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Trump Decides to Promote Last-Minute ACA Sign-ups After All


Lawmakers and health experts pointed out that canceling the ad campaign would cause the exchanges to miss a late surge of enrollment from young, healthy adults and damage the risk pools.

The Trump administration reversed course this weekend and is allowing some parts of the campaign to sign up enrollees for health plans under the Affordable Care Act (ACA).

After Thursday’s decision to halt all advertising and outreach drew criticism, the administration said it would allow HHS to use social email and send e-mails to attract last-minute enrollment. However, about $4 million to $5 million in TV ads were still canceled.

Much of the backlash over the move to cancel all ads, e-mails, and social media outreach came from ACA supporters, such as US Senator Patty Murray, D-Washington, who said the new administration was trying to “sabotage” the healthcare law.

Murray made the same observation as healthcare experts who said that young, healthy people are the target audience of the late enrollment campaign—and health plans need them to sign up to balance the risk pools.

“Republicans haven’t been able to come up with a plan for families’ health care, but (Thursday’s) decision by the Trump Administration to work against getting people covered shows Republicans are wasting no time in ripping the health care system apart, regardless of the harm it will cause to the people they serve,” Murray said in a statement. “Young and healthy people often sign up in response to this very outreach. Cancelling it is not just irresponsible—it will destabilize the market for everyone else.

Washington and Lee University’s Timothy Jost made a similar warning in a blog post for Health Affairs. “Even as Congress is considering legislation to shore up individual insurance markets, the Trump administration took action that could undermine them,” Jost wrote. Referencing Thursday’s directive to ban all marketplace advertising, social media posts, and reminder emails, he wrote, “Evidence from prior open enrollment periods shows that enrollment spikes in the final days of open enrollment period. Increasing enrollment is key to stabilizing the individual insurance market, as the large the risk pool the more likely it is to be balanced.”

Several individual insurers stepped up their social media campaigns over the weekend, including Horizon Blue Cross Blue Shield of New Jersey and Florida Blue. Individual lawmakers joined in as well, with US Senator Kirsten Gillibrand, D-New York, and House Minority Leader Nancy Pelosi, D-California, among those sending out reminders with the #GetCovered hashtag.

Last fall, CMS announced a specific campaign to reach young adults during the 2017 open enrollment period. The agency held a Millennial Outreach and Engagement Summit along with plans to target young adults whose incomes showed they could receive tax credits if they signed up on the exchanges.

Through mid-January, enrollment for 2017 was running ahead of prior year levels. More than 8.8 million people had signed up just on the federal exchange as of January 14, 2017, compared with 8.7 million at the same point in 2016, according to the last bi-weekly e-mail from CMS before Trump took office. More than 22 million people had engaged with HealthCare.gov since November 1, 2016, and 1.3 million had called for help from January 1 to January 14.

Counting state exchanges, enrollment was 11.5 million by Christmas Eve. The Obama administration had set a goal of 13.8 million sign-ups for the federal and state exchanges. Open enrollment ends Tuesday, January 31, 2017.

The federal government already faces lawsuits over failure to fully fund risk corridors, after Congress blocked HHS from using funds other than those paid by other insurers. This has destabilized the market and led carriers to withdraw from markets. On January 3, 2017, Judge Margaret Sweeney of the US Court of Claims certified Health Republic’s suit as a class action open to all qualified health plans whose allowable costs in 2014 and 2015 were more than 103% of their target. Premium increases in 2016 and 2017 were blamed in part on the less-than-expected payments to health plans for the risk corridors.

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