,500 adults Oct. 10 to Oct. 12. Margin of error 3 to 5 percent.
Legacy will spend $25,000 to launch its own advertising campaign in Houston to counteract what she sees as a concerted effort out of Washington to cripple enrollment.
She and other Obamacare advocates are bracing for what they fear will be an inevitable drop in enrollment numbers this time around, which could lead to a spike in uninsured rates both in Texas and across the country.
Slightly more than 12 million people nationally signed up for plans during the 2017 enrollment period with about 1.2 million enrolling in Texas.
Since the law's rocky rollout in 2013, an estimated 20 million people have secured health insurance through the Obamacare exchange. Critics of the law say that number is inflated.
The nation's uninsured rate dropped to its lowest level in history last year at roughly 9 percent, down from around 16 percent when the ACA was signed into law.
Texas, which leads the nation in uninsured, saw its rate drop to just under 17 percent last year, down from around 25 percent, or one in four people in the state lacking coverage.
But that number could begin to rise again as enrollment efforts are suppressed, coupled with sharp premium increases revealed last week in the preview of the 2018 exchange plans.
At the heart of the steep increases, insurers said, is a move by the White House last month to end a key federal payment called cost-sharing reductions baked into the law that defrays out-of-pocket costs for lower income enrollees.
Trump and some congressional Republicans have challenged the subsidies calling them an illegal "bailout" to the insurance industry.A court case on the subsidies remains pending.
The estimated $9 billion in shortfall will ultimately be shifted onto consumers as steep premium price increases. While those who qualify for help with premium prices will mostly be insulated, higher earners will bear the full brunt and could choose to forgo coverage.
Kathleen Sebelius, the Health and Human Services secretary when the ACA became law in its early years, finds the current climate especially disheartening because the law was just starting to stabilize as insurers were better able to price plans and many had grown accustomed to the process.
In a recent interview with the Chronicle, she acknowledged bumps in the road during the first year due to political opposition and computer malfunctions. But she said she is proud of the law's progress over time.
"I know where we started and where we were at the end of 2016. It's a pretty good legacy," she said, but then added about the continuing opposition to the law: "I'm just stunned 7½ years later we're still having the same conversation."