SALT LAKE CITY — The number of Utahns enrolling in insurance plans on the federal health exchange is down compared to this time last year, new data from the Centers for Medicare and Medicaid shows.

Through Nov. 25, a little more than three weeks into this year's open enrollment period, 56,105 Utahns had signed up for a plan, compared to 62,844 at roughly the same point in 2017, a drop of about 11 percentage points. One week prior, new enrollment had an even bigger discrepancy from 2017, at almost 14 percentage points below last year's rate.

But health insurance advocates who help people sign up are confident final enrollment numbers will closely resemble last year's.

"The closer you get to the deadline, the more people who start to sign up. It's like a snowball rolling down hill. … I'm not too worried, because of the huge uptick we got toward the end of open enrollment (last year)," said Randal Serr, director of Take Care Utah, a network of nonprofits which help people sign up for health insurance.

"It's kind of like tax day — everybody waits until the last week to do their taxes."

The last day to enroll in a plan on the exchange is Dec. 15.

Serr said that because of people's tendency to procrastinate, it's hard to pinpoint with much certainty how enrollment will look until the deadline has passed. Last year was the first time open enrollment ended in mid-December, shortening the sign-up window by half, and about a week before the deadline it had appeared uncertain as to whether enrollments could keep pace with prior years.

However, the number of Utahns who signed up for a health plan in 2017 came within about 1.6 percent of the year prior, and sign-ups on the federal exchange around the country were just 5 percent lower.

In Utah, advocates like Serr were happy with the 2017 results, which materialized despite a tumultuous year in which Molina Healthcare announced it would be leaving the federal health exchange in the state, leaving just two carriers. In the same year, the Affordable Care Act came within a few votes of being repealed and state officials forecasted significant rate hikes on the exchange in Utah.

This year, the forecast for the future of the exchange in Utah has been much sunnier, insurers and state officials say. Whereas on average the monthly cost of an exchange plan offered in Utah jumped 39 percent in 2018 compared to the year prior, they are set to increase just 1.6 percent on average.

Additionally, Molina Healthcare has re-entered the health exchange market for 2019 in 10 of Utah's 11 most populous counties. The survival of the Affordable Care Act also appears less tenuous for now.

"I think the exchange is stable. I think the way the carriers look at the exchange is that the numbers seem to be leveling out, so we're able to see this as a stable marketplace, a stable pool," said Chad Westover, CEO of University of Utah Health Plans.

"At least in Utah you're seeing a more stable market and that just comes with the fact that more information is available to the carriers to understand the pricing."

Like Serr, Westover is not worried about the numbers pacing slightly below last year's.

"The numbers may fluctuate year to year, but I think it's important to realize that we're reaching a point where the premiums aren't going up dramatically — in fact, our premiums (at University of Utah Health Plans) went down a little down a little bit."

Serr said it would be difficult to tell, by how hard navigators have been working recently, "that there's a few less people signing up."

"They're seeing really high demand," he said, and answering phones all day and taking people's questions about the plans they are considering buying.

Mandate nixed

The exchange, sometimes called the federal health marketplace, was established as part of the Affordable Care Act and opened for the first time in the fall of 2013. It was designed in part as a way to increase health insurance access for those who are without employer-sponsored insurance, Medicaid or Medicare — and also to help them comply with a new federal mandate requiring Americans to have coverage.

However, the financial penalty accompanying the individual mandate was dropped — or rather, technically reduced to zero dollars — with the passage of the sweeping tax Tax Cuts and Jobs Act shortly before Christmas last year.

That mandate penalty officially becomes a nonfactor 2019. When it was nullified, some health advocates were alarmed that it would mean healthy consumers would stay away from the exchange as a result, causing insurers to raise their rates.

Much of that fear has not been realized, said Tangie Northrup, deputy commissioner of the Utah Insurance Department. She said health insurers on the exchange had already "priced some of that volatility into their rates" that are in effect this year, softening the change's effect on 2019.

Plus, Norhtrup said, "I don't know to what effect to what extent the individual mandate was effective."

National landscape

Nationally, 2,424,913 people have signed up for plans on the federal exchange in the 39 states that use it as their health insurance market place, according to the Centers for Medicare and Medicaid Services. That is about 13 percentage points lower than the total sign-ups reported at about this time last year.

The 2017 open enrollment numbers reported this week reflect sign-ups Nov. 1 through Nov. 25, while this year's indicate those completed Nov. 1 through Nov. 24. The slight discrepancy that exists due to the fact that the federal government always reports numbers on a Wednesday, which fell one day later this year.

Of the new enrollments made this year, 588,131 are from new customers, federal data shows.

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Serr said any deterrents to potential enrollees throughout the country this year are of the federal government's own making. Marketing dollars for campaigns encouraging people to enroll have lagged, Serr said, and health plan navigators, whose job it is to help people sign up for the plan that is best for them, have dwindled somewhat in number.

"Really if there is any sort of drop-off, I would attribute it directly to the drop off in marketing," he said. "The marketing has hurt."

When the U.S. Department of Health & Human Services cut advertising funding for the exchange by 90 percent in 2017 and slashed funds for enrollment navigators, it contended its move was "based on" and consistent with "previous evaluation of past exchange outreach efforts" and also argued navigator organizations signed up only a small portion of the federal exchange's total number of enrollees.

Medicaid's effect

American health insurance advocates generally see a large enrollment base as an important indicator of the relative strength of the federal health exchange, saying it is an indicator it is not just those who need the most thorough and expensive medical care who are signing up, which helps carriers keep rates reasonable and shows the insurance options offered are attractive enough to prompt purchases.

Still, according to Northrup, in the long term it is likely that enrollment in the exchange will decrease noticeably in Utah — but that has to do directly with the Medicaid expansion that the state's voters recently passed, rather than healthy people fleeing the exchange.

The expansion will make everyone in a household earning 138 percent or less of the federal poverty level eligible for Medicaid. Northrup pointed out Centers for Medicare and Medicaid data showing that 58,383 of Utahns on the exchange — about 30 percent of all the state's enrollees — live at between 100 and 150 percent of the federal poverty level.

It isn't clear from the federal data how many exchange enrollees were between 100 and 138 percent of the federal poverty level specifically.

Westover urged anyone on the fence about buying a plan from the exchange to protect themselves financially by getting covered.

"It's about covering those things that are unknown," Westover said. "Everybody is subject to the possibility of having unknown illnesses or unknown tragedies, so we all need to be covered for that, or the rest of our assets are at risk if we do not."

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