SALT LAKE CITY — The number of Utahns who signed up for health insurance for 2018 via the marketplace established by the Affordable Care Act nearly reached the record number of enrollees the state saw in the previous go-around, new data shows.
The number of Utahns who signed up for health plans on the federal exchange reached 194,118 by the end of the open enrollment period earlier this month, according to statistics released Thursday by the Centers for Medicare and Medicaid Services. That means sign-ups reached just more than 98.4 percent of the total number recorded during the previous period.
Health advocates are lauding the total as an encouraging victory following a year of uncertainty over the Affordable Care Act and significant cutbacks in the federal government's efforts to promote signing up for coverage on the exchange.
Matt Slonaker, executive director of the Utah Health Policy Project, a think tank and advocacy organization that also functions as a federal exchange enrollment hub, said shortly after the sign-up period ended earlier this month that he was "very encouraged by the impressive enrollment."
"We know that Utahns want and need quality, affordable health insurance, and strong individual market sign-up rates continue to demonstrate just how valuable the ACA is to Utah families," Slonaker said at the time.
The federal government said Thursday that more than 8.7 million people have signed up for coverage next year under the Obama-era health care law, exceeding expectations for a program that President Donald Trump has unsuccessfully tried to repeal.
The final tally released Thursday for the 39 HealthCare.gov states showed about 80,000 fewer sign-ups than an initial count provided last week. A spokesman for the Centers for Medicare and Medicaid Services said the slight dip was due to late cancellations.
Still, total HealthCare.gov enrollment across the country reached nearly 95 percent of last year's level, outperforming expectations in a show of consumer demand.
A complete national tally may not be available until March, as states running their own health insurance markets are continuing to sign up consumers.
In Utah, the sign-up data is a "good predictor that Utah's insured population, if anything, will remain stable and possibly have light growth," said Tanji Northrup, assistant commissioner of the Utah Insurance Department.
However, Utah's sign-up numbers being roughly the same as before mark a downward break from the earlier trend in the state, which had seen sign-ups increase by an average of 8 percent in the first four open enrollment periods, she explained.
Northrup noted it's possible that the state is experiencing an increase in the number of people who "may have left their coverage on the exchange and purchased off the exchange," thanks to encouragement from both the department and insurers themselves to consider options there as a way to avoid large premium increases attached to silver-tiered plans.
The Affordable Care Act's future appeared in doubt this year, with multiple proposals to repeal much of the law coming up just short in the Republican-controlled Congress. The Trump administration also slashed 90 percent of the advertising budget that promoted use of the federal health exchange, and grant money intended for Utah groups that help people sign up for coverage was reduced by 61 percent.
President Donald Trump has also said he would like to "let Obamacare implode."
The enrollment window was also cut in half, causing concerns about how that would affect the number of people who would sign up, though Utah's two insurers on the federal exchange differed on how worrisome that particular factor was.
Rep. Rebecca Chavez-Houck, D-Salt Lake City, a member of the state legislature's Health Reform Task Force, said opposition to the Affordable Care Act actually may have had the opposite effect of getting more people to sign up for the health exchange that the law established.
"I would think … the lack of surety would (maybe) incentivize (people) to get at least another year under their belt and keep up their coverage as long as they can," Chavez-Houck said. "What I'm pleased by is, even though the enrollment period was short, you still had so many people make the effort to get renewed and re-enrolled.
"That, to me, reinforces the importance of people being able to access affordable health care."
Northrup doesn't view the moved-up deadline for enrolling as having been a major barrier for those who already treasure the coverage the federal health exchange offers them.
"I think the shorter enrollment period has shown that people who value what they're getting for their health insurance are signing up for their coverage," she said.
Sen. Gene Davis, D-Salt Lake City, said he was "kind of surprised by the numbers, but at the same time, it shows that once people get insurance, they want the insurance. They have a need for it."
Davis, also a member of the Health Reform Task Force, said he believes enrollment numbers in Utah would be even higher and premiums would improve if the Trump administration was not harming the Affordable Care Act and "trying to prove that it's a failure by making it fail themselves."
