By Kimberly Leonard
Affordable Care Act’s open enrollment for calendar year 2019 began Nov. 1 and runs until Dec. 15, 2018, at Healthcare.gov or most state exchanges, although a few states have different sign-up periods.
As noted in a recent story for Washington Examiner, the Trump administration has instituted new regulations and changes for customers to navigate as they shop for health plans over the next several weeks. So keep these seven things in mind when reporting on open enrollment in your community:
1. Congress axed the individual mandate penalty so people won’t be fined if they go uninsured.
The GOP tax bill zeroed out the fine, which had been 2.5 percent of income or $695 for an individual, whichever was higher. The penalty still applies for 2018, although there are many exceptions to the mandate.
HOWEVER: The District of Columbia, New Jersey, and Massachusetts have their own fines, and Vermont will implement an individual mandate in 2020. Other states could similarly enact mandates to shore up their markets.
2. People can buy health plans that do not comply with ACA rules and consumer protections.
Health insurance is still extremely expensive for some people who don’t qualify for subsidies. The Trump administration has made “short-term plans” far more available and for longer periods (up to three years) than had been available under the Obama administration.
These plans are cheaper — in part because they don’t have to cover certain “essential health benefits” required under the ACA. Nor are the plans required to cover people with pre-existing conditions (or cover medical care tied to those conditions).
California, Massachusetts, New York, New Jersey, Rhode Island, and Vermont don’t allow short-term plans, and other states limit their duration more than the Trump change allows.
3. We won’t see a lot of commercials or navigators promoting open enrollment.
The Trump administration will spend $10 million on advertising — way down from the $100 million the Obama administration spent in 2016.
The administration also cut grants to “navigators” who were trained to help sign people up in the early years of ACA implementation. The administration will now spend just $10 million on such organizations.
Administration officials argue that this level of outreach is no longer needed now that customers have gotten used to the ACA, and that use of navigators wasn’t cost effective. Some advocacy groups that favor the health law will try to close at least a little the gap in outreach and assistance.
4. Open enrollment is six weeks for most states.
The season runs from Nov. 1 to Dec. 15 in most of the country. Those who do not re-enroll on their own will be signed up automatically for their current plan or a similar one.
California, Colorado, New York, Massachusetts, Minnesota, Rhode Island, and the District of Columbia have longer enrollment seasons.
5. For the first time, premiums will drop slightly overall. Also, more plans will be selling on the exchanges than in 2018.
Premiums in the ACA exchanges are set to drop for the first time, by an average of 1.5 percent for benchmark plans. This decline follows two years of big hikes. Last year the hikes were blamed in part on insurers responding to greater uncertainty about the markets’ future due to Trump administration policies.
Most people shopping in these markets receive federal subsidies, but affordability remains a challenge for those who don’t qualify for financial assistance.
6. Healthcare.gov will again be offline at times for maintenance.
The website will be down most Sundays — typically from midnight until noon. There may be other down-time for maintenance or technical fixes.
Last year, the site was down just 21.5 hours, fewer than anticipated.
7. Nobody really knows what will happen to enrollment this year.
With all the changes – new off-exchange options, no mandate but also a more stable ACA market – it’s impossible to know how many people will sign up. For the current year, 11.8 million signed up, but some later dropped out. That’s typical — some don’t pay their premiums, and others get covered through a job.
Kimberly Leonard is a senior health care writer for The Washington Examiner. She previously covered health care for U.S. News & World Report, where she wrote about the implementation of the Affordable Care Act, social issues in medicine and health industry trends.
