WASHINGTON -- Health insurance sign-ups for the Patient Protection and Affordable Care Act are down with just a few days left to enroll, even though premiums are stable, consumers have more choice and millions of uninsured people can still get financial help.
Barring an enrollment surge, the nation's uninsured rate could edge up again after a yearslong coverage expansion that has seen about 20 million people obtain health insurance.
A status report Wednesday from the Centers for Medicare and Medicaid Services showed nearly 20 percent fewer new people signed up than at about the same time last year. New sign-ups drive the growth of the healthcare.gov marketplaces, helping keep premiums in check.
In Arkansas, 29,049 people, including new customers and those already receiving coverage, had selected a plan for 2019 as of last Saturday, according to the U.S. Health and Human Services Department. That was about 10 percent fewer than the number who had selected a plan for this year by Dec. 9, 2017.
Those who are already enrolled in a plan and don't make a new selection will be automatically reenrolled in coverage for next year. As of Dec. 1, 51,314 Arkansans were enrolled in plans through healthcare.gov, according to the state Insurance Department.
The sign-up deadline in most states is Saturday, for coverage beginning Jan. 1. A few states that run their own health care websites have later deadlines.
Trying to encourage enrollment, former President Barack Obama posted a video on social media Monday encouraging young adults to sign up for his signature program. That same day, a crush of people tried to enroll in what was the highest traffic this open enrollment season.
Disappointing sign-ups will add to the long-running political blame game over health care. Democrats accuse President Donald Trump's administration of "sabotage" on the health law. Republicans counter that pricey Obama-law premiums are too high for solid middle-class people who don't qualify for taxpayer-financed subsidies.
The administration said in a statement this week that "our primary goal is to provide a seamless open enrollment experience for healthcare.gov consumers and ensure that those who want coverage offered through the [program] can enroll in a plan."
The new numbers suggest there may be less demand for government-subsidized insurance during a time of strong economic growth. But interviews with current and former officials, consumer organizations and independent experts also revealed several factors that appear to be cutting into enrollment.
One reason enrollment has slowed, the experts say, is lack of a strategy for expanding the federal insurance marketplace.
The Trump administration didn't set sign-up targets for the health overhaul, according to a report this summer from the nonpartisan Government Accountability Office. Such targets are a standard management tool for government agencies.
"Marketing does matter," said Peter Lee, executive director of Covered California, a state-run insurance marketplace. "Not doing active promotion millions of Americans are not going to find their way to healthcare.gov."
The administration has been using targeted emails and social media messaging that's nowhere near the effort expended in the Obama years. Administration officials say they are focused on providing a smooth sign-up experience for consumers who want coverage.
Also cutting into enrollment is the fact that there is no longer a penalty for being uninsured.
Congress repealed the fine for being uninsured, effective Jan. 1. The tax penalty was the most unpopular part of Obama's law.
The administration also increased access to lower-cost plans that provide less coverage than the more comprehensive insurance offered under the overhaul.
Short-term health insurance plans don't have to offer basic benefits such as prescription drugs, and insurers can turn down people with medical conditions. But such plans may appeal to healthy people looking for a measure of financial protection against an unexpected illness.
Organizations working to enroll low-income workers report that another hindrance to enrollment are heightened concerns among immigrants that applying for health insurance could have negative consequences due to the administration's crackdown on illegal immigration. Only people legally in the U.S. and citizens can get coverage through healthcare.gov, but that hasn't calmed the fears.
"We've had a lot of green card holders coming in because they think they might be affected," said Kori Hattemer of Foundation Communities, a nonprofit organization in Austin, Texas, that helps enroll people for coverage. "Pretty much every day we have someone asking us about it."
Information for this article was contributed by Andy Davis of the Arkansas Democrat-Gazette.
A Section on 12/13/2018