Rep. Jim Dunnigan, R-Taylorsville, co-chairman of the task force, said "overall, it's a decent enrollment considering the adjusted time period," but that doesn't change his view that the exchange as a whole is a failure.
That's because, despite the federal government spending "billions and billions" to set up the exchange, premiums and deductibles have been unacceptably high, Dunnigan said, and "the truth is we have a lot fewer insurers" than when the Affordable Care Act was passed.
"I think it's been very detrimental and very harmful to the commercial insurance marketplace for individuals, but also for businesses," he said. "They've layered on many, many things that increased the cost of insurance, (which) I think … has been a disaster."
Poll: Full Medicaid expansion wanted
Poll results released this week also suggest 59 percent of Utah voters favor expanding Medicaid benefits in the state to all people who belong to households earning less than 138 percent of the federal poverty level.
Such expansion is the end goal of a ballot initiative campaign called Utah Decides Healthcare, which began collecting signatures late this year to put the issue before the state's voters in November 2018.
"We're excited to see the poll results, but it basically confirms what we've known all along, which is that Utahns support this Medicaid expansion ballot initiative," said RyLee Curtis, campaign manager for the initiative. "We've done consistent polling since about 2014, and it's always been around 60 percent."
The Utah Policy poll of 600 registered Utah voters, conducted Nov. 16-21 by Dan Jones and Associates, asked whether respondents "support or oppose requiring the state to expand Medicaid as proposed under the Affordable Care Act to all those who qualify up to 138 percent of the federal poverty level." The survey has a 4 percent margin of error.
The majority of LDS Church members polled who self-identify as "very active" were in favor of full expansion, 51 percent to 43 percent, Utah Policy reported. Self-identified Republicans surveyed, however, were opposed to it, 48 percent to 46 percent, with 93 percent of Democrats and 62 percent of independents saying they were in favor.
Thirty-two percent of survey respondents were strongly in favor of expansion, 27 percent were somewhat in favor, 16 percent were somewhat opposed, and 20 percent were strongly opposed. Just 4 percent of respondents said they don't know, which Curtis said is evidence that "Utahns have basically made up their mind on this issue."
"It shows us that Utahns know where they stand on this, and they stand on the side of doing what's right," she said.
The Utah Decides Healthcare initiative, if it garners enough signatures by April 15 to be placed on the ballot and then is passed by voters in November, would get the funds for Medicaid expansion by raising the state sales tax from 4.7 percent to 4.85 percent. That would produce $91 million annually in state revenue and draw down around $800 million per year in matching federal funds.
As initially passed, the Affordable Care Act was designed to expand Medicaid eligibility to all Americans earning less than 138 percent of the federal poverty level. However, after a court ruling allowed for states to decide for themselves whether or not to expand eligibility, Utah and 17 other states have so far declined to do so.
Multiple health advocacy organizations, both in Utah and nationally, have said that leaves many low-income Utahns in a "coverage gap" wherein they earn too much to qualify for Medicaid, but by virtue of earning less than 138 percent of the federal poverty level do not qualify for critically important subsidies toward their premium on plans offered via the federal health exchange.
A bill authored by Dunnigan in 2016 allowed for the expansion of Medicaid to 4,000 to 6,000 homeless or otherwise extremely poor Utahns. That expansion was formally approved by the federal government in November.6 comments on this story
Davis said he will be introducing a bill in the upcoming legislative session that would enact full Medicaid expansion, though no funding mechanism for such expansion is currently specified in the measure. Davis said he believes having the Legislature "deciding how to pay for it would probably be the best way to do (it)," but that he's supportive of the initiative if his bill, SB47, fails to gain traction.
Chavez-Houck said that while she is personally supportive of full Medicaid expansion, "I just don't see that happening" through the Legislature.
"I'm an ardent supporter of the initiative," she said. "We as a legislative body don't seem to be coinciding with the wishes of the majority of Utahns. … (But) I wish we could've done it legislatively."
Contributing: Associated Press