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8.8 million people signed up for Obamacare coverage despite Trump’s sabotage

Sign-ups dipped slightly, but not dramatically, under Trump.
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.

About 8.8 million Americans enrolled in health coverage through, the Trump administration announced Thursday, a slight dip from last year after the Trump administration cut spending and outreach but far from a dramatic drop.

Last year, about 9.2 million people signed up through, which serves more than 30 states. A dozen states run their own marketplaces and several of those states have not yet closed their open enrollment.

Seema Verma, the head of the Centers for Medicare and Medicaid Services, which oversees the federal marketplace, tweeted next year’s Obamacare enrollment numbers a week after the open enrollment period for 2018 coverage ended.

There are two ways to look at the numbers: On the one hand, in a thriving marketplace, you would expect enrollment to grow every year. On the other hand, given the deep cuts that the Trump administration made to Obamacare advertising and the decision to have the sign-up window, the law has proven pretty resilient.

"We expect enrollment to grow every year, not to shrink. This market is likely to shrink," Caroline Pearson, senior vice president at Avalere, an independent consulting firm, told me recently, before open enrollment had ended. "It is a big deal, for a market that's already too small and unstable."

But on the other hand, she added, "there will still be a market that's mostly the same as last year." (Pearson added on Thursday that 8.8 million sign-ups was “an impressive result.”)

The Trump administration slashed advertising funding for Obamacare by 90 percent and cut spending on the navigator program, which funds enrollment assistance, by 40 percent. It also ended partnerships with state-level enrollment assistance programs and groups that targeted minorities like Hispanics. President Trump also ended federal payments to health insurers, known as cost-sharing reductions, driving up premiums in many states by 20 percent or more.

In spite of all that, enrollment on slid by only 400,000 sign-ups. As Vox has documented extensively, the law has been buoyed by the fact that millions of people qualify for generous federal assistance to help them pay for health coverage.

The final enrollment figures for 2018 dropped the same week that Republicans in Congress repealed the health care law’s individual mandate, the requirement that every American have insurance or pay a penalty. That same day, Republican leaders indicated that they would move on from Obamacare repeal.

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