November 02, 2017

*-- First ACA enrollment under Trump begins amid many changes --*

Millions of Americans begin a new open enrollment period for Affordable Care Act health insurance marketplace on Wednesday amid Republican vows to repeal the law.

The enrollment period will allow people to sign up for coverage for 45 days, from Nov. 1 through Dec. 15 in most states. While it's the fifth enrollment period, it's the first under President Donald Trump -- and it's half as long as it was in previous years.

There are a number of other changes in play.

The Trump administration has cut $116 million in funds for advertising, outreach and navigator programs providing information about the ACA -- and also chose to end some federal subsidy payments that are used to reduce out-of-pocket costs for low-income enrollees.

An annual landscape report released Monday highlighted an increase in premium rates for ACA plans, which rose 24 percent this year in states using the federal exchange, healthcare.gov.

The price has risen in recent years as enrollees were sicker and treating them became costlier than insurers originally expected.

As a result of the increased rate, for example, a 27-year-old will pay nearly $5,000 a year on average for the ACA's "silver" plans -- which provides a basis for premium subsides. The rate increase also will cause premium subsidies to rise by 45 percent, making certain plans more affordable for some enrollees.

The increased subsidies will make some "bronze" plans, which have lower premiums and a higher deductible, more affordable than "silver" plans -- and some "gold" plans, ordinarily the most expensive, cheaper than some "silver" plans.

Health insurers and analyses of federal data also have shown that a growing number of American consumers will be able to get coverage for 2018 without paying any monthly premium -- a result of Trump's decision to end the federal payments.

No-premium plans were available in many places for enrollees with very low income in 2017, but would now be available to people in 2,692 counties out of 2,722 included in the data.

Insurers plan to advertise the opportunity for no-premium plans in hopes of attracting people with few health needs to help balance out the cost of enrollees that require more care -- the primary dynamic that enables the U.S. insurance system to operate.

Trump and a Republican Congress have attempted multiple times this year, unsuccessfully, to scrap the Obama-era health law. However, the new administration has been accused of sabotaging the system -- which some experts say will have an impact on next year's numbers.

For example, about 12 million people enrolled in individual ACA plans for coverage this year, a figure the Center for American Progress estimated this week would have been projected to stabilize in 2018 had the "sabotaging" moves not been made.

Based on U.S. Department of Health and Human Services and state-based marketplaces, the group said more than 8 million people would have re-enrolled for plans in 2018, in addition to about 4 million new enrollees.