The Trump Effect: Postinauguration Changes in Marketplace Enrollment

Area of Science:

• Health policy research
• Public health economics
• Healthcare access studies

Background:

• The Affordable Care Act (ACA) aimed to expand health insurance coverage.
• President Trump's administration signaled intent to repeal and replace the ACA.
• Policy changes and messaging can influence health insurance enrollment.

Purpose of the Study:

• To quantify the impact of the Trump administration's initial actions on Health Insurance Marketplace enrollment.
• To analyze the immediate effects of political messaging and policy changes on ACA enrollment.

Main Methods:

• Utilized difference-in-differences and event-study models.
• Analyzed weekly county-level Marketplace application data from 1,476 counties across 37 states.
• Focused on the post-inauguration period of the 2017 open enrollment.

Main Results:

• Estimated a population-weighted decline of over 700 applications per county-week in the final two weeks of the 2017 open enrollment period.
• Observed a nearly 30% decrease in submitted applications.
• A flexible event-study approach confirmed a similar decline of approximately 660 applications per county-week (-24%).

Conclusions:

• The incoming administration's lack of political support for the ACA had an immediate and significant negative effect on national Marketplace enrollment.
• Policy uncertainty and reduced outreach likely contributed to decreased enrollment.
• These findings highlight the sensitivity of health insurance markets to political actions.