ObamaCare enrollment faces new challenges from courts, COVID-19

The Affordable Care Act’s annual open enrollment period kicked off Sunday amidst uncertainty caused by legal challenges to the law as well as the coronavirus pandemic .

Millions of people have lost their health coverage this year after losing their jobs in the economic downturn caused by the health pandemic.

Open enrollment risks being overshadowed by the disruptions caused by the pandemic, elections, and the Supreme Court’s pending oral arguments and eventual decision in a case challenging the ACA’s constitutionality. 

Additionally, the Trump administration hasn’t made any efforts to publicize open enrollment in recent years and isn’t expected to do so this year either, despite the fact that many more people are lacking coverage during a pandemic.

“I think the major change this year is in who may be looking during open enrollment,” said Karen Pollitz, a health insurance expert with the Kaiser Family Foundation. 

“It’s a pandemic. A lot of people have lost jobs and income and possibly other coverage. People may be uninsured for the first time, people who are used to having job-based coverage. People need to know there are options.” 

Open enrollment for the 30 states using the federal marketplace — healthcare.gov — ends Dec. 15 with coverage starting January 1. People affected by the pandemic or natural disasters might be able to get extensions, but people shouldn’t rely on that and should try to sign up early, Pollitz said. 

Most states that run their own exchanges, like Colorado and New Jersey, have later deadlines. 

Still, she conceded, there is a lot of distractions this year, as people worry about the pandemic, the economy, the election and the Supreme Court’s pending ruling on the act, still known as ObamaCare.

But “because it’s a pandemic, it’s more important than ever to have health insurance,” she added. 

A paper from the Commonwealth Fund estimates that as many as 7.7 million workers lost jobs with employer-sponsored health plans as of June 2020 because of the pandemic-induced recession. 

While a loss of job-based coverage qualifies anyone for a special enrollment period, some people might not know that and wait for the formal enrollment period to begin in November. Many of those people will qualify for Medicaid, which always accepts new applicants.

Nearly 30 million people were uninsured in 2019 before the pandemic, according to the Census Bureau, but the Trump administration opted not to open a special enrollment period for them despite doing so for natural disasters in the past.  But those people will now have the option to sign up for coverage during the formal open enrollment period, with coverage starting in January. 

The number of people without health insurance had been increasing since President Trump took office, partially reversing gains made by the Obama administration. 

The uninsured rate dropped to a historic low of 8.6 percent in 2016, before increasing to 9.2 percent in 2019, according to the Census Bureau. It’s not clear if the uninsured rate will increase again this year.

“We’ve seen historic coverage losses — the greatest coverage losses in American history this year — and that means that there are more people who can be shopping for coverage than potentially ever before,” said Joshua Peck, who oversaw the law’s outreach and education efforts under the Obama administration. 

“At the same time, so many Americans are experiencing really brutal financial hardships, and in many cases, they’re having trouble putting food on the table for their families, and affording health insurance premiums isn’t going to compete with that.” 

Still, most healthcare.gov consumers can find a plan this year with a monthly premium of $10 or less after subsidies, according to Get America Covered, an organization co-founded by Peck that aims to get the word out about open enrollment. 

Most people surveyed in a poll commissioned by the organization said cost is a top concern when they consider signing up for ObamaCare, representing a gap between perception and reality, Peck said. 

Another complication for this year’s open enrollment is the Supreme Court’s oral arguments, scheduled for a week after the election, in a lawsuit filed by Republican attorneys general seeking to overturn the ACA. 

It’s not known when the Supreme Court will reach a decision in that case, which will determine whether the law can stand without the financial penalty for not having insurance that was repealed by Congress in 2017. It’s possible but unlikely that a decision could come before the end of open enrollment on Dec. 15. 

While most legal scholars say it is highly unlikely the Supreme Court will throw out the entire law, 44 percent of people surveyed said they would be less likely to purchase a health plan for next year if the ACA is deemed unconstitutional. 

That the lawsuit has made it to the Supreme Court has people questioning whether they should bother signing up for coverage, Pollitz said.

“People ask ‘should I both signing up?’ The answer is ‘yes.’ Bother signing up,” Pollitz said. 

“The ACA is the law now. Plans are there now. The protections for people with preexisting conditions are there now.”