After all the threats and changes to the Affordable Care Act (ACA) in the past year, consumer confusion may be a key component of the 2019 open enrollment period. From November 1, 2018, to December 15, 2018, consumers in 28 states other than California can purchase health coverage on the federal exchange at HealthCare.gov. This marks the second year of a shortened open enrollment period — in 2017, the Trump administration reduced the length of open enrollment from three months to 45 days.

Consumers shopping for coverage on the federal exchange may find that 2019 premiums have stayed flat or even decreased slightly. In an issue brief, the Kaiser Family Foundation explains that “many insurers are currently profitable after overshooting with 2018 rates” — thus curbing exchange premium increases for the 2019 plan year. However, premiums might be even lower if not for “the repeal of the individual mandate penalty, expansion of short-term plans, and loss of cost-sharing subsidy payments.”

Congress zeroed out the individual mandate penalty (essentially eliminating it) with the Tax Cut and Jobs Act of 2017, and this open enrollment period is the first to reflect that change. Consumers may now opt to forgo coverage without having to pay a penalty, but many health policy experts say that people are intrinsically motivated to purchase health insurance. Matthew Slonaker, JD, executive director of the nonprofit Utah Health Policy Project, told the New York Times’ Robert Pear, “The vast majority of the people we serve, over 90%, are motivated to have insurance because they want coverage for their family and themselves.”

The elimination of the federal individual mandate penalty was responsible for an average increase of 3.5% in premiums to consumers using Covered California. — Peter Lee, executive director, Covered California.

The expansion of short-term plans could rattle the ACA and consumers who may not know what they are — and aren’t — getting in their coverage. Short-term plans are exempt from the ACA’s patient protections, so they don’t have to cover essential health benefits or accept patients with preexisting conditions. While short-term plan premiums tend to be lower than those of comprehensive health plans, they can leave consumers on the hook for steep and often unexpected out-of-pocket costs. Kirsten A. Sloan, vice president of the American Cancer Society Cancer Action Network, told Pear, “These plans may not cover the doctors and hospitals and drugs you need if you get sick.”

In past years, insurance navigators — people trained to help consumers understand and choose insurance plans — have been vital during open enrollment. The navigator program received funding from the federal government to help consumers enroll in health plans on the ACA exchanges. But according to Health Affairs, since taking office the Trump administration has cut the budget for the navigator program by about 84%, down to just $10 million for 2019 plan year. Pear reports that 797 counties served by HealthCare.gov will not have any navigators this year. “If you are confused and you want somebody’s help to try to figure out what’s right for you — what’s junk and what is legitimate — there will be fewer people to help you in most states,” said Sabrina Corlette, JD, research professor at Georgetown University’s Health Policy Institute.

All of this means that consumers wading through insurance options on HealthCare.gov and nongovernmental shopping sites will have more choices and likely more confusion this year.

California Continues to Lead in Enrollment Push

As with many issues, open enrollment in California is a different story. Covered California, the state’s ACA exchange, has an open enrollment period that is twice as long as that of the federal exchange. It began on October 15, 2018, and runs through January 15, 2019. (Full disclosure: CHCF President and CEO Sandra R. Hernández, MD, sits on the Covered California Board of Directors.)

Additionally, Covered California has diverged from the federal government on funding for navigators. In California Healthline, Phil Galewitz writes that Covered California “is holding its navigator funding steady, dedicating $6.5 million to navigators in this year’s budget. That’s more than half of what the federal government is investing in navigators in 34 states.” Even without the help of navigators, Californians won’t have to worry about unwittingly purchasing a short-term plan. In September, California Governor Jerry Brown signed a bill prohibiting the sale of short-term plans in the state.

But even with these protections in place, Californians are likely to feel the effects of attempts to undermine the ACA. Consumers re-enrolling in plans on Covered California may notice an increase in their premiums. Over the summer, Covered California announced an average statewide rate increase of 8.7% but noted that many enrollees could mitigate the increase by switching to the lowest-cost plan in the same metal tier. Peter Lee, JD, executive director of Covered California, said that the elimination of the federal individual mandate penalty was responsible for an average increase of 3.5% in premiums.

As Californians enroll in health coverage for the 2019 plan year, advocates like Anthony Wright, executive director of Health Access California, want them to remember to keep an eye on future federal actions against the ACA. “California is not an island,” he tells Claudia Boyd-Barrett in California Health Report. “We urge Californians to sign up for coverage, but then continue to fight like hell to keep the benefits.”

What have you read about open enrollment? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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