美国国家公共电台 NPR ACA Sign-Ups Have Lagged For 2019. But What Does That Mean?（在线收听）

DAVID GREENE, HOST:

Tomorrow is the deadline to sign up for health insurance on the federal government's HealthCare.gov marketplace. So far, people are choosing health plans at a slower pace than in previous years. NPR's Alison Kodjak reports that it's hard to determine what to make of these numbers.

ALISON KODJAK, BYLINE: Former President Barack Obama released a video earlier this week urging people to shop for health insurance on the Affordable Care Act exchange.

(SOUNDBITE OF ARCHIVED RECORDING)

BARACK OBAMA: Hi, everybody. Well, it is that time of year again.

KODJAK: After Obama's video came out, there was a bump in sign-ups. But overall this year, enrollment in the individual market is lagging. At the end of last week, about 4.1 million people had chosen a health plan on HealthCare.gov. That's about half a million fewer than at this time last year.

ROSEMARIE DAY: I hate to panic, but I do think we're going to come in low.

KODJAK: That's Rosemarie Day, who is the founding COO of Massachusetts' state exchange which launched in 2006. She blames the lower enrollment on the Trump administration's decision to cut the advertising budget for open enrollment. She says ongoing outreach is crucial to make sure people who need insurance know where and when to get it.

DAY: Really the individual market is very volatile because people are in and out of needing that kind of coverage. So there's always potential for new customers who may have really never paid that much attention to the exchange because it wasn't something that they needed. It wasn't really on their radar until they did need it.

KODJAK: The Department of Health and Human Services says it did some advertising on local TV and radio and in print media and sent out more than 600 million emails and text messages to potential consumers. It's hard to say whether the slower sign-ups today mean fewer people will have insurance coverage next year. Katherine Baicker, an economist and the dean of the University of Chicago's School of Public Policy, says some Trump administration policy changes, like eliminating the penalty for not having coverage, could depress sign-ups. At the same time, though, the unemployment rate fell to the lowest level in almost 50 years, which Baicker says usually means more people have insurance through their jobs.

KATHERINE BAICKER: We don't yet know what share of those people would have been getting insurance on the exchange otherwise.

KODJAK: It's also hard to know how many people are just sticking with the plan they have now. Those numbers will be available next year. Another factor in making the numbers hard to read - Virginia is allowing more adults to get coverage through Medicaid, including some who used to get insurance through HealthCare.gov. Virginia's Health Secretary Daniel Carey says so far, about 140,000 Virginians have enrolled in Medicaid as part of the new expansion.

DANIEL CAREY: Given the copays and the deductibles in the exchange plans, you know, Medicaid for the individual is - you know, is a much better deal. So if they do qualify, we certainly encourage them to enroll in Medicaid.

KODJAK: The bottom line is how many people end up with coverage, says Chicago's Baicker.

BAICKER: If fewer people are signing up in the individual market because more people are getting insurance through their jobs, that may be a very good news story for those people. If fewer people are signing up through the exchanges because they're going to end up uninsured, that's a very bad news story for those people.

KODJAK: Consumers have until midnight tomorrow to pick an insurance plan on HealthCare.gov. Alison Kodjak, NPR News.