Americans have until Saturday to sign up for coverage on the federal, online insurance marketplace. The Affordable Care Act set up healthcare.gov to help people find affordable health care and access income-based subsidies to help pay for it.
But the federal government is cutting funding for outreach and the enrollment period has been cut in half. As a result, fewer people are signing up nationwide. Missouri has one of the highest drops in enrollment.
“They are busy. They are steady. but we don’t feel quite the same flood of interest as we did last year,” said Nancy Kelley, program director of the Missouri Foundation for Health.
According to the most recent datafrom the Centers for Medicare and Medicaid Services, 101,274 people in Missouri enrolled in a 2019 plan after the sixth week of the enrollment period, which began Nov. 1. That’s down 25 percent from the same period last year. Nationwide, enrollment is down 11 percent over the same period last year.
Illinois lost more than 30,000 enrollees in the first six weeks of the sign-up period, more than 20 percent less than the year before.
Health policy experts say a number of factors could be behind the drop.
Next year marks the first in which the IRS won’t penalize people for violating the individual mandate, or the requirement that people have insurance coverage, said Kelley, also director at Cover Missouri, a coalition of health care providers that work to decrease the state’s uninsured rate.
That could mean healthy individuals who make too much money to receive subsidies could opt out after getting fed up with more expensive marketplace premiums. Younger people with few health problems with also might be dropping out.
“If people look at what’s available and they don’t like it, they don’t feel like they’re getting enough financial help and it’s maybe not going to be affordable for them,” Kelley said. “They may say ‘Hey … that individual mandate, I don’t have to do this.”
Still, that there remain 4.2 million uninsured people nationwide who would be able to get a free subsidized plan on the exchange speaks to a lack of awareness, Cynthia Cox, director for the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation.
In Missouri, there are 100,000 people who are uninsured but could be getting free health insurance,” she said. “To me that just illustrates a lack of information.”
The federal government in 2017 cut funding for insurance navigators, people who helped educate and assist in signing people up for coverage. Missouri saw its federal navigator funding cut 83 percent between 2016 and 2018.
The midterm elections could also have eclipsed any publicity or news coverage that had previously given the exchange a boost, Cox said.
The drop in enrollment could be an indicator of the market’s stability, Kelley said. People who are already in a marketplace plan are automatically enrolled for the new year, but those numbers aren’t available until later in December.
However, there’s still time for people to enroll before Saturday’s deadline -- but they shouldn’t waste any time, Cox said.
“A lot of people do wait until the last minute, so you’re not alone,” she said. “Just be aware because so many people are waiting until the last minute there could be additional time it takes to sign up and you can encounter delays.”
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