Obamacare, a program that President Trump last year declared “dead,” is enjoying quite the afterlife, with insurers expanding their offerings and the average premium finally beginning to drop, albeit slightly, from astronomical levels.
The administration now even hints that enrollment might increase next year, suggesting a level of stability and health that might surprise Republicans, who hoped to kill the 2010 health care law, and Democrats, who accused Mr. Trump of sabotaging it.
It’s a major turnaround from the past few years, when premiums for key “benchmark” plans spiked, customers were wary of signing up and insurers pulled out of markets, saying they couldn’t find ways to make the economics work.
“While some have publicly been accusing us of sabotage, the truth is we’ve been doing everything we can to mitigate the damage of Obamacare,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services, which oversees the federal HealthCare.gov portal.
She announced the latest positive news Thursday, saying premiums for midtier “benchmark” plans on the federal Obamacare exchange will drop by an average of 1.5 percent next year.
That is the first time since the Affordable Care Act’s exchanges were opened in 2013 that premiums have dropped.
Some places will have double-digit decreases. Tennessee’s rates will dive 26 percent, and Pennsylvania’s will drop 16 percent. States with increases will face “modest” pain, according to CMS.
After two years of declining participation, insurers are coming back to the exchanges, with 23 additional companies offering plans next year. The share of counties with only one insurer dropped from 56 percent in 2018 to 39 percent next year. Four states, compared with 10 this year, will have just one insurer.
The White House released a series of bullet points on Mr. Trump’s efforts to clean up Obamacare, a form of gloating that would seem at odds with the president’s effort to kill the program one year ago.
Market watchers said Mr. Trump can claim some credit for the improvement.
He cut the sign-up period in half and tightened eligibility for special enrollments, which were moves insurers wanted. He also approved reinsurance programs to drive down premiums in seven states.
But premiums also could be falling because insurers realized their massive increases announced a year ago, amid the uncertainty of Republican repeal pledges, were overzealous.
Critics say customers should be paying even less and that Mr. Trump’s signature on a bill that eliminates the penalty for not having insurance, as well as administrative moves, opens the door to cheaper, bare-bones plans outside the exchanges that are still spooking markets.
Analysts declined to choose sides.
“With all things ACA, it’s always complicated,” said Cynthia Cox, director of health care reform and insurance for the nonpartisan Kaiser Family Foundation.
One of those complicated moves was Mr. Trump’s decision to cancel “cost-sharing” payments to insurers, with an eye toward dismantling the law altogether.
Premiums rose in the wake of that decision, but so did government subsidies that were triggered under the law for most exchange customers.
That may have cemented Obamacare’s core base of customers who rely on taxpayer help.
Ms. Cox said companies such as Centene and Molina, which are accustomed to serving low-income populations, are among the insurers expanding their footprints. Another insurer, Oscar, appears to have found ways to appeal to young people as market turmoil recedes.
“This is the first time in years that we’ve seen more companies entering,” she said. “Especially seeing no companies leaving is really remarkable.”
Open enrollment for the 2019 season begins Nov. 1 and will last until Dec. 15 in most states, though places that command their own Obamacare markets may give customers more time.
The new CMS data did not include information from nearly a dozen states operating their own websites, and premiums across all plans are expected to rise by a modest average of 3 percent, according to an outside analysis.
That is still a good sign for taxpayers, who in the past faced soaring tabs for subsidies that rose with rates tied to benchmark plans — the second-lowest-cost silver plan on the exchange.
Also, people who buy insurance on their own but earn too much to qualify for assistance are especially price-conscious and will pay close attention to any changes in premiums.
The unsubsidized population is reeling from premium increases during Obamacare’s early rounds.
Congressional Republicans and other opponents of the law say a correction this year is not enough to ease the pain that has compounded over time and argue that the Affordable Care Act still needs to be repealed and replaced.
“This is by no means a celebration,” Ms. Verma said. “The law needs to change.”