ACA Marketplace Enrollment Falls to 9.9M, U.S. Says

Health Insurance Report™ helps you track and analyze legal, legislative, and regulatory developments affecting the health-insurance industry throughout implementation of the Affordable Care Act...

By Sara Hansard

Sept. 8 — About 9.9 million people got health insurance coverage through the marketplaces set up by the Affordable Care Act as of June 30, a decline from earlier in the year though still higher than the Obama administration’s target.

About 84 percent got government subsidies to buy the coverage, getting an average of $270 a month, according to data released by the Centers for Medicare & Medicaid Services Sept. 8. Enrollment had been 10.2 million at the end of March.

The administration has set a year-end goal of insuring at least 9.1 million people via policies bought in the insurance marketplaces. People fall off the rolls when they stop paying for the insurance. Sometimes that means they’re getting coverage elsewhere, for instance because they’ve married or gotten a job that offers health benefits.

“Millions of Americans are benefiting from the peace of mind that comes with having quality coverage at a price they can afford,” Sylvia Burwell, secretary of the Department of Health and Human Services, said in a statement.

At the end of June there were 7.2 million consumers with effectuated enrollments, meaning they had paid monthly premiums for the plans, through the 37 federally facilitated marketplaces run by HealthCare.gov, including state partnership marketplaces and supported state-based marketplaces, and 2.7 million consumers enrolled through the remaining state-based marketplaces, the CMS said.

Financial Assistance

Nine of the 10 states with the highest rate of consumers receiving financial assistance had not expanded Medicaid programs under the ACA as of June 30— all except Arkansas, according to the fact sheet released by the CMS. Residents in the states that didn't expand with household incomes from 100 percent to 133 percent of the federal poverty level can qualify for coverage through the marketplace with advance premium tax credits (APTCs), it said. APTC eligibility ranges from 100 percent to 400 percent of the federal poverty level.

Of the 9.9 million consumers with enrolled in marketplace plans at the end of June, 68 percent were in silver plans that have average actuarial values of 70 percent, 21 percent were in bronze plans with average actuarial values of 60 percent, 7 percent were in gold plans with an average actuarial value of 80 percent, 3 percent were in platinum plans with an average actuarial value of 90 percent and 1 percent were enrolled in catastrophic plans that are primarily reserved for people under the age of 30 and people who can't afford other plans, the CMS said in the fact sheet.

From April 1 to June 30, enrollment through the federally facilitated marketplaces was terminated for about 306,000 consumers with citizenship or immigration status data matching issues who failed to produce sufficient documentation of their citizenship or immigration status, the CMS said. During the same time period about 734,000 households with annual household income inconsistencies had their APTC or cost-sharing reductions for 2015 coverage adjusted, it said.

Coverage Ended; Aid Adjusted

Overall as of June 30 “the Marketplace has ended 2015 coverage for approximately 423,000 consumers with 2015 coverage who failed to produce sufficient documentation on their citizenship or immigration status and has adjusted APTC and/or CSRs for about 967,000 households,” the CMS said.

The CMS releases marketplace state-by-state effectuated enrollment snapshots on a quarterly basis detailing how many consumers are enrolled, how many are benefiting from the advance premium tax credits and cost-sharing reductions, and the distribution of enrollment by qualified health plan metal level, which is the actuarial value of the plans.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com