The Health Of The Affordable Care Act As another ACA deadline looms, NPR's Lulu Garcia-Navarro talks with reporter Mary Agnes Carey of Kaiser Health News about the health of Obamacare under the Trump administration.

The Health Of The Affordable Care Act

The Health Of The Affordable Care Act

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As another ACA deadline looms, NPR's Lulu Garcia-Navarro talks with reporter Mary Agnes Carey of Kaiser Health News about the health of Obamacare under the Trump administration.


Today is the last day of open enrollment for 2020 under the Affordable Care Act, also known as Obamacare. It's helped provide health care coverage for millions of Americans. Republicans have long been trying to weaken Obamacare, both in and out of court.

And for a checkup on the health of the law itself, we're joined now by Mary Agnes Carey of Kaiser Health News. Hi.

MARY AGNES CAREY: Thanks for having me.

GARCIA-NAVARRO: So remind us who this deadline affects.

CAREY: It affects everyone who's currently enrolled in the Affordable Care Act. It affects people who have been thinking about it, perhaps want to check it out. And they can start at if they want to take a look.

GARCIA-NAVARRO: And what have you seen during open enrollment this time around when it comes to how many people are signing up?

CAREY: Overall, it's down about 6% at this point. However, the number of people who are coming back and actively renewing - that number has been increasing, particularly in the last week's snapshot of numbers, as well as new people coming into the exchange.

So the thought is there's always a last-minute rush. There always has been every single year - that that will perhaps accelerate enrollment or at least keep it stable where it has been. And we have to remember, if you are currently enrolled in an Affordable Care Act plan and you do nothing, you'll be automatically reenrolled.

GARCIA-NAVARRO: What are the possible reasons, though, that the overall enrollment was down from last year?

CAREY: There could be a lot of factors that have been ongoing for last couple of years - big drop in advertising from the federal government. That has been down 90%. The navigators, the assisters - this is the on-the-ground, one-on-one help - that has dropped. There certainly have been a lot of concern, a lot of talk from President Trump and Republicans, opponents of the health care law - that it's a failure, that it doesn't work. People may simply be confused about it. That could certainly be part of it.

But another factor is for people who don't get a subsidy - that's some of the cash assistance - policies in the Affordable Care Act have been unaffordable and might continue to be so for them. So there's a variety of factors, if you will, involved in that.

GARCIA-NAVARRO: As we mentioned, the Republicans have repeatedly tried to weaken the ACA. Among other things, they've eliminated the individual mandate that required everyone to have health insurance or pay a penalty. The Trump administration expanded access to these short-term plans, right? They're...

CAREY: Exactly.

GARCIA-NAVARRO: ...Sort of less comprehensive.

CAREY: Right.

GARCIA-NAVARRO: They don't give you a lot of coverage.

CAREY: They don't have to be as comprehensive as the ACA plans.

GARCIA-NAVARRO: Right. And it's allowed states to require Medicaid beneficiaries to prove that they either work or go to school. I imagine that those - I imagine that all this has had quite a significant effect on Obamacare.

CAREY: No, I think they can. I want to - for example, the work requirements have been somewhat of an issue. They've been challenged in court and so on. But in Arkansas, for example, 18,000 people lost their health insurance under the work requirements. And part of the thought was, people didn't know about it. The information campaign wasn't out there. State officials were trying to correct that.

But the thing to note is that most Medicaid beneficiaries live in a home where people work. And something like 6 out of 10 Medicaid beneficiaries already have a job. So the whole issue of work requirements has been debated whether - is it really worth the investment financially that states are making? - because many of these folks are already working.

GARCIA-NAVARRO: And then there's, of course, been this concern for quite some time about the number of insurers per state. A number of places were down to just one or two available providers. And those numbers have gone up, haven't they?

CAREY: They have gone up. While the average premium has dropped about 4% for 2020, nearly 7 in 10 people will have access to at least three marketplace plans, and that's up from 6 in 10 a year ago.

So insurers who may have left the marketplace because of all the turmoil - whether it was the drop in the advertising or the outreach or the government stopped spending money on these cost-sharing subsidies to help beneficiaries, some of the lower income ones with out-of-pocket costs - that basically, insurers who may have stepped out have now stepped back in. They've seen it's a profit-making enterprise. They can do well in the Affordable Care Act marketplace, and they've come back in. So the number of options available has - they are increasing for 2020.

GARCIA-NAVARRO: What would you say the health is of the ACA right now?

CAREY: I think it is resilient. I mean, you've still got about 20 million people that have received coverage either through the Affordable Care Act exchanges or through the Medicaid expansion. So you mentioned earlier the political fire, the dozens of attempts by Republicans in the House to repeal all or part of the Affordable Care Act, its failure to - for Republicans to repeal it in the Senate. After all of this, the law is still there and is still standing.

GARCIA-NAVARRO: And polls show that most people actually support Obamacare now.

CAREY: Right. It has grown. My polling colleagues at the Kaiser Family Foundation have found that the favorable rating, if you will, has clicked up. It's at about 52%, and the unfavorable about 41%. And that is a change from prior years.

GARCIA-NAVARRO: That's Mary Agnes Carey of Kaiser Health News. Thanks so much.

CAREY: Thank you.

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