Consumers Undeterred by ACA Funding Cuts Designed to Assist Them

November 14, 2017 Phil C. Solomon

From Humana to Highmark, Health Insurers Leave Insurance Marketplace, but Consumers are Undeterred

Recently, federal funds that assist Americans signing up for health insurance coverage under the Affordable Care Act (ACA) were cut by 40 percent and the ACA advertising budget was slashed from $100 million to $10 million.

These moves demonstrate the determination of the current administration and many in Congress to minimize the ACA insurance market and overturn the healthcare law. While these efforts appeared to stall initial sign-ups, they did not deter people. The fifth annual season for Americans to buy insurance under the ACA opened on Wednesday, November 1, 2017, with reports of crowds, technical difficulties and a public confused as never before by the political turmoil surrounding the law.

The funding decrease is problematic for the 2018 enrollment period, which just got started and will only last six weeks this fall instead of three months as in previous years. Sign-ups are taking place with many consumers confused by the political fighting in Washington over whether the law and its marketplaces will continue to exist.

Open Enrollment Begins

The federal website says, “2018 ACA Open Enrollment is here” and “Start a 2018 application now!” as both the federal and state insurance marketplaces attracted the year’s first customers. They came despite the 90 percent reduction in federal advertising about the sign-up window and the decision to send advance emails about enrollment to millions fewer Americans than in past years.

The emails went only to people with current health plans through marketplaces created under the law, leaving out most of the names in a database of about 25 million consumers who once had such coverage or at some point explored the federal website.

Nonetheless, plenty of people in certain states appeared eager to register on November 1 at places still offering in-person assistance through the navigator program.

In the first few days of open enrollment, the number of participants swelled compared with past years, according to federal officials who spoke on the condition of anonymity because the administration has yet to release official numbers.

More than 200,000 Americans chose a plan on November 1, the day open enrollment began, according to one administration official. That’s more than double the number of consumers who signed up on the first day of enrollment last year. More than one million people visited, the official said, which amounts to roughly a 33 percent increase in traffic compared with 2016.

These figures capture only a portion of the nation’s overall ACA enrollment because they encompass states that either uses the federal healthcare marketplace or rely on its website for their consumers to sign up for coverage. More than a dozen states and the District of Columbia run their own programs and do not use

Many industry stakeholders were concerned that consumers wouldn’t sign up for coverage because Congress had tried to repeal it multiple times this year. But on opening day, many state exchange officials said that enrollment had exceeded their projections.

Connect for Health Colorado spokesman Luke Clarke said state officials had expected that 2,700 residents would log on to their exchange on November 1, but more than 4,000 did. “It’s way ahead of where we were last year, and a big surprise,” he said.

That same day in Connecticut, 1,596 residents enrolled in qualified health plans on the state exchange, while another 2,293 people either completed Medicaid applications or determined that they were eligible for the federal entitlement program. Access Health CT CEO Jim Wadleigh said in a statement that the state’s call center and website experienced a 15 percent increase in volume compared to opening day last year.

It’s all well and good that 2018 enrollment has been initially brisk, but what will the enrollment figures look like when the period ends on December 15, 2017, and how many insurers have made insurance plans available at a reasonable cost to consumers?

Healthcare Insurance Marketplaces

Many critics of the ACA say the law is “collapsing” and claim many insurers have left the ACA’s insurance exchanges or state-based online marketplaces where people can buy individual health insurance policies.

Today, it appears that about one-third of counties are projected to have just one insurer available for their insurance exchanges. That leaves 2.9 million consumers with little choice but to select the only insurer available in their county, which, ultimately, could put them in a financial bind due to high costs.

That statistic was echoed in a May 2017 editorial by former Health and Human Services Secretary Tom Price, in which he portrayed the ACA as a house on fire and “many of our fellow Americans are trapped inside.”

Some insurers already have decided to hike their 2018 premiums more than they would otherwise to position themselves for a possible adverse decision affecting the ACA. Consumer choice is limited due to insurers leaving the insurance marketplace. As of the November 1, 2017, open enrollment date, the following insurers have left the 2018 marketplace:

ATRIO Health Plans

Oregon – 6 counties


Delaware – 3 counties

Iowa – 76 counties

Nebraska – 93 counties

Virginia – 51 counties


California – 30 counties

Indiana – 92 counties

Kentucky – 61 counties

Maine – 16 counties

Missouri – 17 counties

Ohio – 87 counties

Virginia – 61 counties

Blue Cross Blue Shield Healthcare Plan of Georgia

Georgia – 73 counties

Blue Cross Blue Shield of Kansas City

Kansas – 2 counties

Missouri – 30 counties

BridgeSpan Health

Idaho – 44 counties

Oregon – 17 counties

Washington – 8 counties

Cigna Healthcare

Maryland – 24 counties

Community Health Plan of Washington

Washington – 14 counties

Health Tradition Health Plan

Wisconsin – 14 counties


Pennsylvania – 7 counties

Highmark Health Insurance Company

Pennsylvania – 4 counties


Florida – 7 counties

Georgia – 9 counties

Illinois – 30 counties

Kentucky – 9 counties

Louisiana – 7 counties

Michigan – 9 counties

Missouri – 5 counties

Mississippi – 32 counties

Ohio – 7 counties

Tennessee – 30 counties

Texas – 10 counties

Innovation Health Insurance

Virginia – 19 counties

LifeWise Health Plan of WA

Washington – 4 counties

MDwise Marketplace

Indiana – 92 counties

Medica Health Plans

North Dakota – 49 counties

Minuteman Health, Inc.

New Hampshire – 10 counties

Massachusetts – 9 counties


Utah- 7 counties

Washington – 6 counties

Wisconsin – 30 counties

Northwell Health w/CareConnect

New York – 8 counties

Optima Health

Virginia – 17 counties

Premera Blue Cross

Washington – 1 county

Premier Health Plan

Ohio – 9 counties

Prominence Health

Nevada – 7 counties

Texas – 3 counties

Regence BlueShield

Washington – 2 counties


Virginia – 32 counties


Iowa – 4 counties

Final Thoughts

Clearly, the decisions by insurers to pull out of the insurance exchanges have been driven by the financial risk and an uncertain outlook for the marketplace. Insurers face continued uncertainty even in the midst of open enrollment. Some insurers explicitly have factored this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market altogether.

What does this mean for consumers? They should expect a reduction of choices for insurers offering plans in their area and higher insurance rates due to the uncertainty of the marketplace.


Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and serves as the Vice President of Marketing Strategy for MiraMed, a healthcare revenue cycle outsourcing company.  As an executive leader, he is responsible for creating and executing sales and marketing strategies which drive new business development and client engagement. Phil has over 25 years’ experience consulting on a broad range of healthcare initiatives for clinical and revenue cycle performance improvement.  He has worked with industry’s largest health systems developing executable strategies for revenue enhancement, expense reduction, and clinical transformation. He can be reached at

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