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Health exchange deadline arrives, but effects of moving it up remain murky

Open enrollment numbers on the federal exchange appear robust so far in Utah, health professionals say, but it's not clear how a shortened sign-up period will affect the end total number of people who buy health plans there as the deadline arrives.
Open enrollment numbers on the federal exchange appear robust so far in Utah, health professionals say, but it's not clear how a shortened sign-up period will affect the end total number of people who buy health plans there as the deadline arrives.
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SALT LAKE CITY — Open enrollment numbers on the federal exchange appear robust so far in Utah following a tumultuous year, health insurance professionals say, though it remains to be seen how a shortened sign-up period will affect the total number of people who buy health plans there as the deadline arrives.

As of Dec. 9, 104,942 people had enrolled in health plans on the federal exchange in Utah, according to the latest available data released by the U.S. Department of Health and Human Services.

That number is about 25 percent higher than after the same amount of enrollment weeks this time last year, reports Get America Covered, an enrollment campaign led by former Obama-era health officials. However, the last day to sign up for insurance on is Friday — a month and a half sooner than last year's deadline.

Chad Westover, CEO of University of Utah Health Plans, one of the state's two insurers on the exchange, is not fazed. Asked whether he thinks enrollment could approach last year's levels despite a smaller window in which to do so, Westover said, "I think it will."

"I think the attention that has been drawn, especially from the administration in Washington, D.C., I think people have been both confused, but interested, and anxious to find a way to get covered," he told the Deseret News.

President Donald Trump's administration has been strongly critical of the Affordable Care Act, especially the president himself, who has tweeted he would like to "let ObamaCare implode."

The administration also cut 90 percent of the advertising budget intended to promote signing up for the federal exchange, slashed federal funding by 61 percent for Utah organizations that help people enroll and announced billions in payments to insurers would be cut off next year.

In addition, Republicans in Congress have put together multiple runs at repealing much of the Affordable Care Act this year, ultimately falling just a few votes short of doing so.

But Westover believes that such fierce political opposition to the Affordable Care Act this year ultimately has made Americans more eager to take advantage of whatever coverage options are currently available to them.

"I think it's a result just of people watching out for their own best interests. I think the administration had a financial point of view on some of the funding, but that just woke up a lot of people to realize the funding may jeopardize (their coverage) and kind of woke them up to examine the options they had."

So far, this year's federal data shows that "as far as the Western states, Utah enrollment is relatively high," said Tanji Northrup, assistant commissioner of the Utah Insurance Department.

"We still have a rather large gap to fill," Northrup said of the difference between those thus far enrolled and last year's total of 172,757 lives covered.

But she added she suspects "most of that activity" gaining ground on last year's numbers can inevitably be expected in the final days of sign-up.

Heidi Castaneda, director for small employer and individual plan sales at SelectHealth, the other insurer offering plans on the exchange to Utah, said the consensus is that sign-ups are "starting to pick up" in the final days, partly due to "phone call volume over the last week."

"I think just natural human reaction is to wait until the last minute to kind of explore all your options," Castaneda said. "I think people are starting to make the move."

Still, enrollment in Utah through the first six weeks of the open period appeared to happen at a steady pace, with sign-ups split almost equally between the first three weeks and the next three.

Tighter deadline

While the window to get insurance on the exchange is much tighter this year, Northrup expects that to be of benefit to insurers in that "when you have extended periods of open enrollment, you tend to have more anti-selection."

"That's when people only select health care coverage when they need it instead of participating in an insurance pool on a consistent basis," Northrup said. "That type of pattern of behavior increases insurance costs for everyone."

As a result, the federal marketplace's "need for longer open enrollment periods … isn't necessarily true," she said.

Castaneda took the same view, saying that while it's viewed as "a controversial thing" to reduce the enrollment window, "I think it's an OK thing to do."

"When you have an open enrollment, it helps to keep it to one effective (coverage) date," she said.

A long enrollment period "gives people opportunities to come and go (and) it's hard to manage that population when there's so many ins and outs," Castaneda added.

But Westover disagreed that a shorter sign-up period is a needed change, saying "it's not certainly the ideal."

"I would like to see a longer period of time. People have been used to a longer period of time. So with the goal of getting people insured and protected from unknown illnesses and diagnoses, let's give them some time to make decisions," he said. "I think that would be helpful to the consumer."

He noted that for the 70,500 Utahns who are losing their Molina Healthcare coverage — after the carrier elected to leave the federal exchange in Utah beginning in 2018 — there is also a special enrollment period that runs through January and February.

Looking off-exchange

Advocates have especially suggested looking at silver level plans outside of the exchange, because it was that tier for which on-exchange premiums are calculated to increase the most next year.

Coverage purchased outside the federal exchange is subject to the same Affordable Care Act regulations on what health plans must cover, but those who buy insurance in that way are not eligible for the same tax credits toward their monthly premium. Anyone who is not receiving that financial benefit anyways can benefit greatly from looking off the exchange, particularly if seeking out silver level coverage, Northrup said.

Plans bought outside of the exchange are also not all accessible from the same online marketplace, as is the case on-exchange at Northrup urged Utahns considering options either on or off the exchange to get free help from an insurance agent — and to find one by using her department's online lookup tool.

"The agents receive a commission from the insurance company and that's built into the premium," she said, and the consumer "pays the same premium whether or not they use the agent."

Utahns considering their options can also get the help of a Take Care Utah health insurance navigator by visiting

For 2017, 86 percent of Utahns using the exchange qualify for subsidies, which pay for an average of 72 percent of their monthly premium, according to data from the Utah Health Policy Project.

Whatever the choice a person decides to make about their health plan, Northrup said, it's critical that they make it proactively rather than allowing their coverage to renew by default, thanks to the constantly shifting values of different types of plans on the exchange in comparison to one another.

"The premiums are different" from year to year, Northrup said. "No one should just sit by and allow themselves to be auto-enrolled in a plan."

The assistant insurance commissioner also made one last pitch to anyone debating whether or not they should get covered for 2018.

"Insurance is a very important aspect in the overall care of your health," Northrup said. "You never know if you're going to get sick or have an injury, and depending on what can happen to you, (those) could be a financial catastrophe to an individual or a family."