ACA exchange enrollment totals 11.8M in 2018, down 3.7% from last year

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New data show that state-run marketplaces saw a slight uptick in their 2018 enrollment figures, while those that use the federal exchange saw a decline. (Image: Leslie Small)

New data confirm that fewer people signed up for Affordable Care Act marketplace plans during the 2018 open enrollment period than last year.

But the final tally is still impressive considering all the political turmoil surrounding the healthcare law, according to an analysis from the National Academy for State Health Policy (NASHP).

The organization examined newly available data from state-based marketplaces and state marketplaces that use the federal platform—in addition to already released data from states that rely solely on Healthcare.gov—to conclude that a total of 11.8 million people signed up for 2018 exchange plans. That’s a 3.7% decline from the 12.2 million total in 2017

The data also show that the two types of states that run their own exchanges performed better, enrollment-wise, than the 34 states that use the federally facilitated marketplace. The latter showed an aggregate increase of .2%, while the former had an aggregate decrease of 5.3%.

To Trish Riley, executive director of NASHP, the results indicate that the ACA exchanges have achieved “remarkable stability.”  

“Despite all the uncertainty and challenges we have seen, particularly for consumers living in states supported by state-based marketplaces, we see millions of Americans continuing to benefit from the coverage they get in the individual market,” she said in a statement.

The latest open enrollment period was indeed unlike any other saw far in the ACA’s history, as it was not only half as long for many states but also taking place after a year in which Congress tried repeatedly to repeal the law that created the individual marketplaces. The Trump administration also slashed outreach and advertising funding.

RELATED: Private insurers step in to fill void of open enrollment advertising

States that run their own marketplaces overcame some of those challenges, according to NASHP, through efforts such as conducting targeted outreach to key populations and improving their enrollment operations. Idaho, for example, allowed consumers to shop online ahead of time to help make the actual sign-up process go more smoothly and compensate for the shortened enrollment season.

Leaders from those states said it also helped that an increase in federal subsidies lowered costs for many customers and that heightened news coverage of the ACA helped boost awareness.

In addition to their efforts during open enrollment, state insurance officials also went to great lengths to ensure there were no counties that lacked an ACA exchange coverage option, according to a previous analysis.

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