For the last three years, millions of Americans have signed up for health insurance under the Affordable Care Act. This year, enrollment will be open from November 1 to December 15.
And although the Trump administration and Congress have not been able to repeal the Affordable Care Act, the president has been taking steps to make the program less effective. More than once, the president has said that the best option may be to let Obamacare fail.
As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!
— Donald J. Trump (@realDonaldTrump) July 18, 2017
The biggest changes include a shorter enrollment period, higher premiums, and a smaller advertising budget. Outreach has also been limited, so you won't see Donald Trump doing anything like this during the enrollment period:
Despite Trump's dislike of the ACA, the program has been relatively successful in Michigan. The state’s uninsured rate has dropped from 11.8% in 2011 to 5.4% in 2016.
So how is the administration changing this year’s enrollment period, and what will that mean for Michigan?
Shorter enrollment period
This year’s enrollment period has been shortened from twelve weeks to six. According to NPR, this is “to reduce the number of people who buy a policy because they find out about a health issue during that time.”
Insurance companies have complained that longer sign-up periods allow customers to wait until they get sick to sign up for coverage, and then drop out after receiving care.
Of course, the new six week period also cuts down on the amount of time people have to sign up for individual health plans, which concerns health care experts and ACA advocates.
In addition to the shorter period, the U.S. Department of Health and Human Services has announced it will take down the healthcare.gov website for 12 hours almost every Sunday for website maintenance, further limiting the amount of time people have to sign up.
Hints and policy changes are leading to uncertainty - and higher premiums
Premiums in Michigan are up by an average of 27.6% for 2018. A majority of enrollees will still qualify for subsidies, but those who do not qualify will be hurt by those price hikes.
So far, one insurance company - the Health Alliance Plan - has left Michigan’s individual marketplace. The company’s CEO Terri Kline stated that the move was largely motivated by uncertainty in the individual marketplace.
One of the motivating factors of the GOP’s attempt to repeal the ACA have also been based on claims that markets are unstable.
But certain claims by President Trump are certainly not helping the insecurity felt by insurance companies.
On October 12, Trump ended a type of health care subsidy called cost-sharing reductions, or CSRs.
CSRs are designed to assist those that don’t qualify for Medicaid, but cannot fully afford deductibles or out-of-pocket costs of insurance plans offered through the individual marketplace.
But instead of going straight to consumers, the subsidies are paid by the federal government to insurance companies. When a qualified individual can’t afford a deductible or out-of-pocket expense, their insurance company is legally required to pay the difference, and the government reimburses the insurer.
Fewer resources could lead to fewer enrollees
The success of the Affordable Care Act relies on a large number of young, healthy enrollees in order to support older, sicker Americans. If healthy Americans do not buy into the program, insurance companies will be left with a sicker pool of people to cover and premiums will rise.
One way to make sure healthy Americans are signing up for health care is to be sure they are aware of enrollment periods. But under Trump, outreach efforts have stalled. As Vox.com explains, Trump officials defend cuts to advertisement and outreach in part “by arguing that people are already familiar with Obamacare after three years.”
The only problem with that? Surveys by the Commonwealth Fund show that nearly 40 percent of uninsured Americans were still unaware of the marketplaces in 2016, and almost half did not know they might be eligible for financial assistance.
Regardless, funding cuts are being enacted by the Trump administration, in addition to shortening the enrollment period from twelve weeks to six.
Significant cuts have been made in funding enrollment assistance groups, which help people sign up on the exchanges. One assistance group, Enroll Michigan, has seen their funding cut by 90%.
The other major funding cut is in advertising, which fell from $100 million to $10 million for the 2018 enrollment period.
Many health care experts agree that less outreach, less enrollment assistance and a smaller enrollment window will lead fewer people to sign up.
A spokesperson from the Michigan Department of Health and Human Services says they do not anticipate a major impact on enrollment in the Healthy Michigan Plan, adding that enrollment has largely leveled off in recent years.