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Obamacare sign-ups surge in final tally

2019 enrollment fell just slightly behind 2018 after a strong final week.

Karen Bleier/AFP/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Obamacare sign-ups for 2019 ended up steady from 2018 in most of the country, thanks to a strong final week on the health care law’s markets.

Nearly 8.5 million people enrolled in a health plan for next year on the federal insurance marketplace. Enrollment on had been lagging 10-15 percent behind last year’s numbers for most of the enrollment period; raw sign-ups had fallen almost 600,000 behind last year’s pace. But after a strong final few days, they will close just 300,000, or 4 percent, off 2018’s totals.

Despite the last-minute surge, lagging enrollment is still worrisome. There are a lot of theories for why enrollment is down. There are some obvious policy reasons: The individual mandate is gone; people can now buy less comprehensive health insurance plans being pushed by the Trump administration; Virginia’s Medicaid expansion is moving people from the Obamacare markets into that program. The Trump administration has also sharply cut enrollment outreach programs and advertising over the past two years.

Auto-enrollment could help explain the last-minute spike in sign-ups. This was the first year that the health care law’s markets didn’t see a mass exodus of insurers. In prior years, a lot of people saw their carrier leave the market, so they got a letter telling them their current plan was canceled and they’d need to go shop for a new year. This year, more people can keep the same coverage, and premiums are generally flat from last year. So more people were expected to just automatically re-enroll in the same plan — and those sign-ups aren’t reported until the end of open enrollment.

But we shouldn’t miss maybe the most obvious reason enrollment was struggling: People just didn’t know it’s time to sign up. Just one in four people who buy their own insurance or who are uninsured could name the correct deadline (December 15) for open enrollment, according to a Kaiser Family Foundation poll taken last month.

We, the media, might be the most to blame. A Media Matters review of cable and network news broadcasts found the big shows had devoted just 15 minutes of airtime to open enrollment since the beginning of October. Even here at Vox, we have spent a lot less time covering the sign-up period than we did in 2017.

Oddly enough, Trump and the GOP’s pointed attacks on Obamacare last year might have also helped amplify press coverage of the law and raised awareness of its sign-up period, as the New York Times’s Margot Sanger-Katz pointed out. This year has been much quieter on the health care beat, at least until a judge’s decision to strike the entire law, issued just days before enrollment closed.

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