START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

Trump killing HC.gov ads didn't impact state exchanges much...but OTHER Trump/GOP sabotage efforts sure did.

Over the past few weeks I've compiled increasingly solid evidence (supported by a separate analysis by David Anderson of Balloon Juice) showing that yes, a significant portion of the reduced 2017 ACA exchange enrollment was due specifically to sabotage efforts on the part of Donald Trump and the GOP.

I've mainly focused on the last-minute "ad kill" stunt pulled by the Trump administration, in which they yanked millions of dollars worth of TV ads reminding people fo the deadline during the critical last 5 days, and the evidence is pretty telling: Enrollment across the 39 states run through the federal exchange (HC.gov) dropped by about 5% from last year, while enrollment on the other 12 state exchanges increased by over 2% (there's still final enrollment data to be added from ID, MN, RI & VT).

The reason this is so significant is that the state exchanges have their own marketing budgets, ad campaigns, outreach efforts and most significantly, branding. Ads promoting "Covered California" are gonna have a far bigger impact on enrollment for the residents of CA than ads for "HealthCare.Gov". There's some residual effect, because some people visit HC.gov first and are then redirected to CoveredCA from there, but for the most part, the state exchange branding is completely separate. (As an aside, this can sometimes have negative consequences, as in the case of "kynect" in Kentucky, which did such a bang-up job of isolating their brand from "Obamacare" that most of the state hasn't the foggiest idea that the two were the exact same law, but that's a separate discussion).

However, even though the state-based exchanges did see an overall growth in enrollment, Trump's efforts still had some negative impact on them as well. I mean, it could be argued that Trump winning the Electoral College in the first place in and of itself had a huge dampening effect (I myself feared the worst the day after the election), although I don't suppose that really counts. However, the GOP House and Senate quickly passed preliminary bills to start the process of formally repealing the ACA which immediately caused a significant impact on the enrollment effort even before Trump took office:

“With almost 9 million people signed up for 2017 coverage just in HealthCare.gov states, it’s clear that Marketplace coverage is a product Americans want and need,” said Secretary Sylvia M. Burwell. “Strong demand is especially striking in light of the unique headwinds created by discouraging rhetoric from ACA opponents. More than 40,000 people have contacted our call center expressing concerns about whether they should sign up for coverage, with a sharp uptick in these questions last weekend.

This was followed by Trump signing an executive order within hours of being sworn in, specifically instructing the HHS Dept. to throw as many monkey wrenches into the implementation of the law as possible this year...all of which happpened in the middle of the Open Enrollment Period itself. Again, this had to have some dampening effect.

And then there was this:

"I received at least three robocalls (that I answered) in January from a recording of Trump screaming at me about "the complete failure of Obamacare" and urging me to add my name to those who support an effort to repeal it. That, added to the lack of reminders on the Jan. 31 deadline had to have an impact."

The woman who posted this lives in South Carolina, one of the HealthCare.Gov states. However, I just read this article by Mara Lee of the Hartford Courant which confirms that similar calls were going out in Connecticut as well:

There was some concern over signups, Access Health CT CEO Jim Wadleigh said, after Donald Trump became president and detailed his plan to repeal Obamacare. This led to calls from people saying they didn't want to buy health insurance and did not think they should have to pay a penalty for going without coverage.

...Wadleigh said robo-calls going out to some Connecticut phone numbers with Trump's voice saying insurance premiums would rise 45 to 55 percent for Obamacare likely dampened signups.

"I don't see how they could not have had an impact," Wadleigh said.

But he called the calls' assertions "alternative facts."

For just over three-quarters of Obamacare customers in Connecticut, their premiums went up $5 or less because the increases by insurers were matched by an increase in subsidies. On average, Obamacare costs $120 a month for those individuals

Even among those who buy plans without government help, the average premium increase in Connecticut was 17 percent, Wadleigh said.

Again, as I noted the other day, I'm not saying that 100% of the "lost" enrollment was due to Trump's shenanigans. My gut tells me that even if Hillary Clinton had become President, my initial projections of 13.5 - 14.0 million QHP selections probably would've been too high--it likely would have been more in the 13.0 - 13.3 million range...only slightly above last years' 12.7 million.

However, there's undeniable evidence here that enrollment was definitely reduced by at least several hundred thousand people due to the active sabotage efforts laid out above...and worse, most of those were likely the very young/healthy types who help keep the overall risk pool from spiraling out of control.