A record number of Oklahomans signed up for health coverage through the Affordable Care Act’s federal exchange for 2020 despite persistent concerns over the future of the Obama-era health-care law.

Preliminary numbers released by the Centers for Medicare and Medicaid Services show nearly 159,000 Oklahoma residents enrolled in health plans purchased through the marketplace during the open enrollment period that ended Dec. 18.  

The enrollment figures will be finalized later this month. Federal officials will count consumers who selected plans in the final hours before the deadline or were given extensions due to technical issues or high call volumes.  

Unless Oklahoma’s numbers are revised downward, 2020 will see at least a 5.5% increase in plan selections over last year and a 13.4% increase over 2018’s total.  Many of the plans are heavily subsidized by the federal government.

The spike comes as opponents continue trying to diminish or dismantle the controversial health-care law that was enacted nearly a decade ago. The efforts include an ongoing federal lawsuit, supported by President Donald Trump, that seeks to strike down the law and recent federal and state moves to expand the use of cheaper, stripped-down plans available outside of the exchange.  

But advocates and providers who support the ACA say the newly released numbers show the exchange is working as planned. 

“Overall, this is a story about stability and that is very positive news,” said Josh Peck, who served as  healthcare.gov’s chief marketing officer during the Obama administration and now works for Get America Covered, a nonprofit that backs the law. “This looks to be one of the most stable years we have seen under the Trump administration.” 

What’s Driving the Increase 

Oklahoma is one of 38 states that use the federal exchange. Enrollment numbers for many of the 12 state-run exchanges haven’t been counted because they have different enrollment periods.

The Centers’ preliminary numbers for federal exchange states show about 300,000 fewer Americans purchased plans than in the previous year. But federal officials said that enrollment trends overall “remained stable” when all factors are considered. Among those are thousands of people moving from ACA coverage after their state expanded Medicaid and New Mexico switching to a state-run exchange.

Oklahoma is one of 11 states that saw an increase over last year. Only Florida, Iowa and Mississippi saw larger increases.

Peck said many factors can impact the enrollment numbers, but the addition of a third insurer to the market, Bright Health, could be among the reasons for Oklahoma’s growth.  

“We know that cost is the most important factor when it comes to selecting a plan,” he said. “And when insurance companies go into a new market, there are more options.” 

Gayla Machell is a project coordinator with Legal Aid of Oklahoma, which served as a federally funded navigator to help consumers find and enroll in plans during the open enrollment period. 

She agreed the increase in low-cost plans was likely a reason for this year’s spike. But she said even in the seventh year of the exchange, many Oklahomans who are eligible for significantly subsided plans likely missed out on coverage because they lacked information or had the wrong information. 

“We are able to do little promotion, so it’s mostly word of mouth still,” she said. 

Peck blamed this on the Trump administration’s moves to slash funding for outreach, advertising and navigators. 

“This administration has not let up its attacks on the ACA and open enrollment,” he said, adding that further actions to eliminate the individual mandate and some cost-sharing provisions also are hampering success of the marketplace. “If it wasn’t for all that, we can only imagine how many million more could have coverage.” 

In a statement after the release of the preliminary numbers for 2020 open enrollment, Centers Administrator Seema Verma called the ACA “fundamentally broken” and said “nothing less than wholesale reforms can fix it.” 

Verma rejected critics’ assertions that administration policies, such as slashing the open enrollment’s marketing and outreach budget, are undermining the health-care law.

“Far from undermining the Affordable Care Act – as some hysterical and inaccurate claims would have it – the Trump administration is making the very best of what remains a failed experiment,” she said. “For all our successes, too many Americans who do not qualify for subsidies still cannot afford premiums that remain in the stratosphere – constituting a new class of uninsured.” 

The Big Picture 

The increase of enrollment on the exchange alone is unlikely to lower Oklahoma’s uninsured rate much, which at 14.2% is second highest in the country next to Texas’ 17.7%. 

“We are thrilled more Oklahomans are being covered,” said Cassidy Heit, a spokeswoman for the Oklahoma Primary Care Association. “But there is still a long way to go.” 

Heit said expanding health coverage in the state not only would improve health outcomes for Oklahomans, but also would protect the financial health of the state’s health providers and community health centers, which have struggled in recent years.

Despite Oklahoma’s challenges over years in lowering the uninsured rate, Heit said she is optimistic now that Gov. Kevin Stitt and lawmakers have pledged to make this issue a priority.

Stitt and many lawmakers oppose a direct expansion, saying it could swell Medicaid enrollees to unaffordable levels, especially if the federal government later pulls back on its subsidies. Various alternative plans are being drawn up to recommend to legislators and the public.

Oklahomans could have an opportunity to take matters into their own hands. A citizen-led group secured enough signatures to get a state question on the ballot this year that will ask voters to expand Medicaid and add health coverage for an estimated 200,000 low-income Oklahomans.  

Peck said this is one of Oklahoma’s top options to make significant gains toward insuring more people. 

“For me, it seems criminal for a state to refuse money to help its lowest income citizens get health care,” he said. “We are pleased that about the growth in the marketplace, but in reality, it’s a drop in the bucket compared to what Medicaid expansion can do.”

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