Obamacare sign-ups for 2019 off to a slow start

(CNN) — Fewer people are rushing to sign up for Obamacare for 2019.

Nearly 1.2 million Americans selected plans in the first 10 days of open enrollment this year, compared with nearly 1.5 million in the first 11 days last year, according to federal data released Wednesday. The average number of sign-ups per day is about 12.5% lower than last year.

Last year, with the Affordable Care Act fresh off the threat of being repealed, people rushed to sign up in the early days of open enrollment. Ultimately, nearly 11.8 million people selected coverage on the federal and state-based exchanges during a shortened enrollment period. That was down only 3.8%, much less than some advocates of the health care law had feared.

While it’s still too early to draw conclusions about this year’s enrollment, which runs through December 15 in most states, health policy experts fear the numbers could drop further.

“It’s likely real,” said Eliot Fishman, senior director of health policy at the left-leaning Families USA and a former Obama administration official. “It’s certainly not a surprise.”

The main reasons why: the repeal of the individual mandate penalty and the availability of alternative policies that cost less but offer skimpier benefits.

Starting in 2019, people will no longer face a penalty for not having health insurance. Congress effectively eliminated the individual mandate by reducing the penalty to $0 as part of the 2017 tax cut bill.

Also, the Trump administration made it easier for people to sign up for coverage that doesn’t have to adhere to all of Obamacare’s rules, such as short-term health plans. These policies, which last just under a year, typically have lower premiums, but they can also exclude those with pre-existing conditions or charge them more. And they generally don’t offer as comprehensive benefits as those found on the Affordable Care Act exchanges.

The Trump administration has also pulled way back on advertising open enrollment, despite studies that show that it helps drive people to sign up. It will spend $10 million on advertising this period, the same as last year but a massive drop from the $100 million the Obama administration spent in 2016. States that ran their own exchanges and kept up their marketing campaigns saw better enrollment results.

Plus, unlike last year, Obamacare is not in danger of being repealed — especially now that the Democrats captured control of the House in the midterm elections last week. But this means the open enrollment period is not in as bright a spotlight, so fewer Americans may even realize that they have to sign up now.

People will get less assistance signing up for coverage, which research has also shown to be important. The administration awarded only $10 million to 39 navigator groups, which help consumers shop for policies on the exchanges. That’s down from $36 million last year and $63 million in 2016. And the budget cut comes at a time when people need more guidance since there are more options now in the individual market.

“The effect of another year with minimal outreach, limited navigator funding and an administration actively working against enrollment is greater than the sum of its parts,” wrote Joshua Peck, co-founder of Get America Covered and a former Obama administration official. “These actions impact awareness of deadlines and availability of affordable plans.”

Still, there is one big bright spot; Americans who do shop on the exchanges will likely find lower premiums and more insurers offering policies. The average rate for the benchmark silver plan will dip about 2%. Some 155 insurers are participating in 2019, up from 132 this year.