On Dec. 15, open enrollment under the Affordable Care Act for 2018 will come to a close. Unless you experience a major life event, you will not be able to enroll for health care through HealthCare.Gov until the next calendar year. The reason for this comes down to economics — if you can enroll in health insurance anytime, it would risk crippling the entire insurance system.
Essentially, it's all a risk-based system. If people could enroll in health insurance at any time, there's a significant possibility that they may not do so until they absolutely need it, like when they find out they're sick or when they suffer a major injury. It may seem obvious that always having health insurance is a good idea, but for many people it's a very costly service. The monthly payments are frequently hundreds of dollars, and the price is even higher when a plan covers more than one or two people.
Open enrollment periods exist to make sure healthy people to register for health insurance whether or not they know they will need it in the coming year. Health insurance systems rely on the monthly payments (also known as premiums) that its subscribers pay in to maintain its cash "risk pools." When a person needs their health insurance provider to cover some of their expenses, that money comes from the pool that all the other health insurance users covered under that company's plans are paying into.
If people only signed up for health insurance when they knew they would absolutely need to draw on the dollars stored in those risk pools, then there might not be enough money to go around. Open enrollment periods make sure that the risk pool stays stable and consistently funded. (It's a major reason why mandatory health insurance enrollment is a thing.)
Under the ACA — or Obamacare, as it's also known — there are exceptions to the open enrollment period. For example, someone who is pregnant, recently had a child, lost their insurance due to a divorce or job change, recently left prison, or adopted a child can apply for a special enrollment period. This special enrollment period is also an option for those who have recently moved out of their previous zip code, had someone on their plan die, or for someone who has recently left prison.
Under President Obama, the open enrollment period under the ACA was twice as long, and the administration enthusiastically advertised it and encouraged eligible Americans to sign up. Under President Trump, who has made repealing the ACA one of his top goals, the open enrollment period was halved. Additionally, the advertising budget for the open sign-ups was cut by at least 90 percent. However, despite these attempts to temper the marketplace, millions of Americans have signed up since open enrollment began on Nov. 1.
Nearly 1.5 million people reportedly signed up in the first week of this period alone. And by the beginning of the final week for open enrollment, nearly 4.7 million people had registered through the HealthCare.Gov portal.
Trump has repeatedly referred to Obamacare as a "disaster," and has sworn over and over again that it is doomed to fail. In fact, however, enrollment is reported to have surged during this round of open sign-ups — people are registering for health care under ACA at a higher rate than expected.
Overall, though, less people are expected to enroll than have in previous years — largely because of the limited window. While this can't be helped now, the fact that people enrolled so quickly indicates that, despite the White House's attempts to sabotage the health care program, Americans are utilizing it, enthusiastically.