Enrollment in private health insurance plans under the Affordable Care Act has been strong despite surging prices in some policies and Republicans' intent to "repeal and replace" President Barack Obama's signature health care law.
Figures released Wednesday from the federal government show that through Dec. 10 more than 4 million people picked plans on the federal exchange, Healthcare.gov. The numbers exceed last year's total at the same time by 250,000 people and include a100,000-person spike in enrollment that occurred a day after Donald Trump won the presidential election.
The increases come even as the Republican-controlled Congress discusses how to effectively begin repealing Obamacare. GOP lawmakers are looking atdefunding parts of the law as early as January, though they still are working out if and how long repeal will be delayed and haven't settled on details of a replacement plan. Their rhetoric has been scattered, with some Republican lawmakers seeking a total rollback and others proposing partial changes. Trump, who called Obamacare a "total disaster" on the campaign trail, has even shifted his own stance on the issue, suggesting after his election that he would be willing to consider keeping some of the popular provisions of the law.
Obamacare's defenders point to the strong enrollment numbers as evidence that the law is providing people with a product that they value and want, suggesting that alterations to Obamacare could leave them uninsured. The Department of Health and Human Services has said in past releases that the numbers demonstrate the "strong demand for quality, affordable coverage."
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"Momentum is building," Health and Human Services Secretary Sylvia Burwell said in a statement Wednesday, noting that as the deadline is approaching the agency has seen "hundreds of thousands of consumers each day signing up for coverage they want and need."
In past years, officials have also seen faster enrollment as people rush to meet the Dec. 15 deadline to ensure that they'll get coverage by Jan. 1. Enrollment has accelerated each year as more people get used to how the process works and as the technology has improved.
Political upheaval hasn't been the only variable during this enrollment. In many states, premiums have risen by double digits. Officials have tried to soften the news by reminding consumers that most people will receive significant tax subsidies to help them pay for coverage, but data show that between 6 million and 9 million people would still feel the full brunt of the cost. Consumers also have complained about limited coverage options and about out-of-pocket costs they have faced in the form of deductibles or co-pays.
To combat some of the negative publicity, federal officials and navigators have reached out to customers directly to tell them about the subsidies they could receive. They also have developed initiatives aimed at enrolling young, healthy people who have proved elusive in past years and who are key to helping keep costs down in future years.
Ahead of open enrollment – which began before the election – federalofficials said they expected to sign up 1.1 million more people by the Jan. 31 deadline, aiming to secure 13.8 million people for coverage on federal or state exchanges. Customers have until then to enroll if they want to avoid paying a penalty of $695 or more. Existing customers who don't sign up for a new plan by Dec. 31 will be automatically re-enrolled in their previous policies if they are still available, meaning another jump is likely ahead.
Preliminary data show trends in some of the 11 states and the District of Columbia that have created their own exchanges are mirroring those of the federal exchange.
In Minnesota, enrollment through the MNsure exchange reached 43,256 on Dec. 12, more than double the 17,678-count on Dec. 8 last year. In the District of Columbia, 2,896 new customers have enrolled this year compared to 1,294 new customers at the same time last year.
In Connecticut, enrollment is about 3 percent higher this year than last. Total enrollment by Dec. 13 was 108,105, while last year it took until Jan. 19, 2016 to reach similar figures, according to a spokeswoman at Access Health CT.
This year, the state has invested in ads they show during previews at the movies and that they display on public transportation. The agency also says it has shifted its focus to help people understand the benefits of having health insurance and how to use it.
In California, which also has had successful enrollments in the past, the numbers are about the same as those who selected new plans by this time last year, at 139,000 people. An additional 1.2 million renewed the plans they had previously.
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"Our numbers have been very good," says Roy Kennedy, a spokesman for Covered California. "We continue to do the things that have worked for us in the past." These include social media campaigns and providing navigators to help people sign up for coverage who don't speak English.
But not all states saw such increases. In Rhode Island 1,292 customers selected plans by Dec. 10, a decrease from 2,189 who had selected plans Dec. 12 last year.
Open enrollment began a week before Election Day, and several states reported that they didn't begin running ads until after that, saying they didn't want to compete with the attention the election was getting and noting that space sold during that time was particularly expensive.
That was the choice for Colorado, where enrollment is 16.3 percent higher than last year, totalling 50,207 people.
Luke Clarke, a spokesman for Connect for Health Colorado, the state's exchange, says navigators and officials are telling people that they will get health insurance in 2017 if they sign up for coverage, regardless of what happens to Obamacare.
"It's a yearlong contract so we have emphasized people will be set," he says. "Beyond that, there are a lot of unknowns. We just have to acknowledge that."
He notes that, like the federal exchange, Connect for Health Colorado saw a surge in sign-ups on the day following the election.
"You can't know people's motives without surveying them, but you have to think the election outcome is causing it to go up," he says.
He adds, "We are staying away from the speculation of 'repeal and replace' or 'repeal and delay' or 'repeal and collapse.' We are trying to get straight to the message of what is known."