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Obamacare just had its best week in months

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With little fanfare, Obamacare just had its best week in months.

On Tuesday, Maine voted overwhelmingly to participate in the Affordable Care Act's Medicaid expansion. If enacted (and there are still some questions about that), this will expand Obamacare to cover about 70,000 low-income Maine residents.

Then on Thursday, the federal government released data showing that Obamacare sign-ups are off to a strong start, with more people signing up each day than in the previous years.

President Trump had previously declared the Affordable Care Act dead. His administration has cut off funding for advertising and enacted policies that will hurt Obamacare. But even in spite of that, states are voting to expand the ACA — and Americans are signing up for it in droves.

The ballot initiative in Maine wasn't a squeaker. The state voted to expand Medicaid with 58 percent voting in favor and 41 percent voting against. This has inspired activists in other states to pursue ballot initiatives for 2018. Utah and Idaho both have efforts that will begin gathering signatures in the coming week.

And it's possible that Virginia may also have a Medicaid expansion in sight. While we're still waiting to see who controls the legislature (a few races may head to recounts), it's possible the state could see a Medicaid expansion effort as well.

As Medicaid expands in additional states, Obamacare gets bigger. Its footprint in the American health insurance system becomes more significant and more entrenched.

At the same time, early Obamacare enrollment data is promising. The Trump administration released data Thursday showing that just over 600,000 people have selected coverage plans through This indicates a significantly higher pace of sign-ups than we've seen in years past.

Data compiled by Get Covered America, a nonprofit that works on signing people up for Obamacare, provides a helpful comparison. It shows that during the first week of this year's open enrollment (OE5, on the right in the chart below), there were an average of 150,366 enrollments per day. That is significantly higher than the average of 84,018 enrollments per day last year.

Get Covered America

Also encouraging to advocates is the fact that the pace of new enrollees has increased. This suggests that people are still learning about Affordable Care Act coverage, even those who didn't use it last year.

Now, we're only in the early stages of Obamacare open enrollment. There are still plenty of ways that sign-ups could ultimately fall behind last year's results. The sign-up period is just 45 days this year, instead of 90. The in-person outreach budget is 70 percent lower than last year's.

In other words: People have less time to sign up, and less help navigating that process. So even if enrollment is high now, it could still fall below expectations. (If you want to dive deep into what will likely happen this year, definitely check out Charles Gaba's blog,, which often has the most up-to-date information.)

Still, these early sign-up statistics are encouraging to Affordable Care Act supporters. They suggest that even with a lack out of outreach, initial enrollment has not been depressed. If anything, all the controversy and attention paid to the Affordable Care Act may have actually increased awareness.

Or, as President Trump put it in his book The Art of the Deal, "bad publicity is sometimes better than no publicity at all."

Chart of the Day

Most uninsured can get coverage for a lower cost than paying the individual mandate penalty

Kaiser Family Foundation

Let's do a bit of math. Or, actually, let's rely on the Kaiser Family Foundation. KFF finds that many can get coverage that will cost less than paying the fine for not being insured — and that 42 percent of the uninsured can get a bronze plan for free on the marketplaces. Read the foundation's analysis here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “Five states ask judge to halt Trump's rollback of birth-control mandate”: “Five states are asking a federal judge to halt the implementation of the Trump administration's recent rollback of ObamaCare's birth-control mandate. The attorneys general in California, New York, Maryland, Delaware and Virginia filed the motion for a preliminary injunction Thursday night with the U.S. District Court for the Northern District of California.” —Jessie Hellmann, the Hill
  • “New deal would keep Pentagon out of product approvals”: “Product reviews remain solely within the FDA's jurisdiction, but would give the Pentagon new powers to get the FDA to expedite those reviews, according to the agreement reached between [Sen. Patty] Murray and Sen. Lamar Alexander.” —Sam Baker, Axios
  • “Senate Advances Health Care Overhaul, Single-Payer Study”: “The Massachusetts Senate approved a wide-ranging health care reform bill late Thursday that includes a call for the state to study how much a single-payer insurance system would cost.” —Bob Salsberg, Associated Press

Analysis and longer reads

  • “Hospitals and PhRMA face off over drug prices and 340B program”: “There’s a big, expensive fight brewing between the two powerful lobbies around a somewhat obscure drug discount program called 340B. Created in 1992 to help rural and charity hospitals and clinics, the 340B program is supposed to offset the cost of medicines for providers that serve a lot of low-income people with discounted drugs.” —David Pittman, Politico
  • “Growth in healthcare prices slows to near-historic low”: “Healthcare prices rose just 1.1% year-over-year through September, representing the lowest price growth rate in roughly two years, according to a new report from Altarum.” —Maria Castellucci, Modern Healthcare
  • “Pressure Builds To Cut Medicare Patients In On Prescription Deals”: “Medicare enrollees, who have watched their out-of-pocket spending on prescription drugs climb in recent years, might be in for a break. Federal officials are exploring how beneficiaries could get a share of certain behind-the-scenes fees and discounts negotiated by insurers and pharmacy benefit managers, or PBMs, who together administer Medicare’s Part D drug program.” —Sarah Jane Tribble, Kaiser Health News

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