This year as usual, fewer people enrolled in marketplace coverage under the Affordable Care Act (ACA) by paying their first premium than signed up during open enrollment. President Trump cited this normal drop-off to show that the ACA marketplace is in a “death spiral” because, the Administration says, people can’t afford to pay the premiums after they sign up for coverage. In fact, not only is this year’s drop-off not unusual, but it’s a little lower than last year’s, when measured correctly. That’s why Politifact deemed Trump’s claims “mostly false” and the Washington Post awarded them “three pinocchios.”
The Centers for Medicare and Medicaid Services (CMS) compared the number of people who signed up for 2017 marketplace coverage (12.2 million) during open enrollment to the 10.3 million who paid their premiums, which officially enrolled them in coverage that started in January or February. But of that 12.2 million, the CMS report includes about half a million people whose coverage started in March. Comparing the approximately 11.7 million people who signed up for coverage that started in January or February to the 10.3 million people who paid and officially enrolled in coverage for those months shows a 12 percent drop-off rate, less than the 13 percent for 2016.
There’s no evidence to support the Trump Administration claims that the drop-off is because people couldn’t afford their premiums. In fact, premium tax credits protect most consumers from price increases, as the Administration’s earlier enrollment report showed. More than four-fifths (83 percent) of consumers receive premium tax credits that peg their share of the premium to their incomes so that assistance rises as premiums do.
An official enrollment rate slightly better than last year’s is especially impressive in light of the confusion created by ongoing congressional efforts to repeal the ACA and the Administration’s repeated claims that it’s already dead. It shows that people still need and value the coverage that the ACA provides.