Last week HHS released final numbers for health care enrollment through the ACA. Overall enrollment this year was 11.8 million, a 3.3 percent year-over-year decrease. A decrease that many see as undercutting claims that the exchanges are collapsing. Perhaps most significantly, the report shows that premiums did increase significantly but the offset purchasers received through tax credits significantly reduced what families paid.

Premiums went up by more than 30 percent in 2018 going from an average premium was $621, up from $476 last year but 83 percent of shoppers received subsidies that partly or fully protected them from those premium hikes. For customers receiving subsidizes the average monthly payments were $89, down from $106 last year. There was a decline in younger buyers, the “young invincible” with people under age 35 dropping by 26 percent but it also showed third-quarters of purchasers shopping for policies and not simply letting policies automatically renew.

Overall the picture is of a government system that withstood attacks from the government through the actions of HHS and the President. The Congress has failed to renew one set of subsides to the industry that help hold down premiums and it doesn’t appear that will happen any time soon if at all. It was a priority for Senator Susan Collins (R-ME) who had received a commitment from Majority Leader McConnell to vote on the matter in exchange for her support of the tax cut. The failure to act (which got bogged down in an abortion-language debate) will likely add to premium increases shortly before this year’s election.