Yesterday, the Centers for Medicare and Medicaid issued a press release stating that ACA enrollment during Open Enrollment 2023 is just about 16.3 million people enrolled on the marketplaces. It is a record that beats 2022 which had beaten 2016
The Centers for Medicare & Medicaid Services (CMS) reports that 16.3 million Americans have signed up for 2023 individual market health insurance coverage through the Marketplaces since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1, 2022 through January 15, 2023. This includes 12.2 million plan selections in the 33 Marketplaces using the HealthCare.gov platform for the 2023 plan year, where the OEP ran through January 15, 2023, and 4.1 million plan selections in the 18 State-based Marketplaces (SBMs) in 17 states and the District of Columbia that are using their own eligibility and enrollment platforms, through January 15, 2023, which represents the end of the OEP for many SBMs
There is one massive upside factor for the ACA in 2023 that was not present in 20216. Subsidized plans are way cheaper. Subsidized Silver plans are way cheaper because of the combination of higher subsidies for a given income level and the removal of income caps for subsidy eligibilty due to the combination of the American Rescue Plan and then the Inflation Reduction Act. Not Silver subsidized plans are substantially cheaper due to Silverloading when CSR payments were stopped in 2017.
There is a massive downwards pressure on ACA enrollment since 2016. Medicaid Expansion has become much more common. Individuals who earn between 100% to 138% Federal Poverty Level (FPL) are eligible for either Medicaid or high value subsidies on the Exchanges. If a state expands Medicaid, these folks go to Medicaid. The under 150% FPL group is a very large group so the 100-138% group which faces zero premium plans is a huge source of enrollment. That pool has shrunk over time.
There are probably differences on partisan take-up. Actively opposing the ACA is not a core performative element of being conservative in 2023 while it was in 2016 and 2017. This may help boost enrollment. We have also seen navigator funding and advertising get flipped back on after substantial reductions or eliminations during the Trump Administration but those elements were humming at the end of the Obama Administration.
There is still a couple of days of enrollment left for a few State Based Marketplace states, so I would not be surprised if the final number for the end of the OEP is closer to 16.4 million rather than 16.3 million, but these are some of the factors at play right now on enrollment.
narya
The navigators are a BFD, I think. In IL, the primary health care association (supporting FQHCs) got a bunch of money last year to fund navigators; I’m pretty sure it was federal dollars. That is, the folks who are most likely to need help navigating are precisely the folks the navigators target. But that doesn’t explain the increases you mention. I’m just glad that folks are getting covered.
stinger
Do you mean “is no longer”? In the first seven years alone, Republicans tried at least 70 times to repeal or slash the ACA. As Wikipedia is my witness.
David Anderson
@stinger: yes, to be edited in a second!
David Anderson
@narya: I agree that navigators are really important (Myerson and Li have a great paper on this! https://www.journals.uchicago.edu/doi/full/10.1086/721569 )
But Navigators were going full tilt in 2016 and Navigators are going full tilt in 2023.
Navigators could explain a lot in a comparison of 2016 vs 2019 or 2023 vs 2018 but not 2016 v 2023
stinger
@David Anderson: 😊
StringOnAStick
Navigators were a critical condition for my husband and I being able to get ACA insurance; they are hugely important to help people with the complexity of obtaining health insurance, which is why the Orange Beast and company wanted them gone.
Martin
So, I think I’ve relayed this anecdotal information before.
Because I retired early, we went to the exchange for our insurance. Ms Martin was opposed to this, because in her mind, the exchange was for poor people. Took me a few days to bring her to a more accurate view.
The cost of the exchange also played a factor on whether I would retire at all, and whether I would take retirement at all. My employer, if I take retirement within 6 months of my separation date, would allow me to stay on my employee plans at their group plan cost. That was a pretty good price. But it would require me to start my pension at an unfavorable age. So there was some simple math to do comparing pension pay out now vs when I turn 60, and the delta between the exchange and what I would pay through my employer. This comparison was also easy to do because right after ACA passed, most CA public employee insurance plans aligned with the exchanges, in part because it would allow insurers to look at the exchange and these big group policies as a single risk pool (basically the state is offering to pay more for employees to subsidize the rest – a very oblique single payer mindset) and because it made public employees more mobile – I could retire early and get basically the same plan I had as an employee, reducing my decision tree size.
So with the subsidies set up for my salary level, the exchange was about $220 a month more than my employer plan for health and dental. That was quite a bit less than the difference in the pension payout, so we went with the exchange. We skipped the vision because there was a cheaper (quite a bit cheaper) plan that better fit our usage off exchange. It’s got a clearly worse actuarial value, but the value cut (new lenses every year) was a value that we never would have used – our prescriptions change very little from year to year and even when we could get lenses every year, we never once did.
The exchange and how the subsidies work did significantly change how we structure our income and expenses because cutting my income well below what my take-home was extremely valuable, so things like paying off the house tipped in favor because not taking income in order to pay a mortgage had better benefits from exchange subsidies than whatever benefits that money could have done for us elsewhere.
Regarding the Navigator, we tried not using one and ultimately used one. The reason is that California is trying to do something useful, but is the opposite of useful for us. In CA, signing up for the exchange is the same process as signing up for Medicaid (MediCal). The idea from the state here is to collect information for both programs to allow people to more easily move between them, so MediCal becomes an easy safety net for people on the exchange and if they income out of MediCal, they’ve already done the work for the exchange and just need to pick a plan. It’s a super idea. Problem are people like me who have worked very hard to reduce my income need but still have high net worth. To the state, for all the information used to determine subsidy for the exchange and whether you qualify for MediCal on income, we looked MediCal eligible, but they would later ask for net worth and we’d surely fail there. So we didn’t even want to be considered for MediCal, and couldn’t figure out how to get the system to do that. So we called a Navigator and he immediately understood the problem, had dealt with it before, spent about 5 minutes checking boxes in our account and asked us to call him back in 2 days to check that everything processed correctly so we could finish the process, and we did and everything was great. I couldn’t have asked for more. And I kind of expected that, my mom has been a volunteer counselor for Iowa SHIIP for like 25 years (basically the same program but for Medicare). But without the Navigator, I don’t know how we would have sorted that situation out. We spent days trying to get it off of the MediCal path with no success. But clearly we’re outliers, and I really like the concept of trying to marry the exchanges and MediCal together to work more like a single program so I didn’t mind the frustration.
So, yeah, almost identical coverage to what I had at work. My plan is gold, not silver. Cost is a few hundred more than what my employer’s cost was, which isn’t unreasonable. IIRC the closest silver plan would have been less than what I could get through the employer, but the value was worse enough that it was about a wash in out of pocket and that would have only gotten worse if we had more prescriptions/treatment needed.
Chris T.
My ACA-plan cost went up in comparison to 2021, but I’m in WA state.
I did go with a “gold” plan this year because I’m on expensive prescription drugs, so the monthly premium is a bit higher but the cost-to-me of the $550/mo drug is lower.
Nevermoor
Long-time lurker, but one think I don’t see talked about much is flexibility.
My small company is in CA, and we have some employees who like Kaiser Permanente (basically a one-stop umbrella for medical care) but others who like their existing doctors. At our size, the only possible way to offer that choice was via exchange plans.