At the Health Affairs Blog, I looked at the on-Exchange enrollment changes in 2018 stratified by the type of exchange and the state strategy for dealing with the termination of Cost Sharing Reduction (CSR) subsidies.
This is the money exhibit:
Unsurprisingly, to me at least, pricing matters. Silver Loading, the CSR strategy that placed all of the CSR costs into the Silver plans, saw the comparatively best results. I believe this is because Silver Loading strategies lowers the relative price of Bronze and Gold plans while holding Silver plan premiums constant for subsidized buyers. Lower prices for two plan categories and constant pricing for the third should lead to some increased demand.
Silver Loading was not a panacea for enrollment. Silver Loaded states saw a 3% enrollment decline as a whole but there were some states with significant enrollment gains. I thought that the split in experience between Healthcare.gov states and state branded website states to be interesting as well. I am using state branded websites as a mental proxy for local support for the ACA (Idaho is a notable exception). I think that local support and better pricing will produce better results than less local support and more federal counter-messaging to enrollment despite better pricing.
But the short story is the expected story: prices matter.
Amir Khalid
I don’t know why, but your graph isn’t loading for me.
Yutsano
@Amir Khalid: Same. I thought maybe it was the browser but I’m not even getting the metadata.
Yarrow
@Amir Khalid: It’s not loading for me either. I clicked through to the linked article and there are several images, but I’m not sure if one of those is the one that’s supposed to be linked here.
Edit: Looks like it’s fixed now.
Yarrow
David, I have a question. As a consumer going on the exchange looking for a health insurance plan, are we supposed to be able to see Silver Gap vs Silver Loading vs whatever else kind of Silver plan? As far as I could tell, the plans were just gold, silver, bronze.
David Anderson
@Yarrow: No, you won’t see anything labelled as Silver Load or Silver Gap.
You’ll see Silver plans with a premium and everything else is language that nerds have developed to describe the relationship and rationale of Silver prices to everything else.
dnfree
There was an article from the Washington Post today about how most people believe the individual market is failing. (Most people of course don’t follow Balloon-Juice.) What ways are there to inform the general public of the situation, and what’s working and what isn’t, and how it should be improved? This is one of the biggest failings of the news media.
https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/04/03/the-health-202-half-of-americans-think-obamacare-marketplaces-are-crumbling/5ac26e2b30fb042a378a301e/
David Anderson
@dnfree: Pricing in November when people enter their information and see their premiums about the same as last year if they get subsidies.