As of midnight last night, the ACA health insurance exchanges on healthcare.gov and most if not all of the state based marketplaces have re-opened to at least a very broad and loose special enrollment period if not a full open enrollment period.
I have a piece coming in the next few days with a co-author on what to expect. I expect some enrollment gains, but right now, the big changes between this open enrollment period and the COVID general special enrollment period is elite political messaging and some paid advertising. The paid advertising is only a difference in states and media markets that served by Healthcare.gov.
Paul Shafer and I had looked at the impact of presidential statements and administrative actions on enrollment in the ACA individual marketplace. We had looked at the change in enrollment in the last two weeks of January 2017 after the change in administration with a concurrent whirlwind of elite anti-ACA messaging: “It’s failed”, “it’s bad” “going to replace it with something so much better….”
We had found a significant decrease in enrollments (depending on the model we used 24% to 30%) in the last two weeks of 2017 compared to what we should have expected given our counterfactual was that 2017 enrollment under the Obama Administration was trending very tight to 2016 enrollment at the same point in time and it was running even to slightly ahead. We think that this was due to the change in administration, messaging and policy as similar changes in direction for ACA information seeking behaviors were seen in Kentucky when a Republican governor who was a loud and strong opponent of the ACA replaced a Democratic governor who was very supportive of the ACA.
We have good evidence that changes in political administration that replace pro-ACA elite support with anti-ACA elite support can keep marginal buyers from making an active choice to enroll. We don’t have good evidence that moving from anti-ACA elite messaging to pro-ACA elite support will produce the opposite but equal enrollment reaction, yet. I hypothesize that pro-ACA elite support is valuable and useful but the challenge is that the decision to enroll requires active choices to be made and then actual actions to be taken. Doing something instead of doing nothing is a bigger ask, in my opinion, than doing nothing instead of doing something.