ACA enrollment reaches 11.8 million for 2018

Two Californians wait to meet with an enrollment counselor to sign up for Affordable Care Act insurance in Sacramento. Nationwide enrollments are holding up despite uncertainties about the health law's future

State-based marketplaces control their own funding for outreach and consumer assistance. California is one of 11 states, plus the District of Columbia, that runs its own health insurance exchange.

With the Trump administration taking steps to undercut these marketplaces and congressional Republicans having spent much of a year ago trying unsuccessfully to dismantle large parts of the ACA, leaders of state insurance exchanges and other health-policy experts said that enrollment was surprisingly resilient. The federal government also terminated cost-sharing subsidy payments to insurers in advance of the open enrollment period, leading to increases in premiums but also increased premium subsidies for many consumers that in some cases led to reductions in what they had to pay for coverage.

But in a marked contrast, two-thirds of the marketplaces run by states instead of the federal government saw increased enrollment between 2017 and 2018, including CT and NY. Several states extended their season into January, with California and NY allowing people to select plans until the end of the month.

The Centers for Medicare and Medicaid Services is expected to release its comprehensive review of 2018's open enrollment period in coming weeks.

"If you see overall enrollment dropping that is a formula for less healthy people covered and higher premiums", said Lee. In the 12 fully state-operated marketplaces, enrollment ticked up just slightly by 0.1 percent, ranging from 6.3 percent drop in Vermont to a 12.1 percent increase in Rhode Island. Nevada, in the end, saw a 2.2 percent increase in enrollment this year.

That has been particularly tough for consumers who make too much to qualify for federal insurance subsidies through the health care law.

The annual enrollment tally remains a relatively crude metric that doesn't account for what kind of consumers are signing up for coverage.

While the state exchange directors said Obamacare remained strong this year, they were concerned about Congress' elimination of the individual mandate starting in 2019. And the totals don't include Americans who are buying health plans on their own rather than through the official marketplaces created by the health care law. Here in Texas, though, we saw some of the most significant drops of any state. And though federal money was sharply curtailed for advertising and other outreach activities, some state exchanges ran robust programs to encourage sign-ups. It is in the process of relaxing federal regulations to allow the sale of more insurance policies that don't adhere to Obamacare's mandates, for instance.

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