The Health 202: Obamacare marketplaces survived Trump’s term better than expected

“The overall impact of the Trump administration’s policies towards the marketplaces have probably been more muted than most expected — at least so far,” said Adam Gaffney, a professor at Harvard Medical School and president of Physicians for a National Health Program.

Enrollment in and the state-based marketplaces is open through Dec. 15.

People can shop for private plans, and qualify for federal subsidies if their income is between 133 percent and 400 percent of the federal poverty level.

To the concern of health-care advocates, enrollment has ticked down over the past four years, contributing to the nation’s worsening uninsured rate amid the coronavirus pandemic and fueling a growing sense among Democrats that further health restructuring is needed.

Yet by some measures, the marketplaces look healthier than ever.

Individual insurance premiums and choices have steadily improved over the past four years, despite Democrats’ insistence that the administration’s policies would destroy the marketplaces. That trend will continue in the 2021 enrollment season.

“One thing the marketplaces proved is how resilient they actually are,” said Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services under President Barack Obama.

Still, there’s a clear difference in how a Joe Biden administration would approach the ACA.

It certainly would invest more in boosting marketplace enrollment, advisers say. The Democratic nominee, if he wins tomorrow’s election, is expected to restore funds Trump scrapped to advertise the law and may push Congress to pass legislation increasing the income-based subsidies available to people. 

A Democrat-led administration may also reverse some of the changes President Trump made to the marketplaces — although Trump’s record on them is more nuanced than either party claims.

“The truth is somewhere in middle between what Republicans say and what Democrats say,” said Larry Levitt, a vice president for the Kaiser Family Foundation.

The average Obamacare customer can choose from plans offered by four to five issuers.

That’s up from an average of three to four issuers in 2020, according to data from the Centers for Medicare and Medicaid Services. Four percent of enrollees will have access to plans from just one issuer, up from 12 percent of enrollees this year.

And premiums are declining for the third straight year. The average premiums for the second-lowest-cost “silver”-level plan will be 2 percent lower next year. Average premiums for these “benchmark” plans have declined 8 percent since 2018.

“Despite the uncertainty of the pandemic and concerns about the future of the ACA, the marketplaces are strong and healthy, and premiums for high-quality, comprehensive coverage remain very affordable,” said Joshua Peck, co-founder of Get America Covered — a nonpartisan group that has worked to spread the word about the marketplaces even as the administration has cut advertising for it.

It’s a distinct shift from how things looked during the Obama administration. The first few years of the marketplaces were marked by double-digit premium increases and a steady stream of exits by insurers, as they struggled with how to price and sell insurance

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