An Anatomy of Open Enrollment in the Exchanges (11/1/16 to 1/31/17)

Open Enrollment in the Exchanges (11/1/16 to 1/31/17)


Despite the best efforts of the Trump candidacy and Trump Presidency to dissuade Americans from enrolling in the Exchanges, they seem to have had little effect so far. Enrollment has grown from 8 million in 2014, to 11.7 million in 2015, to 12.7 million in 2016, to 12.2 million in 2017. In state based Exchanges like California, enrollment grew from 2.6 million in 2014 to 2.9 million in 2015, to 3.1 million in 2016 and to 3.1 million in 2017. In other words within a steadily improving economy, with ever more people at work, Exchanges are holding their own and proving their mettle.

Thirty-one percent of enrollees in 2017 were new enrollees.  So the Exchanges are remaining vitally attractive in the individual marketplace. Eighty-three percent (five in six) were using premium assistance tax credits and 58% (six out of ten) were using the tax credits to reduce their cost sharing (copays and deductibles).

Rural and lower income voters are heavily using the program. Eighteen percent of subscribers were rural; 71% had incomes lower than 250% of the federal poverty level, and another 17% had incomes below 400% of the FPL.

Few (only 1%) are buying catastrophic coverage; three fourths are buying silver (covers 70% of expected medical costs) coverage, and more than one in five (21%) are buying bronze coverage (covers 60% of expected medical costs). Those buying silver coverage can also receive tax credits to reduce their copays and deductibles, and nearly 60% of all exchange participants are applying for and receiving tax credits to reduce their copays and deductibles.

For those selecting silver (6.2 million persons), the tax credits paid $385 per month for their coverage and the individuals paid $101 on average. For those selecting bronze, the tax credits paid $341 per month and the individuals paid $98 on average.

Twenty-seven percent of subscribers are over the age of 55; 36% are ages 35-54; and 37% are under the age of 35. Those percentages changed less than 1% between 2016 and 2017, so there is little evidence of increasing adverse selection by age.

Sticker shock awaits these Exchange members if the Republican House Proposal passes. For a 64-year-old making $26,500 a year, under the Affordable Care Act (current law) their coverage on average costs $15,300; their tax credits are $13,600 and they pay $1,700 (6.4% of their income). Under the House Republican proposal, their coverage costs $19,500; the tax credits are $13,600, and their share of premium is $14,600 (55% of their income).

This bill has been jammed through three House Committees without even so much as a CBO analysis before the first two committees. The leadership is now buying votes with Amendments, such as the Buffalo bonanza that shifts Medicaid costs from upstate New York counties to the state government, and the premature (2018) Medicaid block grants to certain states all of whom are woefully unprepared for such unparalleled and unaccountable discretion. The President is threatening members.

This needs to be defeated and sent back to committees for careful consideration, debate and necessary compromises.


Prepared by: Lucien Wulsin

Dated: 3/21/17

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