Even as it seeks to have the Affordable Care Act declared unconstitutional, the Trump administration on Monday reported that about 11.4 million people signed up for coverage in 2019 on the act’s state- and federally run exchanges.
That represents a dip from about 11.8 million in 2018, defying fears of a more precipitous drop after the Trump Administration cut promotion and outreach efforts and Congress eliminated the tax penalty for not having coverage.
In Missouri, final figures show enrollment fell to 220,461 in 2019 from 243,382 in 2018, a 9.4 percent drop. In Kansas, enrollment fell to 89,993 from 98,238, an 8.4 percent drop. Both states use the federally run exchange, Healthcare.gov.
The Centers for Medicare & Medicaid Services (CMS), which oversees the health law, also known as Obamacare, said in a news release that the national numbers showed enrollment remained "steady" and represented "a minimal decline" – a contrast to claims by the president that Obamacare is collapsing.
Average premiums fell by 1.5 percent, the first time that premiums have declined since the law went into effect in 2014. In 2017, average premiums rose by 23 percent, according to CMS, and in 2018 they rose by another 31 percent. Most of the people who get coverage on the exchanges qualify for tax credits to reduce their premiums.
"This small decline in premiums in 2019 moves in the right direction, but, for unsubsidized people, premiums remain considerably higher than before the (law's) main requirements were implemented in 2014," CMS said.
On Monday, the Trump administration asked a federal appeals court in New Orleans to strike down the entire Affordable Care Act. The move, which reverses the administration's previous position seeking only to invalidate the law's protections for people with pre-existing medical conditions, came in a lawsuit filed by Republican attorneys general and governors seeking to have the law declared unconstitutional.
In December, a federal judge in Fort Worth, Texas, sided with them, finding that Congress' elimination in 2017 of the tax penalty for not having health insurance coverage rendered the entire law unconstitutional.
Democratic attorneys general appealed the ruling, and on Monday the Justice Department, in a departure from the Trump administration's previous position, said the appeals court should uphold the judge's position.
If the appeals court does that, millions of people who obtained private insurance through the exchanges and the expansion of Medicaid could lose their health insurance.
Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.