The number of Louisiana consumers who picked an Obamacare health plan for 2018 through the online federal marketplace plunged 22 percent from last year to 111,373.
The 2018 sign-ups compare to 143,577 for this year's coverage, though those numbers shrunk by about 20,000 as people either failed to pay for their insurance or dropped out. By that count, sign-ups for 2018 are down by about 10 percent.
The Centers for Medicare and Medicaid Services said enrollment was down nationally, but sign-ups came in stronger than was expected after President Donald Trump and the GOP-led Congress repeatedly tried to take down the program.
About 8.8 million people have signed up for coverage next year under the Affordable Care Act, the government said Thursday. A detailed breakdown was not immediately available, but last year the 39 states, including Louisiana, served by the federal HealthCare.gov website enrolled 9.2 million people. Total national sign-ups won't be known for weeks, as some states with later deadlines continue to enroll customers.
Health insurance experts speculated on three possible reasons for the drop in Louisiana:
• A double-digit jump in premiums rendered the coverage too costly for people who may not have realized the increase was offset by an accompanying boost in federal subsidies.
• Consumers thought they didn't have to buy coverage for 2018 because the just-passed tax bill ended the individual mandate that people must have health insurance. The bill does end that requirement but not until 2019.
• Many more people realized they qualified for Medicaid than did a year ago, when the state first expanded the program.
There was just a lot of confusion among consumers, said Brian Burton, who heads Southwest Louisiana Area Health Education Center, a nonprofit that helps people enroll in health plans.
Close to 90 percent of Louisiana consumers qualified for a subsidy, Burton said. But when consumers got letters from their insurance company listing the premium increase, an average of 18.5 percent in Louisiana, the payment assistance wasn't adequately explained.
Even when people were told about subsidies they'd receive to offset premium increases, the message often didn't get through, Burton said.
A farmer who had always bought coverage through an agent, and not through Healthcare.gov, learned his monthly premium was increasing from $1,600 to $1,800, Burton said. The farmer decided to see if the center could help, and the navigators discovered that the farmer qualified for a subsidy that would have reduced his premium to $400 a month.
"But he didn't trust it. He wouldn't do it …. He didn't trust Obamacare," Burton said.
Whether that was because of all the political rhetoric or misunderstanding of what was included in the tax legislation, Burton didn't know. But the farmer chose to pay more rather than taking advantage of the federal subsidy.
Some say the shorter enrollment period, six weeks instead of nearly 13 a year ago, may have also played a part in Louisiana's lower enrollment numbers. Although the early enrollment numbers were ahead of last year, they say, time ran out before the 2018 numbers could match 2017's.
B. Ronnell Nolan, who heads Health Agents for America, said she doesn't know what had the biggest impact on enrollment.
"There's no doubt that there were more people signing up for Medicaid this time around," Nolan said.
Last year, lots of people heard that the state had expanded Medicaid, but many working-class residents didn't realize they qualified, she said. Many of the people who asked for help enrolling in an ACA plan were surprised to find that out.
Open enrollment ended at 11 p.m. Dec. 15. Nolan said she was still taking phone calls a half hour after that from people who wanted to buy an individual plan.
"Now we're trying to make sure people pay the first month's premium," she said, "because if they don't, that knocks them out of coverage for the whole year."
Nolan said what helped last year and will help this year is that agents didn't assume that just because a person picked a health plan that they would follow through on paying the premium. Instead, she and other agents got consumers to set up an automatic monthly draft on their bank account or got the insurance company to do so.
Still, more than 20,000 people who picked a 2017 plan either didn't pay their first month's premium or dropped out sometime during the year. It's unclear how many will drop out this year.