Andrew Sprung raises a very interesting point about ACA enrollment:
enrollment in the ACA marketplace as a whole in the Open Enrollment Period for 2023 is on pace to finish about 13% higher than in OEP 2022, enrollment in the eighteen states that run state-based marketplaces (SBMs) is on course to come in about 3% below the OEP 2022 total.
This is WEIRD!
If you had asked me in October if I thought the Healthcare.gov states would have higher enrollment growth than State Based Marketplaces (SBM), I would not have been surprised if that was the case. I could tell you a story that SBM states all had expanded Medicaid so the pool of plausible enrollees is smaller. I could say that the wrap-around subsidies that SBM states have enacted mediate the effect of the enhanced ARPA/IRA subsidies a bit. I could say that the SBM states aren’t experiencing a substantial information infusion through increased advertising and navigator funding that has only turned back on in Healthcare.gov states as the SBM states had kept that constant(ish) over the Trump administration.
I could tell that story which could explain a general growth in enrollment with more growth in the Healthcare.gov states that are heavily exposed to zero premium silver plans.
But that is not the story that we actually see.
I don’t have a good initial story that explains why Healthcare.gov enrollment went up substantially but SBM enrollment is down a smidge.
Any good ideas?
Victor Matheson
How about – states running their own show had higher enrollment to start so not much room for growth. States on the national marketplace were lagging in enrollment so had room to grow. Kind of a low-hanging fruit argument.
David Anderson
@Victor Matheson: I could buy that if the SBMs were flat or up slightly. The decline is what seems to be puzzling to me.
narya
Is there any interaction with unemployment rates by state? more people getting jobs that have insurance would lower marketplace enrollment, I imagine.
Starfish
I wanted to ask what narya asked. Were people who were unemployed during the pandemic more likely to find employment?
West of the Cascades
I found this fact about the data sort of interesting/odd:
(for Healthcare.gov) The returning consumers count doesn’t currently include consumers who have been automatically re-enrolled in their current plan for 2023 coverage.
(for SBMs) The returning consumers count doesn’t currently include consumers who have been automatically re-enrolled in their 2022 plan or an alternate suggested plan.
I get health insurance through New Mexico’s BeWellNM marketplace. The insurance company I used last year exited the NM market for 2023, so the marketplace automatically re-enrolled me in an alternate suggested plan with a different company. Had I done nothing, I would not have counted as a “returning customer” under this definition. I did actively go in and select a different plan (with the same new company), so I would count as a “returning customer” per this definition.
But if I had been on Healthcare.gov, in the default scenario (without an active choice on my part) I would have been counted as a “returning customer” because I would have been enrolling in the alternate suggested plan the marketplace reenrolled me in.
So I wonder if that slight difference in how the data defines a “returning customer” suppresses some of the figures for SBMs?
Mai Naem mobile
Here’s some anecdats. I have a Hispanic friend who initially enrolled in the ACA when there were decent subsidies. Once the subsidies went he just went without insurance. Once the subsidies came back he went back on and he mentioned how there were a lot of ACA ads on Spanish media. Also you mentioned several posts ago that healthcare.gov enrollment was basically a story of Fl, NC, Texas and GA. I am wondering if the economy being hot(according to their governors) in those states leads to higher enrollments.
Frank Wilhoit
@David Anderson: Surely the decline is noise? We won’t know until next year.
David Anderson
@Frank Wilhoit: Not sure — off of a sample of ~11 million (Healthcare.gov) and <5 million (SBMS) for 2022 enrollment, noise is tiny — a meaningful signal is likely at +/- 1% of total enrollment.
FlyingToaster
For Massachusetts, I suspect it’s a combination of 1) unemployment drop — there isn’t a store/restaurant/gas station without a help-wanted sign hereabouts — which with corporate entities includes health insurance off-exchange and 2) population drop. We’ve seen a number of folks whose employers are at “fully remote and we rent one office space for meetings/team gatherings” (waves). So a number of employees and contractors (waves again) who used to live in the exurbs are now living in Vermont or Maine, and commuting in one day a month. ‘Way cheaper, and often you get the same level of schools/amenities with twice the property.
I moved one (more expensive) town over, and we’re on my spouse’s (corporate) insurance; but several colleagues left the state, and hence left MassHealth.
MassHealth has a very good outreach for parents — every school or school district hits you up the first week of September, trying to enroll your family. So I don’t think it’s a matter of outreach, here.
Other states’ mileage are likely to vary.
Yutsano
@FlyingToaster: I was just up in Canada, and it makes me wonder if the labour shortage is international. I saw lots of help wanted signs and not just for restaurants.
Barker
@West of the Cascades: Footnote [1] actually says the opposite but is also identical to last year’s footnote [3].
The final sentence of the fact sheet also confusingly has: “SBMs have reported the following data on plan selections for auto re-enrolled consumers.” with no follow-up
Hard to draw any conclusions given the conflicting fine print