Enrollment in Obamacare's exchanges dropped by 3.7 percent in 2018 compared to past year, an independent health group reported Wednesday, saying the program displayed "remarkable stability" in an uncertain climate, despite the decline.
Overall the 39 states that use the federal HealthCare.gov website saw their enrollment slip by about 5 percent.
The data also show that the two types of states that run their own exchanges performed better, enrollment-wise, than the 34 states that use the federally facilitated marketplace.
"The states live in a period of uncertainty, so when you see stable enrollment, it's good", said Trish Riley, the health policy group's executive director.
The law offers subsidies to Americans making between 100 percent and 400 percent of the federal poverty line, or between $12,060 and $48,240 a year. State-by-state, enrollment shifts ranged from a 23.5 percent drop in Louisiana to 4.5 percent increases in both Hawaii and Nebraska.
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That in large part reflects extensive efforts in many of these states to market health coverage, lengthen enrollment periods and conduct aggressive outreach campaigns to attract younger, healthier consumers who are critical to insurance markets. But it remained essentially flat in the 12 state-based marketplaces and in the five states that have their own exchanges, but outsource the enrollment process to healthcare.gov.
Even bigger enrollment increases were recorded in Washington state, which had 7.6 percent increase, and Rhode Island, which led all states with a 12.1 percent increase.
The difference, according to NASHP, was state-based exchanges used "effective communication"-since they didn't cut their advertising budgets like HHS-to reach out to key populations who may be eligible for larger subsidies, shielding them from the double-digit premium increases seen across the country".
But the final tally is still impressive considering all the political turmoil surrounding the healthcare law, according to an analysis from the National Academy for State Health Policy (NASHP). "We worked hard to communicate the message in every corner of our state that we had affordable health insurance available despite the market uncertainty".
They have been buffeted for much of the past year by uncertainty over their future, with insurers in some areas raising rates steeply or exiting markets altogether. After Minnesota instituted a reinsurance program, premiums dropped by as much as 13 percent and insurers have called for Congress to offer up to $15 billion to bring down costs for consumers.