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How Are Changing Laws Affecting ACA Enrollment?


A new report sheds light on how ACA enrollment fared in 2019, and what insurers are thinking about the future.


With the repeal of the individual mandate effective on January 1 of this year, many wondered about the impact to overall ACA enrollment-and the ACA itself.

A new report from online insurance exchange eHealth shows that while enrollment figures were largely within expectations (69% said sales figures were within 10% of expectations, 15% said sales outpaced expectations by 10 to 15%, and 15% said sales fell 10% below expectations), a significant number insurers saw a decrease in enrollment due to the repeal of the tax penalty.

Overall, about 64% said they saw an enrollment decline because of that repeal-even though a 2018 survey saw 54% of insurers say they did not expect the repeal to reduce enrollment. An additional 33% of insurers said they lost membership as a result of the new law.

Even as some are seeing declining rates, however, many insurers are seeing the ACA market stabilizing. Sixty percent of insurers said they intend to expand their offerings next year (compared to 53% the previous year). Of those, 44% said they plan to expand because the market has stabilized, and a third said the ACA market has become profitable.

Just 7% of insurers planned to withdraw from the market in 2020, while 33% said they will maintain their current level of market participation.

Related article: The Future of the ACA

Those stabilizing effects are being felt by members as well. While 42% of the polled insurers said they expect to raise 2020 premiums by 5 to 10% over 2019 rates, 33% said they do not expect to make any significant changes and 23% said they expect to reduce premiums by at least 5%.

Insurers were also asked about the chances for increasing out-of-pocket costs for members: 17% of insurers said deductibles will increase by more than 10%, an additional 17% said deductibles will increase 10% or less, while 58% said they do not plan on making any changes on their 2020 ACA plans.

Plan members can also expect new offerings in 2020. Around half (45%) of insurers said they plan to add to the number of offered ACA plans in 2020, compared to 21% in last year’s survey. In 2020, 18% of insurers plan to further restrict provider networks, (compared to 36% last year) while 18% intend to expand provider networks. 

Policy changes

Insurers were also asked about the potential impact of proposed policies. When asked about how members will be affected by no longer allowing drug manufacturer coupons to apply to out-of-pocket costs, 73% predicted the proposed policy would result in consumers paying more for prescription drugs, 45% said the policy could save money by encouraging generic use, while 9% said the proposal would likely limit consumers’ medication access.

As for the Medicare for All debate, insurers were less concerned about any big changes to Medicare than they were last year. In 2018, 27% thought big changes to Medicare were possible in the future. This year, just 6% said the same. In 2018, 7% said this was a political issue they weren’t taking seriously at the time, which increased to 24% of respondents this year. The majority of respondents (71%) are merely paying attention to the Medicare for All discussion but don’t expect any major changes.

And if the ACA disappears completely? 82% of respondents said more instability in the individual and family health insurance markets is likely, 53% expect higher premiums for older and sicker members.

Nicholas Hamm is an editor with Managed Healthcare Executive

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