ACA Sign-Ups Lag by Half-Million as Open Enrollment Nears End

The apparent dip in ACA plan selection follows a year of efforts by the Trump administration to sand off some of the Obama-era law's teeth.

Open enrollment ends this Saturday for federally facilitated Affordable Care Act exchange plans, and the number of sign-ups through the HealthCare.gov platform is lagging behind last year's numbers.

About 934,000 people selected plans using the HealthCare.gov platform last week, bringing the cumulative total for the first six weeks of the 2019 open-enrollment period to about 4,132,000 plans selected, according to the Centers for Medicare & Medicaid Services.

By contrast, there were 546,000 more sign-ups at the same point in last year's open-enrollment period, when the cumulative number of plans selected reached about 4,678,000 at the end of the sixth week.

Comparing this year to last year, however, should come with a bit of a caveat: The cumulative total for the first six weeks of the 2019 open-enrollment period (November 1, 2018, through December 8, 2018) is a day shorter than the first six week of the 2018 open-enrollment period (November 1, 2017, through December 9, 2017) because each week is measured Sunday through Saturday, CMS noted.

Counting the seventh week, the open-enrollment periods for this year and last year are 45 days apiece.

Even so, the apparent dip in ACA plan selection follows a year of efforts by the Trump administration to sand off some of the Obama-era law's teeth.

A year ago, Congress zeroed out the ACA's individual mandate penalty, effective next month. Since then, the administration has slashed funding for the "navigators" who help consumers sign up for coverage, touted skimpy alternatives to ACA-compliant plans, and sided against key provisions of the ACA in a lawsuit brought by Republican state attorneys general seeking to have the entire law overturned. (A ruling in that case could come any day now.)

More recently, the administration has reinterpreted some of the terminology in the ACA's "guardrails" for Section 1332 waivers, giving states more leeway to sidestep certain requirements in the law—a move critics warn could lead eventually to the collapse of ACA-compliant markets.

CMS Administrator Seema Verma has repeatedly rejected claims the administration is seeking to sabotage the law, arguing the administration has instead delivered stabilization.

As demand swells in the final days of open enrollment, CMS said the call center may ask some prospective enrollees to leave their contact information to enroll in a plan after the December 15 deadline.