On the eve of the first full open enrollment period of the Trump era, several independent studies estimate that enrollment will drop this year as a result of the administration’s actions to gut outreach funding, cancel planned subsidy payments to insurers, and sow confusion with public statements declaring the Affordable Care Act “dead.”
S&P Global Ratings published a report Tuesday projecting that enrollment will drop between 7 and 13 percent compared to last year—meaning between 0.8 and 1.6 million more people will go uninsured in 2018.
S&P predicts that the vast majority of people who currently have insurance will maintain it going into next year, because despite double-digit premium hikes across the country, “over 80% of this population is likely receive an advanced premium tax credit, which will offset the impact of the 2018 premium increases.”
But S&P expect far fewer new enrollees to sign up when open enrollment begins Wednesday due to a range of factors including “the expectation of reduced active outreach at the federal level, a reduced broker presence in the individual market, shorter enrollment periods, and higher non-subsidized premiums.”
The Trump administration’s decision to gut 90 percent of the budget for open enrollment outreach, S&P said, will significantly impact the signup rate among younger and healthier individuals, and lead to a sicker, more expensive and less stable risk pool.
“The marketplace would benefit from growth in enrollment, especially if it helps improve the morbidity of the risk pool,” the report says. “But we don’t expect that to happen in the near term. This means that for now, insurers will have to continue pricing for a higher-morbidity marketplace. On average, premiums will not decline without a higher level of new enrollment.”
Other independent reports on projected marketplace enrollment have reached similar conclusions.
California’s exchange, Covered California, estimates that 1 million fewer people will enroll this year as a direct result of Trump’s outreach cuts. Health care analyst Charles Gaba takes a darker view, predicting that more than 2 million more people will be uninsured next year.