2019 Year in Preview

Why the ACA is ‘not dead yet’ and lives on in 2019

Insurers are figuring out the market, say the law’s defenders.

Robert Calandra

At many levels and from multiple perspectives, President Trump and the Republican Party seem as intent as ever on trying to kill off the ACA. The administration has, for example, drastically cut funding for ACA navigators and ordered the Justice Department not to defend the law against a suit brought by Texas and several other states. Short-term health plans that aren’t ACA compliant are poised to become a bigger factor in the individual market in 2019 because of Trump administration policies. The loosening of the rules for association health plans could also whittle away at the ACA market.

But the ACA—and more specifically, the individual ACA exchange market—is doing quite well these days, thank you very much. The “I’m not dead yet” line from Monty Python and the Holy Grail comes to mind.

ACA premium prices have stabilized and even gone down for many plans. In October, CMS announced that the average premium for the second-lowest-cost silver plans for 2019 had decreased by 1.5%. The enrollment period still had several weeks to go as we went to press. But in 2018, almost 12 million Americans bought coverage through the ACA exchanges, a 3% decline from 2017, but not the kind of mass flight that many were either predicting (the law’s detractors) or worrying about (some of its supporters).

Marketplace premium changes in 2019 vary dramatically by state

Source: Kaiser Family Foundation

The ACA is also getting more popular, although Republican-led repeal of the unpopular individual mandate might have something to do with that. A Fox News poll conducted in late October found the ACA had a 54% approval rating. The large premium increases last year for coverage this year were a one-time adjustment, argued Ezekiel Emanuel in the New York Times. “After a few rocky years, insurers are figuring out how to price the market, and premiums are leveling out,” wrote Emanuel, a top Obama administration health official.

The Trump administration has a different take on reasons for the taming of premium increases. The press release announcing the silver plan premiums credited elimination of “overly burdensome regulations,” market stabilization rules issued by the administration in 2016, and the administration’s granting of waivers that have cleared the way for state-level reinsurance programs.