Republicans should have learned their lesson back in June. As Republicans fought to repeal the Affordable Care Act in 2017 with no plan for its replacement, and more and more Americans feared that their health care would be yanked from them with no alternative, popular support for the government health plan rose significantly. Opinion polls like one from the Kaiser Family Foundation demonstrate the rising favorability of Obamacare from January 2017 to the end of the year, with a steady rise during the spring ACA repeal debate.
Now, similarly, after months of the GOP threatening to revoke the individual health care mandate through their tax bill and eventually succeeding, HealthCare.gov, the online portal for government insurance registration, was flooded with enrollments over the past two months, astounding industry experts and defying expectations.
More than 8,743,642 people are now enrolled in Obamacare. Those who renewed last year received automatic re-enrollment, but many in the health sector were surprised at the number of new enrollments: 2,460,431 as of December 23, according to a final CMS report. In some highly populated states like New York, California, Colorado, and Massachusetts, enrollment is still open, so the number may surge in the remaining weeks as Americans try to enroll before the deadline.
Larry Levitt, a spokesperson for the Kaiser Family Foundation, tweeted his amazement at the figures just before the holidays: “I confess to being very surprised that ACA marketplace enrollment is down only slightly. That didn't seem possible . . . About 8.8 million people have signed up through the ACA federal marketplace for 2018, down slightly from 9.2 million this year. That is truly remarkable.”
Joshua Peck, former HealthCare.gov CMO, wrote in response to Levitt, “If we ever get it, it will be interesting to see how many people actively renewed vs auto this year. But agree the bigger concern this year was with awareness among the uninsured.”
The high number of newly insured Americans choosing the government’s health plan is surprising, since the Trump administration purposely made virtually no effort to publicize the Obamacare enrollment deadline. As Levitt wrote, the advertising 'efforts' for 2018 enrollment saw a “90% reduction in outreach, an enrollment period cut in half, and a constant refrain that the program is dead” from the current president. The signup period in 2016 lasted a full 90 days, whereas this year it was slashed to just 45 days. Trump proudly proclaimed that the GOP tax bill signed in December “essentially repealed Obamacare,” a claim that is certainly not true. Peck estimated that the Trump administration's cuts to advertising HealthCare.gov plans resulted in at least one million fewer Americans insured. That's a huge number that shouldn't be ignored while progressives celebrate the 2.5 million newly insured, especially since about 27 million Americans remain without insurance.
That's not the only damage Republicans did this year to the public health care option. Trump’s threats and executive orders to tear down the ACA, combined with the repeal of the individual mandate and talk in Congress of cutting health care funding to Medicare and Medicaid, create a perfect storm of market uncertainty that will likely lead to rising health care costs for consumers.
The individual mandate repeal that was lumped into the December tax bill was an additional and devastating blow to ACA proponents, though there is a small silver lining, as Topher Spiro, vice president for Health Policy and a senior fellow for Economic Policy at the Center for American Progress, explained:
There are differing views on just why and how the message about enrollment got out to so many people. A huge amount of credit must be given to groups like Get Americans Covered and the Kaiser Health Foundation, plus Barack Obama himself, who conducted massive outreach campaigns to spread public awareness about the enrollment period. During GOP efforts to revoke the ACA over the spring and early summer, widely publicized demonstrations, from protests on American city streets to wheelchair-bound activists who were forcibly removed from the Senate building, brought national attention and outrage to Republicans' schemes.
In several ways, Republicans have unintentionally boosted the Affordable Care Act's popularity. Additionally, the Republicans’ ongoing war against the ACA has sowed instability within the private health insurance sector. Experts like those at the Government Accountability Office in their assessment of the GOP House and Senate repeal bills said those bills would raise private premiums by 10 percent annually. For many Americans, the rising prices of private plans have motivated them to enroll in the more dependable government plan.
Misha Segal, a former director at the Centers for Medicare and Medicaid Services, claimed Health and Human Services did the bulk of the outreach, combined with a massive effort on the part of private health advocates:
Other health advocates didn’t agree that the government made the process smoother:
As health journalist Robert Pear explained in the New York Times, CMS administrator Seema Verma “tried over the summer to persuade Congress to repeal the Affordable Care Act, but on Thursday, she boasted about how well the law’s insurance marketplace — under new management — was meeting the needs of consumers.”
On the other hand, it’s possible that Republicans’ efforts to do away with Obamacare this spring effectively promoted the government health plan, much to Mitch McConnell's chagrin. As Pear summarized, “Republican efforts to dismantle the Affordable Care Act this year had an unintended effect: They heightened public awareness of the law and, according to opinion polls, galvanized support for it among consumers who feared that it might be taken away.”
One health care advocate pointed this out in response to Larry Levitt’s tweet: "I think you're underestimating the value of the non-stop coverage of the value of the ACA to market enrollees during repeal/replace. Exposure of ads & outreach vs the exposure from being primary content of national news for months."