Biden Administration Predicts Record Obamacare Enrollment, But Trump Takeover Looms

The Biden administration said on Friday it expects another record year of health insurance enrollment through the Affordable Care Act, aka Obamacare.

But that could be the last good enrollment news for a while, depending on what happens next year once Donald Trump and the Republicans have full control of the federal government.

Open enrollment for the Affordable Care Act’s private insurance options began on Nov. 1, which means that people who don’t have access to an employer policy can buy insurance directly through one of the law’s online marketplaces ― that is, either HealthCare.gov or a state-run marketplace like Covered California.

Those policies meet the law’s guidelines for comprehensive benefits and are available to anybody, at uniform prices, regardless of preexisting conditions. People buying these policies can also qualify for financial assistance, worth hundreds and frequently thousands of dollars a year, depending on their income.

Roughly 21.5 million people signed up for insurance that way last year, a record high. The Department of Health and Human Services now thinks even more people will get insurance through the marketplaces this year, thanks primarily to the number of people who have coverage already and will decide simply to re-enroll in their current plans.

“We feel quite confident to project that we will again hit a historic high for open enrollment,” Ellen Montz, deputy administrator and director for the HHS Center for Consumer Information and Insurance Oversight, told HuffPost on Friday.

The recent surge in marketplace enrollment comes as the number of Americans without health insurance has plummeted to record lows, although many millions remain uninsured and even many with coverage still struggle with the high cost of medical care.

Fewer New Enrollments So Far This Year

HHS predicts the higher enrollment figure for this coming year even though the number of new customers so far, in the first two weeks of enrollment, is a little less than 500,000. That’s down from about 900,000 at this point in last year’s open enrollment cycle.

Montz said their analysts attribute that decrease to a few factors. Among them is a decision to roll out advertising for HealthCare.gov at a different pace this fall, because the first days of open enrollment overlapped with the last days of the presidential campaign, when television airtime was both more expensive and less available because of political ads.

In addition, Montz said, an unusually large pool of people were looking for coverage last year because they had recently lost their government-provided Medicaid, after states resumed stricter eligibility procedures they had suspended during the pandemic.

Looking forward, Montz said, another factor that could hold back enrollment at the margins ― though not enough to prevent another record high ― are new procedural requirements for agents and brokers who sell policies on the marketplaces for commissions.

These requirements were a response to reports that some agents and brokers were signing people up for coverage or switching their plans without authorization, and HHS has suspended a few altogether.

“I do think that our actions are kind of deliberate actions on new requirements that we placed on agents and brokers, that we are seeing the impact of that, particularly in the renewal population,” Montz said.

Trump, Republicans And Their Plans For The ACA

The efforts to cut down on inappropriate agent and broker behavior is noteworthy in light of the coming change of power in Washington, and what that could mean for the Affordable Care Act.

Trump and many Republicans have a long history of hostility toward Obamacare, including their attempts to repeal the law in 2017, the first time Trump became president. In his campaign this year, Trump said on social media he remained interested in finding an “alternative” and, during a televised debate, said he had “concepts of a plan” in mind.

Trump never outlined those plans, nor did he make the law’s repeal a top, explicit promise like he did the last time he campaigned. Republicans serving in or running for Congress mostly avoided the topic, except when asked about it.

But Trump and Republicans might still try to change, scale back or weaken the law. And one way they could do that would be to allow a temporary boost in the law’s financial assistance to expire.

That boost, which President Joe Biden and Democrats enacted as a pandemic relief measure in 2021 and then extended with legislation in 2022, will lapse after 2025.

Neither Trump nor Republicans have said much about their willingness to extend the assistance again, as Democrats have proposed. But extending the assistance would require tens of billions of dollars in extra federal spending every year, and that is going to be a tough sell with many in the GOP.

Prominent conservative analysts like Brian Blase, a former Trump administration official who is now president of the Paragon Health Institute, have already been making the case against extension by citing the agent and broker behavior HHS is now trying to combat. These conservatives say that behavior is an example of broader problems with making so much financial assistance available.

It remains to be seen how effective those HHS measures to crack down on unauthorized enrollments will be ― or whether those effects alter Republican sentiments about the future of the temporary financial assistance.

But there’s a lot less mystery about what would happen if the money goes away. People buying coverage through the Affordable Care Act would have to pay more for it. Estimates from the Urban Institute suggest roughly 4 million people might drop coverage altogether.

“I don’t have a model, but I do have knowledge of just how important [the extra financial assistance] has been to folks,” Montz said. “Sad to say, I think that those numbers could be conservative.”