Obamacare sign-ups are now down 500,000, or 12 percent, from last year with just a few days of open enrollment left to go.
Through six weeks of open enrollment this year, 4.1 million people have signed up for 2019 coverage. Last year, through six weeks, sign-ups had topped 4.7 million. Enrollment closes on December 15 in most states, so there isn’t much time to close the gap.
There are a lot of theories for why enrollment is down. There are some obvious policy reasons: The individual mandate is gone; people can now buy less comprehensive health insurance plans being pushed by the Trump administration; Virginia’s Medicaid expansion is moving people from the Obamacare markets into that program. The Trump administration has also sharply cut enrollment outreach programs and advertising over the past two years.
The sign-up numbers also might be artificially low and we could see a recovery in the last days of open enrollment. There are two reasons for that. First, sign-ups always surge in the final days before the deadline.
But second, this was the first year that the health care law’s markets didn’t see a mass exodus of insurers. In prior years, a lot of people saw their carrier leave the market, so they got a letter telling them their current plan was canceled and they’d need to go shop for a new year. This year, more people can keep the same coverage, and premiums are generally flat from last year. So more people might just automatically re-enroll in the same plan — and those sign-ups aren’t reported until the end of open enrollment.
But we shouldn’t miss maybe the most obvious reason enrollment is down: People don’t know it’s time to sign up. Just one in four people who buy their own insurance or who are uninsured could name the correct deadline (December 15) for open enrollment, according to a Kaiser Family Foundation poll taken last month.
We, the media, might be the most to blame. A Media Matters review of cable and network news broadcasts found the big shows had devoted just 15 minutes of airtime to open enrollment since the beginning of October. Even here at Vox, we have spent a lot less time covering the sign-up period than we did in 2017.
Oddly enough, Trump and the GOP’s pointed attacks on Obamacare last year might have also helped amplify press coverage of the law and raised awareness of its sign-up period, as the New York Times’s Margot Sanger-Katz pointed out. This year has been much quieter on the health care beat.
One other thing to consider: The volume of celebrity plugs seems lower than it was last year. Left-leaning advocacy groups and their allies in show business stepped up in 2017 to fill the hole left by the Trump administration’s dramatic cuts to outreach.
“It was in a sense part of the resistance,” Larry Levitt at the Kaiser Family Foundation told me. “I haven’t seen that as much this year.”
There are still advocacy groups dedicated to Obamacare enrollment, of course, and former President Obama and some celebs have again pulled out their social media megaphones to plug open enrollment. But the sense of urgency just doesn’t feel the same this year as last.
Obamacare has been around for a while now, but people still need reminders to sign up for health insurance. Medicare has been around even longer, and the federal government still runs ads for its open enrollment period.
The evidence shows that advertising does make a difference. This is what happens when health care fades from the headlines, when the federal government pulls its resources, and nobody steps in — media or celebrity — to educate the public. People just forget.