Arizona ‘Obamacare’ enrollment dropped in 2020. Could that be a good thing?
azcentral | Stephanie Innes, Arizona Republic Published 7:00 a.m. MT Jan. 24, 2020
Enrollment in “Obamacare” health insurance for 2020 coverage declined slightly both in Arizona and nationwide.
But considering significant forces against the U.S. health law - an ongoing federal lawsuit seeking to overturn it and President Donald Trump's vocal opposition to it, among other things - the decline in Obamacare enrollment is much less than one would expect, some health policy experts say.
Enrollment went down by 2.4% nationally, but the drop was nearly 5% in Arizona, preliminary federal data shows. There were 153,020 Arizonans who selected private insurance for 2020 on the federal marketplace created by the Affordable Care Act, down from 160,456 in 2019.
Nationally, 8.3 million Americans enrolled in Affordable Care Act plans on the federal marketplace, also known as “Obamacare” coverage, for 2020. The U.S. Centers for Medicare & Medicaid Services is expected to release a detailed final national enrollment report in March, which will include plan selection data from state-based exchanges.
“There have been so many mini-devastations to the ACA,” said Swapna Reddy, a clinical assistant professor at Arizona State University’s College of Health Solutions and an adjunct professor at the Mayo Clinic Alix School of Medicine. “And yet people are still enrolling. What it has shown is reflective of the resiliency of the law, to be perfectly honest. It shows people need comprehensive health coverage.”
Other factors working against the law noted by Reddy: there no longer is an “individual mandate” with monetary fines for Americans who don’t have health insurance, and marketing and outreach dollars for Obamacare have been drastically cut since President Trump took office.
That means in Arizona and in the rest of the country, there has been very little public education about insurance available through the ACA, and yet people continue to purchase it, Reddy said. Also, she said, the markets have stabilized with more insurers and stable or decreased premium prices.
Arizona’s Obamacare enrollment decline is not much different than what’s happening nationally, Reddy said.
Most Arizonans who buy insurance on the federal health insurance marketplace qualify for federal subsidies to help them pay for it. The people who don't qualify for subsidies and continue to face expensive premiums are likely some of the people leaving the marketplace, Reddy said.
The U.S. Centers for Medicare & Medicaid Services deemed the national enrollment numbers as "stable," and said some of the decline could be because of a strong economy that may have moved more people into job-based coverage.
The elimination of the “individual mandate” that all Americans have health insurance or face federal penalties has not had the negative effect on enrollment that some had predicted, Kaiser Family Foundation president and CEO Drew Altman recently wrote in a column published by the news website Axios.
“Healthy people do not appear to have fled the market. ACA enrollees spent fewer days in the hospital in 2019 than in the previous four years,” he wrote. “The financial health of insurers participating in the ACA marketplaces is stable, and dramatically improved since the early years of the ACA.”
Most Arizonans get their health insurance through an employer or a government health insurance program such as Medicaid or Medicare. Obamacare enrollees represent a small fraction of the U.S. health insurance market.
Arizona is one of the top states in terms of job growth, so the fact that some state residents are leaving the marketplace could be because of people getting employer-sponsored coverage, said Dr. Daniel Derksen, a professor of public health at the University of Arizona.
“When you subsidize a premium for a low-income population you can keep that enrollment remarkably stable,” Derksen said.
Extending subsidies for insurance premiums to other populations could improve health insurance coverage, he said.
The most recent U.S. Census data shows 750,000 Arizonans or about 1 in 10 state residents, are uninsured - a number that Derksen said is “unconscionable,” and shows there is still work to do in getting the word out to people who are eligible, he said.