3‑minute read

Join our guest blog­ger, Devin McBray­er, as she reviews the out­comes of the 2019 open enroll­ment peri­od for health care exchanges. Devin is a Leg­isla­tive and Pol­i­cy Ana­lyst based in Sacra­men­to, Cal­i­for­nia.

The open enroll­ment peri­od to pur­chase Afford­able Care Act (ACA)-compliant indi­vid­ual health insur­ance cov­er­age off the health insur­ance exchanges for 2019 has come to an end. Sign-ups were off to a slow start at the begin­ning of the enroll­ment peri­od, leav­ing many experts fear­ful that ACA plans would expe­ri­ence a sig­nif­i­cant decrease in enroll­ment. How­ev­er, total enroll­ment only decreased by about 3.8% nation­wide on Healthcare.gov, much of this due to a 15% reduc­tion in new sign-ups.

While the total enroll­ment drop in indi­vid­ual health insur­ance plans on the exchange may have been less dras­tic than expect­ed, it is still worth explor­ing why new enroll­ment decreased con­sid­er­ably and why year-to-year enroll­ment con­tin­ues to decline. Sev­er­al 2018 pol­i­cy changes, com­bined with a grow­ing econ­o­my, could help explain the decrease in enroll­ment in ACA plans for the 2019 plan year.

Are policy changes to blame?

In 2018, Con­gress reduced the tax penal­ty for not hav­ing an ACA-com­pli­ant health insur­ance plan to zero, effec­tive­ly elim­i­nat­ing it. The fed­er­al gov­ern­ment also short­ened the open enroll­ment peri­od and reduced mar­ket­ing for open enroll­ment. Simul­ta­ne­ous­ly, the fed­er­al gov­ern­ment passed sev­er­al rules that expand­ed the avail­abil­i­ty of cheap­er and less com­pre­hen­sive insur­ance plans such as short-term lim­it­ed dura­tion plans. No tax penal­ty for lack of cov­er­age, com­bined with a short­er sign-up peri­od and more plan options out­side the exchanges, may help explain the enroll­ment decrease.

The impact of the economy

Anoth­er pos­si­ble expla­na­tion for the drop in enroll­ment could be attrib­uted to an improv­ing econ­o­my. When open enroll­ment start­ed on Novem­ber 1, 2018, 2 mil­lion more jobs were added to the econ­o­my than were added at the same time in 2017. As more peo­ple head back to work, it’s pos­si­ble that they’re gain­ing access to employ­er-spon­sored health insur­ance, elim­i­nat­ing the need to renew their ACA plan.

What does this mean for dental?

Any loss in enroll­ment for med­ical cov­er­age also means less peo­ple enrolled in den­tal cov­er­age on the exchange. (As a reminder, den­tal cov­er­age is an essen­tial health ben­e­fit for chil­dren but not for adults.)

In the exchanges, den­tal cov­er­age is includ­ed in some health plans or con­sumers can get a stand-alone den­tal plan and pay a sep­a­rate pre­mi­um. How­ev­er, there is no way for con­sumers to pur­chase a stand-alone den­tal plan with­out also pur­chas­ing a med­ical plan on the health care exchange. Push­ing for states and the fed­er­al gov­ern­ment to allow for the inde­pen­dent pur­chase of stand-alone den­tal plans on state and fed­er­al health insur­ance exchanges is a top pri­or­i­ty for the Pub­lic & Gov­ern­ment Affairs team at Delta Den­tal.

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