Administration releases last big Obamacare sign-up report amid Hill fight

More than 11.5 million people were signed up for Affordable Care Act plans on the federal and state insurance exchanges as of Dec. 24, federal officials said Tuesday.

“Nationwide demand for health coverage is higher than ever, as Americans prove again that marketplace coverage is vital to them and their families,” Health and Human Services Secretary Sylvia Burwell said in a statement.

The numbers, up nearly 300,000 from the same point last year, come despite what HHS senior counselor Aviva Aron-Dine called "significant headwinds" on Capitol Hill. Congressional efforts to repeal the ACA without a replacement plan sets policymaking on a "dangerous path" that jeopardizes the health of up to 30 million people, she said.

Sen. Rand Paul, R-Ky., said Monday that he plans to introduce his own ACA replacement, possibly by early next week. Paul, who opposed the repeal contained in a budget resolution because it would add to the deficit, said he met with President-elect Donald Trump on Friday to discuss their shared belief that the law shouldn't be repealed without a replacement.

The HHS release is the administration's last major enrollment report. It comes as the Kaiser Family Foundation releases a breakdown of where the people most affected by an ACA repeal live — and who represents them. About 6.3 million live in congressional districts represented by Republican House members, while 5.2 million live in Democratic districts.

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"This might be part of why we’re seeing Republicans get cold feet," says Cynthia Cox, the foundation's associate director of health reform and private insurance.

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HHS officials echoed a new White House Council of Economic Advisers report refuting suggestions by House Republicans that the ACA is in a "death spiral." Aron-Dine noted that a death spiral is defined as a market that is "rapidly shrinking," unlike what the market the new data suggests is "not only stable but on track for growth."

A possible "repeal and delay" strategy for replacement could lead the ACA marketplace to implode and lead to a death spiral, Cox says. But Christopher Condeluci, a former Republican Senate Finance Committee counsel, said whatever Republicans propose will have a transition period "to make sure people are protected" for two or three years.

"They recognize the political fallout of causing people to lose coverage," said Condeluci, who helped draft portions of the law.

Despite some of the huge increases in premiums in several parts of the country, the White House report said growth in plan selections was similar in states that saw larger and smaller increases in what's known as the "benchmark" premiums. And it noted that the 2017 increases were a "one time correction" and that changes made to plans and prices were "roughly sufficient to return premiums to a sustainable level."

There will be one more enrollment update on Jan. 18, two days before Trump's inauguration. Christen Linke Young, a principal deputy director at the Centers for Medicare and Medicaid Services, expressed confidence that the career government officials who stay on at the department will continue efforts to promote open enrollment, which ends Jan. 31 for 2017 plans.

The turmoil in Congress has already had an effect, however. Officials said more than 35,000 people have called HealthCare.gov asking whether they should still sign up insurance given the uncertainty on Capitol Hill, officials said.

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