A shortened open-enrollment period for health coverage comes to a close early Saturday, giving millions of Americans, including tens of thousands of Arkansans, just hours to sign up or risk paying a penalty when they file their tax returns next year.
The open-enrollment period is the time each year when people who buy coverage on their own, rather than through an employer, can sign up or change plans.
Last year and this year, enrollment started on Nov. 1, but last year, the sign-up period lasted until Jan. 31. This year, it ends at midnight today Pacific time -- 2 a.m. Saturday in Arkansas.
Andy May, an insurance agent in Newport, said he's seen a last-minute surge in customers.
"It's been crazy," he said. "The phone rings off the hook."
As of Dec. 1, 60,560 Arkansans were enrolled in non-Medicaid plans offered through the federal site healthcare.gov, down from 65,972 who were signed up on the same date last year, according to the state Insurance Department.
Because of the shorter sign-up period, enrollment in the 39 states, including Arkansas, that use healthcare.gov are expected to fall short of the more than 9 million people who signed up for 2017 coverage.
Enrollment in the District of Columbia and 11 states that run their own enrollment websites brought the total sign-ups for 2017 to about 12 million nationwide.
Robin Fletcher, an insurance agent at The Hatcher Agency in Little Rock, said she and another agent had helped about 700 people sign up or change plans as of Thursday afternoon.
That put the agency on track to sign up at least as many people as they did last year, despite this year's shorter enrollment period.
"We have been busy," Fletcher said.
According to the U.S. Census Bureau's American Community Survey, 231,775 Arkansans lacked health insurance in 2016, down from 277,547 a year earlier.
Under the 2010 Patient Protection and Affordable Care Act, the penalty for going without coverage next year is the greater of $695 or 2.5 percent of the person's household income above the tax filing threshold. This year the threshold is $10,400 for an individual or $20,800 for a married couple filing a joint return.
The penalty is capped at the national average annual premium for a "bronze" level plan, designed to cover 60 percent of the typical enrollee's medical expenses. The cap this year is $3,264 for an individual or $16,320 for a family of five or more.
According to a report by the Congressional Research Service, 5.3 percent of Arkansas' 2015 tax returns included penalties for failure to maintain health coverage, with the penalty amounts totaling $28 million.
Nationally, 4.5 percent of tax returns included penalties, which totaled more than $3 billion.
In Arkansas, more than 70,000 people had signed up for 2017 coverage by Jan 31. Enrollment typically drops after the end of the sign-up period, as some people stop paying premiums, qualify for Medicare or find jobs with health benefits.
The enrollment period is also the time when low-income Arkansans whose premiums are paid by the state Medicaid program under Arkansas Works can change plans. But those who qualify for that program can sign up throughout the year.
Critics of President Donald Trump's administration blame the expected lower enrollment this year on what they describe as efforts to undermine the Affordable Care Act.
In addition to shortening the period, the Trump administration has reduced federal spending on advertising promoting enrollment from $100 million to $10 million and stopped reimbursing insurance companies for providing enhanced coverage to low-income consumers.
"The administration has done what it can to limit sign-ups," said Sandy Praeger, a Republican who served for 12 years as Kansas insurance commissioner and was president of the National Association of Insurance Commissioners.
"But the marketplaces are still around. ... I think that demonstrates that people need good health coverage, and these markets have been able to provide it."
Attracting a large number of customers is considered important to holding down the rates charged by insurance companies to consumers. If only people with expensive health conditions sign up, insurance companies will increase their premiums to pay for the higher average cost.
Trump's decision to end the company subsidies, known as cost-sharing reduction payments, caused insurers in Arkansas and elsewhere to increase their 2018 rates by more than they had initially planned.
But a different type of subsidy, provided through federal tax credits, has shielded many low-income consumers from the higher rates.
The tax credit subsidies, which are paid directly to insurers to lower a consumer's monthly premiums, are available to people with incomes of up to 400 percent of the poverty level: $48,240 for an individual, for instance, or $98,400 for a family of four.
Among those who qualify for the subsidies, "I'd say about 70 percent of them have lower premiums" that they will pay in 2018 compared to this year, Fletcher said.
"Most of them are pretty happy about it," she said.
Not as happy, she said, are those who had been covered by Arkansas Blue Cross and Blue Shield's Essential Blue Freedom plan, which was considered a "limited duration" plan because it offered coverage for only 364 days at a time rather than a full 12 months.
Such short-term plans didn't need to meet requirements established under the Affordable Care Act, and those who signed up for them were still subject to the law's penalty for failing to have coverage.
But the premiums for some people were cheaper under that plan than under plans that comply with the Affordable Care Act.
Because of a federal regulation, issued last year, that barred insurers from offering such short-term policies for more than three months at a time, Arkansas Blue Cross and Blue Shield is ending coverage under Essential Blue Freedom after Dec. 31.
Some of those covered by the plan had "sticker shock" when they learned what they'll be paying for a plan that meets Affordable Care Act requirements, Fletcher said.
About 1,200 people remained in the plan as of Thursday, Arkansas Blue Cross and Blue Shield spokesman Max Greenwood said.
May said many of his customers who are already enrolled in plans that meet Affordable Care Act requirements have been switching to plans with higher deductibles to avoid the increased premiums.
"If they're not getting any type of premium assistance, it hurts," May said.
Information for this story was contributed by Noam Levey of the Tribune Washington Bureau.
A Section on 12/15/2017