GRAHAM-CASSIDY REPEAL BILL DEADLINE:

Time: D H M S

SABOTAGE: Trump kills final-week HC.gov ads. Effective Nov. 1st, Obamacare is officially TrumpCare. He broke it, he owns it.

NOTE: I started writing this up as an update to an earlier post, but it was already pretty lengthy so I've broken it off onto a separate entry.

Last year, around 12.7 million people selected QHPs via the ACA exchanges nationally, including roughly 9.6 million via the federal exchange (HealthCare.Gov) and another 3.1 million via the 13 state-based exchanges.

This year, prior to the November election, both the HHS Dept. and I were projecting somewhere in the 13.5 - 14.0 million range.

After the election results, and in light of the aggressive actions being taken by both the Republican-held Congress and the Trump Administration to repeal the law, causing massive confusion and worry about the future of the law, I downgraded my projections to anywhere from a low of 12.0 million to a high of perhaps 13.2 million.

Over the past week or so I've put together a collection of solid evidence to show that Donald Trump and the Republican Party have been doing everything in their power to sabotage the ACA in order to deliberately create a premium death spiral (which would also cause many of the carriers participating in the exchanges to bail for 2018) regardless of whether the GOP actually officially repeals the law, partially or entirely.

This puts the nail in the coffin:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

...The last five days of the open enrollment season are seen as critical because many individuals procrastinate and then join a last-minute sign-up surge. That’s particularly true for younger and healthier customers who are crucial to making insurance markets work.

...The decision to scrap Obamacare outreach and advertising came directly from the White House, according to sources.

This seals it. Effective Immediately, the Affordable Care Act can no longer be rightly referred to as "Obamacare". Donald Trump and the Republican Party are now responsible for every enrollment shortfall, every person who misses the deadline, every lost CSR reimbursement, every missing APTC payment, every quarterly carrier loss and, especially, every worsening of the individual market risk pool which causes 2018 premium increases and/or carriers to pull out of the exchanges or the entire individual market.

How big of a negative impact could this have?

Now, killing the ads and outreach for HealthCare.Gov itself should have only a partial impact on the dozen state exchanges, since they have their own branding and advertising/ promotional/ outreach budgets. However, the HC.gov ads still help drive traffic to the state exchanges as well, so they'll probably be hurt to some degree.

I can't really use the 2014 Open Enrollment Period to compare with for several reasons: For one thing, it lasted 6 full months instead of 3; the massive technical problems at launch meant that enrollments were artificially end-loaded; and there was a 2-week "overtime" period tacked onto that as well.

However, both the 2015 and 2016 Open Enrollment Periods are pretty reasonable comparison points. Both lasted 3 months, and both ended at around the same time as this year (2/15/15 and 1/31/16 respectively). There were shorter "overtime" periods for each, but they only lasted 7 days in 2015 and 1 day in 2016, so didn't really skew the numbers that much

Here's the weekly enrollment numbers specifically for HealthCare.Gov in both 2015 and 2016:

As you can see, in 2015, during the final week of Open Enrollment, over a million people signed up via HC.gov. Another 242,000 jumped in during the extra "overtime" week.

By 2016, more people had gotten used to how the system works, and more people were signing up earlier, so there was a less dramatic final-week spike. However, a still-impressive 687,000 people still signed up over the final week, around 550,000 of which came in the final 5 days. Another 85,000 or so signed up via the state exchanges, which had mostly tapped out by that point.

So how about this year?

Well, assuming enrollment would otherwise have been basically flat year over year, that means that I'd normally expect a good 500,000 - 600,000 people to sign up via HealthCare.Gov over the next five days, plus another 60,000 - 100,000 via the state exchanges, or up to 700,000 people nationally.

I've confirmed at least 11.8 million people nationally through around January 14th, though it's probably closer to 12.0 million by now. If all 700K sign up, the final tally will come in at around 12.7 million...virtually dead even with last year. Disappointing compared to the original 13.8 million pre-election target, but not bad all things considered.

HOWEVER, seeing how vitally important the last-minute advertising/outreach/reminder blitz is to getting that final surge over the final few days, the Trump administration pulling the plug on the ads (some of which were already paid for, I should reiterate) will likely result in several hundred thousand people who otherwise would have enrolled by the deadline not doing so. Worse yet, as noted in the article, the final surge enrollees tend to be younger/healthier folks, which means that the exchange risk pool (which isn't great to begin with) will likely be dealt a crippling blow.

So, will enrollments come up short by the full 700,000 people? Unlikely. Many people do know about the 1/31 deadline, after all, and will still go ahead and sign up between now and Tuesday night. The state exchanges will do as much as they can to spread the word, of course, and third-party organizations like Families USA, Enroll America and so forth will do their part. Obviously I've been reminding people via this site, Twitter, Facebook and so forth.

However, many don't know about it (or have forgotten/need a reminder), and won't get that message. The Trump administration is doing everything they possibly can to damage the individual market risk pool, causing carriers to have massive quarterly losses in that market, bail out of the exchanges in 2018 and drive up premiums as much as possible...all just so Trump/Ryan/McConnell can then "justify" killing off the ACA entirely while pinning the blame on the Democrats.

They've admitted this is their gameplan, and now they're carrying it out to a T(rump).

It's important to remember:

  • FIRST: In theory, at least, none of this should dissuade anyone from signing up for 2017 coverage. In fact, the more people sign up (especially young/healthy types), the less ugly things will be next year. Make sure you sign up by January 31st.
  • SECOND: It's the 2018 Open Enrollment Period which is where the ugly will actually show up, assuming the Trumpublican-induced Death Sprial does indeed occur.

Therefore, as stated in the title: Assuming this wholehearted sabotage effort is "effective", starting on November 1st, 2017, Obamacare will cease to exist; it will then be known as TrumpCare.