The fourth marketplace open enrollment period begins on November 1, 2016. On October 19, the Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) released projections of 2017 marketplace enrollment. CMS also released an effectuated enrollment snapshot for the first half of 2016.
Where We Stand Now
During the first half of 2016 (January 1 to June 30, 2016), 10.4 million individuals nationwide had effectuated marketplace enrollment—that is, they had paid their premiums and had an active policy. This is an average number for the six month period and is lower than the 10.5 million enrolled at the end of the period in June, since individuals were still enrolling during the open enrollment period in January and February. It also does not count 650,000 individuals enrolled in the Basic Health Programs of Minnesota and New York who would otherwise have been eligible for marketplace coverage. Of the 10.4 million, about 8.8 million (84 percent) received advance premium tax credits (APTC) and 5.9 million (56 percent) received cost-sharing reduction payments (CSRs).
During the period from April 1, 2016 to June 30, 2016, 113,000 consumers had their coverage terminated because of unresolved citizenship and immigration data matching issues, while about 425,000 had their APTC or CSRs adjusted because of household income data matching issues. This does not mean that these people were necessarily ineligible, but rather that they were not able to submit required documentation in a timely manner to resolve inconsistencies. Individuals whose eligibility was terminated for data matching issues are not included in the effectuated enrollment numbers.
CMS, insurers, and consumer advocates have been working to reduce data matching problems. The number of consumers whose coverage was terminated for citizenship or immigration issues was down 63 percent from the same time period in 2015, while the number with APTC or CSR adjustment was down 42 percent. But documentation of eligibility, and in particular of projected incomes, continues to be a problem for many of those served by the marketplaces and the data matching issue needs continued attention.
Where We're Headed
In its October 19 brief, ASPE projects that by the end of the 2017 open enrollment period, 13.8 million individuals will have selected a marketplace plan, an increase of 1.1 million or 9 percent over the 12.7 million plan selections during the 2016 open enrollment period. ASPE estimates that 11.4 million will effectuate enrollment on an average monthly basis over the course of 2017, an increase of 1 million over the effectuated enrollment numbers for the first half of 2016. (This again does not include 650,000 Basic Health Program enrollees in New York and Minnesota).
ASPE estimates that 9.2 million of the 13.8 million will be re-enrollees from 2016, 3.5 million will be new enrollees who were previously uninsured, and 1.1 million will be individuals who will transfer to the marketplace from off-marketplace individual coverage.
The largest share of the 2017 enrollees will be re-enrollees from 2016. ASPE expects that 10 million individuals will be enrolled in marketplace coverage at the end of 2016 and that, as mentioned, at least 9.2 million will reenroll for 2017. This is consistent with the October 19 effectuated enrollment report and in line with ASPE projections from the fall of 2015.
ASPE believes that a total of about 18 million individuals currently purchase insurance in the individual market. About 6.9 million of these are in the off-exchange individual market, about 5.1 million of whom have incomes above Medicaid eligibility levels. ASPE recently estimated that about 2.5 million of these could be eligible for APTC and 1.1 million for CSRs were they to enroll through the marketplace. Given the increases in premiums across the individual market for 2017 and the efforts of CMS to increase awareness of the marketplaces and of APTC, it is not unrealistic to expect a significant move from off-marketplace to on-marketplace coverage during the 2017 open enrollment period.
ASPE estimates that there are 10.7 million uninsured Americans are eligible for enrollment through the marketplaces—that is, they are legally present in the United States, not otherwise insured, and not incarcerated. ASPE believes that about 84 percent of these QHP-eligible enrollees have incomes that make them eligible for ATPC. About 40 percent are between the ages of 18 and 34, 56 percent are men, and 40 percent are people of color (including 25 percent who are Hispanic).
To determine how many individuals are likely to enroll for 2017, CMS stratified those eligible for coverage into those who would receive substantial premium assistance (250 percent of the federal poverty level (FPL) and below; those who would receive some assistance (250 to 400 percent FPL); and those not eligible for assistance (400 percent and above). It then projected likely enrollments based on past enrollments for these groups and adjusted these for increases in outreach and awareness of the marketplaces, the increased individual enrollment penalty, and changes in premiums and plan offerings.
ASPE projects that average effectuated enrollment rates will again for 2017 be lower than initial plan selection rates, because of a drop off from initial plan selections to actual effectuated enrollments and then further attrition over the course of the year as individuals drop coverage. Enrollees often drop coverage because they get coverage elsewhere, such as employer-sponsored coverage, Medicaid, or Medicare. Effectuated enrollment may hold up better during 2017 because of continued improvements in data matching, mentioned above. On the other hand, tightening up of special enrollment period verification may reduce the number of enrollees who enroll in marketplace plans after open enrollment ends. In 2015, about half of these enrolled because of loss of other coverage.
Where ASPE's Projections For Marketplace Enrollment Could Be Too High
One factor that the ASPE report does not take into account is eligibility of the uninsured for employer coverage. An October 18 Kaiser Family Foundation Brief on the remaining uninsured estimated that 4.5 million of the remaining uninsured were eligible for, but not covered by, employer-sponsored coverage. If an individual has an offer of employer-sponsored coverage that meets minimum value requirements and is affordable (for 9.66 percent or less of modified adjusted gross income currently), that individual is ineligible for APTC. Because of the "family glitch," employer coverage is considered to be affordable by an employee's family if individual-only coverage is affordable by the employee.
Kaiser offers no estimate as to how many of the individuals with employer coverage available are ineligible for APTC because the coverage is both affordable and of minimum value. But it is likely that the number of APTC-eligible uninsured is well below ASPE's estimates, and that their projections of the number of uninsured individuals who will enroll in the marketplace may be high as well. A number of individuals in the off-exchange market who have incomes that would make them eligible for APTC may also have offers of affordable marketplace coverage and thus in fact be ineligible for assistance
Finally, the ASPE brief includes a note as to why its projections of 2017 marketplace coverage are lower than the projections of the Congressional Budget Office, which projected in March 2016 that the marketplaces would enroll 15 million people in 2017. ASPE explains that the CBO continues to, as in the past, expect a significant decline in employer coverage and shifting from off-marketplace to on-marketplace coverage, which has not yet materialized and which ASPE does not expect at the levels the CBO projects. Both the CBO and ASPE have similar expectations as to overall level of coverage, but they have different expectations as to where people will get their coverage. ASPE also expects that it will take longer for the marketplaces to reach steady-state levels than the CBO has projected.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2dAYiDk
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