Director of Immigration Policy
Despite uncertainty created by repeated congressional attempts to repeal the Affordable Care Act (ACA) and Trump Administration efforts to undermine the health insurance marketplaces, nearly as many people signed up for marketplace coverage for 2018 as for 2017. While enrollment remained strong, significant headwinds that confronted this open enrollment period almost certainly reduced sign-ups. And looming challenges — including repeal of the ACA’s individual mandate and additional harmful Administration actions — will require states and independent groups that help support marketplace outreach and enrollment to work even harder to sustain coverage gains, as we explain in a new paper.
The 2019 open enrollment period will present major additional challenges. The end to the ACA’s requirement that most people enroll in coverage or pay a penalty and the potential expansion of short-term health plans that don’t have to meet ACA standards may prompt fewer healthier consumers to enroll in marketplace coverage. A less healthy pool of consumers will drive up premium sticker prices and make health care less affordable for those who wish to keep comprehensive coverage. Other challenges include a new Administration rule that will further limit access to consumer assistance to help people enroll, and immigration rules under consideration that could deter marketplace-eligible people from signing up for health insurance.
The outcome of open enrollment for 2019 will depend in large part on whether states take steps to protect their markets and their consumers. States should:
Independent groups that contribute to marketplace outreach and enrollment will also have an even more important role to play for 2019. During 2018 open enrollment, many groups stepped up their efforts to help compensate for the Administration’s outreach cuts. Next year will require new and strengthened partnerships, an aggressive media strategy to promote open enrollment, and more investment to conduct outreach and support consumer groups that provide enrollment assistance.