ACA enrollment holds quite steady for 2018

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

The final 2018 ACA marketplace enrollment figures are out – and they are higher than many people had expected going into year two of the Trump presidency.

Overall enrollment is 11.8 million – a drop of 3.3 percent from 12.2 million in 2017. (The peak was 12.7 million in 2016, the final enrollment period that took place completely during the Obama administration.)

The decline has been almost all at the federal exchange, not the state-run exchanges. In the federal exchange, enrollment fell 5 percent from 9.2 million to 8.7 million this year. State-exchanges were flat at 3 million.

In the not-so-hot category, enrollment fell for people under age 35 – a prized slice of the market. Insurers want to see younger and healthier people in the market to support a viable risk pool.

Premiums rose by a steep 30 percent – but subsidies shielded most the wallets of most people with an annual income under $48,000.  More than four in five people – 83 percent – in the exchange are subsidized. Premium increases, however, have hit the unsubsidized, which is one reason exchange enrollment has not grown more. That’s one reason we’re likely to hear a lot about “rising premiums” and “unaffordable costs” from both left and right heading into the November congressional elections.

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