Health Care

Obamacare enrollment down about twice as much in Kansas and Missouri as nationwide

Enrollment in insurance plans under the Affordable Care Act, or Obamacare, are down nationwide. But they’re down more in Kansas and Missouri.

In the first open enrollment period since Republicans removed the tax penalty for not having insurance, about 4 percent fewer Americans nationwide chose plans on than the year before. In Kansas and Missouri, enrollment was down almost 10 percent, leaving advocates concerned that more people may be risking going without coverage.

“Hopefully there were more people insured through their employer or they went about getting insurance other ways,” said Katrina McGivern, policy and public affairs director for the Kansas Association for the Medically Underserved. “We certainly don’t like people to be uninsured.”

When the open enrollment period for 2019 coverage ended Saturday, about 90,000 Kansans and 223,000 Missourians had signed up. Last year’s open enrollment drew about 98,000 people in Kansas and 243,000 in Missouri. This year’s numbers were the lowest seen in either state since the ACA’s first open enrollment period in 2013, which was beset by problems with the federal website’s rollout.

The website functions well now, and some people who qualify for income-based subsidies can get high-deductible plans without paying any premiums.

But premiums have risen steadily for those who don’t qualify for subsidies, making it more tempting for them to go uninsured, especially now that there’s no financial penalty for doing so.

The Trump administration also expanded access to “short-term” insurance plans sold outside of Obamacare that are often cheaper because they don’t have to cover pre-existing conditions or other things mandated by the ACA.

Since taking office in 2017, Trump has also sliced the federal budget for advertising open enrollment and for navigators to help people select a plan and see if they qualify for subsidies.

McGivern, whose organization trains navigators in Kansas, said the United Methodist Health Ministry Fund and Kansas Health Foundation had stepped in with grants to replace some of the lost federal money.

“Those were all a huge benefit to the program and to help with outreach across the state,” McGivern said. “We’re very lucky to have that funding.”

But she said uncertainty about the status of the law continues to be a factor in depressing enrollment. Republicans have tried repeatedly to repeal it, without success. A federal judge in Texas ruled it unconstitutional on Friday, the day before the end of open enrollment this year.

That decision is expected to be appealed and doesn’t immediately affect enrollment. But McGivern said it wasn’t clear how many people knew that.

“We got a few questions on that from the public about ‘What’s this mean?’” McGivern said.

The 2019 enrollment numbers are preliminary and may be revised slightly upward, because people who called into an enrollment center before the 11:59 p.m. Saturday deadline and had to leave a message due to high call volumes are considered still “in line” and able to enroll.

After the problem-plagued first year, open enrollment had never been lower than 96,000 people in Kansas and 243,000 people in Missouri. Both states had their highest enrollment at the end of 2015, when 101,555 Kansans and 290,201 Missourians signed up for 2016 coverage.

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.