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State, National, Enrollment in ACA Marketplace Down Over Last Year

As Trump targets Obamacare, fewer New Jerseyans are signing up for health insurance on the federal marketplace despite price cuts and push by Trenton to bolster enrollments. In other states, it’s worse

Phil Murphy
Credit: Edwin J. Torres/Governor's Office
Gov. Phil Murphy urges New Jerseyans to enroll in the Affordable Care Act in Elizabeth on Monday.

With just days left to sign up, 16 percent fewer New Jersey residents have sought to enroll in the federal health insurance marketplace that allows them to purchase discounted coverage for 2019, when compared to last year’s statistics. And the Garden State is far from alone.

Federal data released Friday showed that, a month into the six-week sign-up period, interest in the Affordable Care Act’s exchange is down in all 39 states that participate in the national marketplace system. Most states have seen a larger drop-off than New Jersey, where 13,000 fewer sign-ups were recorded, despite a coordinated state outreach initiative — and premium costs that have declined more than 9 percent, on average.

Policy experts have attributed the national decline to efforts by the Trump administration and Republicans in Washington, D.C, to scale back or eliminate the ACA, also known as Obamacare, actions that observers believe have confused or discouraged participation. Federal officials also eliminated funding for outreach and enrollment services, a change that cost New Jersey more than $90 million in annual support.

Time to enroll is running out

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According to a recent poll from the nonprofit Kaiser Family Foundation, only one in four eligible consumers surveyed was able to correctly identify when the current six-week enrollment period ends. Six years after the law was enacted, 61 percent of respondents did not know they could sign up for these programs between November 1 and December 15.

To underscore the urgency and the limited time remaining before the enrollment window closes, Gov. Phil Murphy joined cabinet leaders and elected officials on Monday at a public library in Elizabeth to promote the GetCovered.NJ.gov campaign. Since it was launched, the state’s website alone has attracted some 50,000 visitors, state officials said. (While enrollment is technically handled through the federal government and the HealthCare.gov website, the state has launched the informational campaign and is working with local agencies and nonprofit organizations to help residents navigate the process.)

New Jersey has also taken several steps to support the market, some of which have also helped stabilize prices, supporters have said. Murphy signed laws last spring to create a state income-tax penalty on those who don’t secure health coverage, replacing the federal mechanism designed to expire at the end of the year in an effort to encourage healthy people to participate in the system and further spread the risk and the cost. Another law allowed the state to tap into $218 million in federal funding this year for a reinsurance pool that can be used by companies to offset their most costly claims.

Marlene Caride
Credit: NJTV News
Marlene Caride, commissioner of the New Jersey Department of Banking and Insurance

“It is extremely important that residents realize that in New Jersey there is a requirement to have healthcare coverage,” Banking and Insurance Commissioner Marlene Caride said at the Elizabeth event. “The alternative to that is, unless you qualify for an exemption, you will pay a penalty at tax time.”

(Confusion on these details seems to be the norm. According to the Kaiser poll, less than one-third of those surveyed nationwide realized the federal government had eliminated the national insurance mandate for 2019. Nearly four in 10 said it was still in place.)

Numbers down despite Trenton’s efforts

This year, some 340,000 ACA plans were sold to New Jersey consumers, including about 140,000 purchased directly from insurance companies, not through the federal system; data for these plans was not included in federal information released Friday and details on these sales won’t be available for some time, officials stressed.

The other 200,000 plans are sold to New Jerseyans through the ACA exchange; most of these consumers receive subsidies to offset the premium costs, officials note. But while more than 79,000 had signed up by this time last year, fewer than 66,500 have enrolled in the past four weeks, the federal data showed. (State officials note that for those currently enrolled, the system will sign them up for the same policy in 2019 if they do not proactively chose an option — something that generally happens to tens of thousands of policy holders.)

ray castro
Raymond J. Castro, senior policy analyst for New Jersey Policy Perspective

Ray Castro, healthcare program director for New Jersey Policy Perspective, a liberal think tank that has tracked the 2010 law and its implementation, praised the state’s outreach campaign — designed in part to replace federal efforts, which Trump has scaled back dramatically — but said it may take time to have a real impact.

“Hopefully next year New Jersey will do much better,” Castro said. “Any decrease in enrollment in the exchange is problematic,” he added, “but maybe we will see a last minute surge” in sign-ups.

Nationwide, 2.4 million applications had been submitted between November 1 and 28, according to the Centers for Medicare and Medicaid Services, nearly 350,000 fewer than government had collected last year at this time. (Officials note that this period was actually one day shorter than it was last year.)

A closer look at the numbers

An NJ Spotlight review of these numbers shows that, state-by-state, the decline ranged from less than 1 percent in Florida to 39 percent in Virginia, where nearly 48,000 fewer people have signed up so far.

Two dozen states had sign-ups that declined more than that in New Jersey and half of these had drop-offs greater than 20 percent, including Pennsylvania, where interest has dropped by a quarter, compared with last year’s figures. (A number of other states, including New York, operate their own exchange programs.)

NJPP’s Castro said the decline may also reflect how some customers — especially those who may not qualify for subsidies — are migrating from plans sold on the exchange, to plans sold directly by insurance companies.

Changes in how these new silver-level plans are crafted could allow some consumers to save thousands of dollars a year, he said.

“They have much better deals” off-market than in the past, he said.

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