Health Reform WK-EDGE Unsubsidized health insurance market enrollment declines significantly
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Wednesday, August 21, 2019

Unsubsidized health insurance market enrollment declines significantly

By Cathleen Calhoun, J.D.

Enrollment has declined, but by how much?

CMS has outlined health insurance market enrollment trends for people who purchase health insurance, including those with and without advanced payments of the premium tax credit (APTC) subsidies. The report includes national as well as state-specific, average monthly enrollment covering plan years 2014 to 2018. The report points out that enrollment has declined significantly on both the state and national levels and breaks down the changes by years (CMS Letter, August 12, 2019).

National trends. APTCs first became available in 2014, and from 2014 through 2016, enrollment rose each year. In 2014, the average monthly enrollment in the individual market was about 8.4 million members, of which 4.6 million enrolled with APTC subsidies and 3.7 million enrolled without APTCs. In 2015, enrollment rose to 13.6 million members (63 percent) and rose another 7 percent in 2016 to 14.5 million members.

The trend reversed from 2016 to 2017, when enrollment declined by 10 percent. From 2017 to 2018, enrollment decreased another 7 percent. The report notes that the decline in enrollment in 2017 and 2018 occurred at the same time as monthly premiums increased significantly.

Between 2017 and 2018, the decrease in enrollment occurred exclusively among individuals who did not receive APTC subsidies. Unsubsidized enrollment dropped by 24 percent, and APTC subsidized enrollment increased by 4 percent.

For the two-year period from 2016 to 2018, unsubsidized enrollment declined by 2.5 million people (a 40 percent drop nationally).

State level trends. The trend across the states is continual decline after 2015. From 2014 to 2015, every state experienced growth in average monthly enrollment. From 2015 to 2016, ten states saw a decline, and the decline was greater in the unsubsidized portion of state markets. The decline accelerated in 2017 to 44 states, and 43 states saw a decline in 2018.

Overall, from 2016 to 2018, the percent change in unsubsidized enrollment ranged from a drop of 0.4 percent in Rhode Island to a 91 percent drop in Iowa.

Other states with large declines in unsubsidized enrollment from 2016 to 2018 were:

  • Arizona (-79 percent)
  • Nebraska (-78 percent)
  • Tennessee (-76 percent)
  • Georgia (-71 percent)
  • Oklahoma (-71 percent)

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