Administrative Burden

the actions of the Trump administration have likely led to enrollment declines. Between 2016 and 2018, enrollment declined from 12.7 to 11.8 million. Although states that ran their own exchanges saw a total decline of 3 percent, representing one hundred thousand people, the decline in federally run exchanges was 9 percent, or nine hundred thousand. Indeed, states that ran their own exchanges saw no decline in enrollment between 2017 and 2018, but those that participated in the federal exchanges saw a drop of five hundred thousand. 54 In short, states found ways to stem the decline of enrollees despite the opposition of the federal government.