Final ACA enrollment slips from last year

The number of participants in what could be the final enrollment period of the Affordable Care Act dipped from the previous year, especially during the final days as the Trump administration and congressional Republicans waged an orchestrated attack on the law.

About 9.2 million people made plan selections for 2017 through the exchange between Nov. 1 and Tuesday's 11:59 p.m. deadline, the U.S. Department of Health and Human Services reported. That compares with 9.6 million, according to plan selection figures released almost exactly a year ago on Feb. 4, 2016.

In Texas, about 1.2 million people selected plans during the enrollment period, compared with just more than 1.3 million a year ago. In Houston, enrollment rose to 359,932 from 346,822.

The year's enrollment period has been closely watched by both supporters of the law known as Obamacare and those who want it repealed.

Critics of the law, including those within the new administration, heralded the decline as proof the law was doomed and people do not want it.

"Obamacare has failed the American people, with one broken promise after another," Health and Human Services spokesman Matt Lloyd said in a statement Friday afternoon. He cited a Centers for Medicaid and Medicare Services report that over the past year ACA premiums increased 25 percent and the number of insurers declined 28 percent.

"We look forward to providing relief to those who are being harmed by the status quo and pursuing patient-centered solutions that will work for the American people," the statement said.

Not everyone read the numbers the same way.

"I do not see that as a collapse of the market," said Ken Janda, president and CEO of Community Health Choice, a nonprofit insurer offering health maintenance organization plans on the exchange in Houston.

He added, "1.2 million people in Texas have individual health insurance, many of those who would not have it without the subsidies that are part of the ACA. That's a very good thing."

He said he sees enrollment as "roughly the same" as the previous year.

President Donald Trump, elected one week after enrollment began and inaugurated 11 days before the final day of sign-ups, ran on the promise to dismantle the law he called "a disaster." Just hours after Trump was sworn in, he signed a sweeping executive order directing federal agencies to lift or ignore regulations attached to it.

The Republican-led Congress showed similar zeal by setting up the framework for repeal in the opening days of its session with a promise of eventual replacement with a still-undetermined substitute.

That momentum seems to have slowed as Republicans disagree on the best course forward, with some wanting to delay repeal until they have a replacement in place and others arguing to begin unspooling it quickly and coming up with and implementing replacement over time.

A leaked audio recording from a Republican retreat late last month that was reported by the Washington Post revealed wide disagreement and some trepidation within the party.

Friday's numbers show that confusion sown by the upheaval may have had an impact. Enrollment had been running slightly ahead of 2015 as 2016 came to a close, but it dropped in the final weeks and days, a time when traditionally there has been a surge of sign-ups.

Plan selection this year between Jan. 15 and Jan. 31 was 376,260. By comparison, last year 686,708 peopled signed up in the final week alone.

Former HHS officials have alleged "sabotage" by the Trump administration to suppress enrollment. Last week the agency acknowledged it had canceled radio and television ads to remind people to sign up before the deadline.

"We know that more young people enroll during the final days of open enrollment, but they need to be reminded of the Jan. 31 deadline," Kevin Counihan, ex-CEO of healthcare.gov, said in a blistering statement last week.

But Ryan Murphy, a senior communications adviser to HHS under Trump, was unapologetic.

"We aren't going to continue spending millions of taxpayers' dollars promoting a failed government program," he said in a statement to the Chronicle earlier this week.

In Houston, those involved in enrollment reported the final surge from previous years was not as robust and that people seemed confused about signing up. Some thought the ACA had already been repealed.

One of the biggest criticisms of the existing law has been rising prices for premiums and a lack of choices, both from insurers exiting the market and from narrowed networks, which reduces the number of providers covered. The average national rate increase for 2016 was 25 percent, more than three times higher than the average increase in 2015.

Insurers have left the exchanges after complaining of losses in ACA plans because those covered were sicker and used more expensive medical care than anticipated.

Still, the uninsured rate in the nation has dropped to historic lows, and there is concern that if repeal comes without swift and comparable replacement, as many as 20 million people could lose coverage through a dismantling of provisions in the law.

Janda acknowledges problems with the current law that need to be addressed. He remains hopeful that as Republicans find out how difficult it could be to continue covering the same number of people, it will open discussions on ways to repair it.