Obamacare is looking healthier as its seventh open enrollment period begins Friday, even as the nation's uninsured rate has begun to tick up and a federal appeals court considers a case that could invalidate the entire law.
Many consumers signing up on the federal exchange, healthcare.gov, will find lower rates and more choices for 2020. The average premium for the benchmark plan will drop 4% -- the second year in a row of lower rates -- while 20 more insurers are offering policies, bringing the total to 175.
Two-thirds of Americans currently on the federal exchange can find policies for $10 or less a month, according to Get America Covered, an advocacy group that promotes enrollment in the Affordable Care Act.
While the Trump administration is claiming credit for stabilizing the exchanges, industry experts say insurers have raised rates high enough in recent years to make selling plans on the exchanges a profitable businesses. A dozen states have also instituted "reinsurance" plans, which help reduce premiums because they shield insurers from high-cost patients.
Open enrollment runs through December 15 in the 38 states using the federal exchange.
Some states that run their own marketplaces have longer enrollment timelines and have been touting the options available to their residents and providing enrollment assistance. Maryland, for example, is launching an advertising campaign that will appear on social media and gas station screens, as well as print, online and television, and is holding nearly 20 "Get Connected" events in the initial days of open enrollment.
Still, it remains to be seen how many people will select Obamacare policies for 2020.
While the landmark health reform law has proved resilient, signups slid to 11.4 million in 2019, down from a high of 12.7 million in 2016. While most people with coverage are re-enrolling, fewer new consumers are signing up. Also, those who don't receive premium subsidies are leaving the individual market, particularly after insurers hiked rates several years in a row.
Get America Covered expects fewer people will pick policies for next year.
"All of the data points very, very clearly about incredibly low levels of awareness about open enrollment, about what's available, about how much it costs, about when it is," said Joshua Peck, the group's co-founder and a former Obama administration official.
The Trump administration has slashed funding for advertising and enrollment assistance, while broadening alternatives to the law, such as short-term plans. These policies, which typically have lower premiums because they offer less comprehensive coverage and can turn away people with pre-existing conditions, may attract more enrollees this year since insurers have had more time to promote them.
Some red states are highlighting these alternatives. Iowa Insurance Commissioner Doug Ommen, for instance, sent an email Thursday announcing the start of open enrollment, but noting that residents can sign up for short-term plans or policies offered by non-profit agricultural groups.
"The ACA-compliant insurance market is available to Iowans, however, many Iowans have been priced out of that market," Ommen said. "Changes made at the Iowa state legislature and by the federal government have provided a few more options in addition to ACA-compliant coverage for Iowans to review as they plan out their health needs for 2020."
Separately, the administration's crackdown on immigrants may make some fearful of signing up, Peck said.
Administration officials continue to say the the law is not working. Seema Verma, who runs Obamacare as the administrator for the Centers for Medicare & Medicaid Services, has blamed the increase in the nation's uninsured rate last year on the fact that Obamacare premiums had risen substantially between 2016 and 2018.
The biggest threat to the Affordable Care Act remain a case that's working its way through the federal court system. Appellate judges in Louisiana are considering a district court ruling that found Obamacare to be unconstitutional. District Judge Reed O'Connor in Texas announced his decision the day before open enrollment ended last year but did not block Obamacare's continued operation.
Health and Human Services Secretary Alex Azar has said that open enrollment will continue and 2020 coverage will not be disrupted if the 5th US Circuit Court of Appeals upholds O'Connor's ruling.
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