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February 6, 2017

Federal exchange sign-ups lagged behind last year. But why?

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CMS on Friday announced that about 9.2 million U.S. residents selected health plans through the federal exchange by the open enrollment period's Jan. 31 deadline—a slight dip from last year.

The Affordable Care Act's latest open enrollment period started Nov. 1, 2016, and ended Jan. 31. HHS has projected that 13.8 million individuals would select plans through state or federal exchanges this open enrollment period, up from 12.7 million who selected plans during the last open enrollment period. CMS said more than 11.5 million U.S. residents had signed up for plans through the federal and state-run exchanges as of Dec. 24, 2016.

Federal exchange sign-ups

CMS' latest enrollment snapshot accounts for sign-ups in the 39 states that used the federal exchange for enrollment. The data do not include figures on how many individuals paid their first month's premiums, which effectively ends the enrollment process. The numbers also do not include sign-ups through state-run exchanges. CMS said it intends to release data on state exchange sign-ups in March.

The 9.2 million figure is down slightly from the 9.6 million people who signed up for federal exchange coverage by last year's open enrollment deadline. According to Axios' "Vitals," the states that saw the largest declines in sign-ups this open enrollment period when compared with last year's include:

  • Georgia;
  • Louisiana;
  • Missouri;
  • North Carolina; and
  • Texas.

According to "Vitals," the decline is not surprising in states like Georgia and Texas. Both Georgia and Texas have Republican governors and GOP-led legislatures and have resisted coverage expansions under the ACA. However, sign-ups in some states with Republican political leaders increased this open enrollment period when compared with the last. For example, when compared with the last open enrollment period, there were:

  • 21,550 additional sign-ups in Utah this open enrollment period;
  • 17,206 additional sign-ups in Florida; and
  • 3,829 additional sign-ups in Wisconsin.

The latest CMS data show about three million new consumers and about 6.2 million returning customers signed up for federal exchange plans this year. That's compared to about four million new consumers who signed up for federal exchange plans during last year's open enrollment period.

This open enrollment period could be the law's last, depending on ACA repeal efforts

According to the Washington Post, the federal exchange did not experience the same last-minute surge in exchange plan sign-ups it has seen in past enrollment periods. The data show that about 376,000 people signed up for coverage during the last two weeks of this year's open enrollment period. In comparison, nearly 700,000 people signed up for federal exchange plans during the last two weeks of last year's open enrollment period, the Wall Street Journal reports.

Total sign-ups, which include those made through both the federal and state-run exchanges, could still meet HHS' initial projections, Modern Healthcare reports.


HHS spokesperson Matt Lloyd attributed the decline in federal exchange sign-ups to rising premiums for exchange plans, adding that the ACA has "failed the American people, with one broken promise after another." He continued, "We look forward to providing relief to those who are being harmed by the status quo."

According to the Post, that statement was a "sharp contrast" to the Obama administration's previous comments on open enrollment, which usually praise final sign-up numbers.

Senate Finance Committee Chair Orrin Hatch (R-Utah) in a statement also cited rising premiums for exchange coverage, saying, "Enrollment numbers are down, and costs are up." He added, "These cost hikes are exactly the reason why Republicans are committed to repealing and replacing [the ACA]."

According to the Journal, ACA opponents have argued that declining exchange plan enrollment shows the law is not working.

But Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, said while "enrollment is down somewhat, which is hardly good news for the program," the final enrollment numbers are "hardly a sign of a collapse."

Trump admin pulls ACA enrollment ads

Further, Enroll American President Anne Filipic said, "The fact that in the face of opposition and controversy, millions of Americans continued to enroll is an incredible testament to the importance of [ACA] coverage to families all across the country."

Separately, Joshua Peck, former chief marketing officer for, accused the Trump administration of sabotaging ACA enrollment efforts, citing a directive that partially halted enrollment outreach efforts and an executive order intended to scale-back the law.

"The administration's actions may have blocked nearly half a million people from getting covered," Peck said. He estimated that scaling back enrollment-related television ads for the law resulted in 350,000 fewer sign-ups, while the executive order might have discouraged an additional 130,000 people from signing up (Hackman, Wall Street Journal, 2/3; Sanger-Katz, "The Upshot," New York Times, 2/3; Dickson, Modern Healthcare, 2/3; Goldstein, Washington Post, 2/3; Nather, "Vitals," Axios, 2/6; Hellmann, The Hill, 2/3).

Health care industry trends for 2017


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