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ACA Marketplace Open Enrollment Finishes Higher Than Feared

By Steven Porter  
   December 19, 2018

More than 8.5 million people signed up for 2019 coverage during the nationwide open-enrollment period. That's about 367,000 sign-ups behind last year.

Despite a newly toothless individual mandate, a federal judge declaring the entire Affordable Care Act invalid, and other potential headwinds, the number of people who signed up for 2019 coverage through the federally facilitated ACA exchange during open enrollment finished higher than some had feared.

Six weeks into the seven-week period, sign-ups were trailing by more than half a million compared to a similar time frame last year. But by the time open enrollment ended Saturday, that gap narrowed to about 367,000 sign-ups behind last year's open enrollment, according to preliminary figures published Wednesday by the Centers for Medicare & Medicaid Services.

More than 4.3 million plans were selected during the seventh week, bringing the cumulative total to nearly 8.5 million, down about 4% from the 8.8 million sign-ups last year.

Citing the numbers, CMS Administrator Seema Verma declared vindication from claims that she and the rest of the Trump administration have sought repeatedly to undermine the ACA's success.

"This Administration has taken strong steps to promote a more competitive, stable health insurance market and these steady enrollment numbers are yet another sign that the Administration's efforts are working," Verma said in a statement, adding that at least some of the enrollment drop for exchange plans could potentially be explained by an increase in employment.

In a series of tweets, Verma rebuffed notions that the Trump administration's reductions to the ACA advertising budget and promotion of short-term limited-duration plans would necessarily diminish enrollment.

"Big ad budget does not drive enrollment," she wrote. "Enrollment dropped in 2017 after boosting ad spending by $47 mil and then increased in 2018 after ad funding reduced by $91 mil. Enrollment steady into 2019 with lower ad spending, more focused outreach."

As evidence that promoting short-term plans wouldn't undermine demand for ACA-compliant plans, Verma noted that New Jersey saw an 8% drop in enrollment despite instituting its own individual mandate and banning short-term limited-duration options in the state.

Aside from rising employment and the Trump administration's actions, there's another noteworthy reason why ACA enrollment might dip, as Business Insider's Bob Bryan and Zachary Tracer reported: Virginia expanded Medicaid, extending eligibility to about 100,000 people who would otherwise buy ACA exchange plans.

As demand surged ahead of Saturday's deadline, an unspecified number of people seeking coverage were asked to leave their contact information for follow-up calls, CMS said. The process of enrolling those consumers in 2019 plans has begun, so the final number of sign-ups is expected to rise.

Editor's note: A previous version of this story stated, based on rounded numbers, that open enrollment sign-ups are down about 300,000, or 3.4%, from 8.8 million for 2018 to 8.5 million for 2019. The change is more accurately described as a drop of about 367,000, or 4%, from 8,822,329 sign-ups for 2018 to 8,454,882 sign-ups for 2019. 

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: txking /


Critics have accused the Trump administration of seeking to undermine the ACA's success by slashing advertising budgets, promoting skimpy plans, and declining to defend certain key provisions of the law.

Even amid heightened uncertainty over the ACA's future, open-enrollment sign-ups on the federally facilitated exchange dropped only about 4% compared to last year.

The drop could be explained in part by Medicaid expansion in Virginia and falling unemployment nationwide.

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