CMS Reports Show Enrollment in the Health Insurance Marketplace is Declining among Those Who Do Not Receive Subsidies > Hospital Association of Pennsylvania


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CMS Reports Show Enrollment in the Health Insurance Marketplace is Declining among Those Who Do Not Receive Subsidies

August 16, 2019

The Centers for Medicare & Medicaid Services (CMS) this week released two reports that identify trends in the Affordable Care Act's (ACA) individual health insurance marketplace (also known as the exchange) for 2018, and provide insight about the market for 2019. According to this data, overall enrollment has been fairly consistent since 2017, but affordability still is a problem for those who are not getting tax subsidies. 

The Early 2019 Effectuated Enrollment Report provides a full year of exchange enrollment data for 2018 and a snapshot of the 2019 February exchange data, including information about premiums and the enrollees who receive advance premium tax credits (APTC). 

Enrollment in the exchanges remained steady during 2018 and 2019, while average 2019 premiums declined slightly—the first drop since the exchanges began operation. State markets continue to struggle with helping those who do not qualify for APTCs, and between 2016 and 2018, 2.5 million people left the market (a 40% drop).   

The Trends in Subsidized and Unsubsidized Enrollment Report provides 2018 enrollment data for the entire individual health insurance market, including both on- and off-exchange plans, for people who purchase coverage with and without APTCs. It shows that people who do not qualify for the APTCs continue to be priced out of the market. 

The report also found:

  • Following a decline of 1.3 million unsubsidized people during 2017, another 1.2 million unsubsidized people left the market during 2018
  • Enrollment declines among unsubsidized enrollees coincided with a 21 percent increases in average monthly during 2018 and a 26 percent increase during 2018
  • Enrollment declines began during 2016, as 23 states saw decreases in unsubsidized enrollees from the prior year
  • Forty-three states saw decreases in unsubsidized enrollment from 2016 to 2017, and forty-seven states saw decreases from 2017 to 2018
  • From 2018 to 2019, nine states lost more than 40 percent of their unsubsidized enrollment

Overall, Pennsylvania is faring much better than other states in terms of individuals being able get and keep their health care coverage; however, these reports highlight the fact that there is still much work to be done.

HAP endeavors to support helping as many Pennsylvanians as possible obtain affordable, comprehensive health insurance coverage. HAP has a long-standing history of partnership with federal and state policymakers and government agencies, and has advocated for the preservation of coverage gains made through the ACA and supported the Pennsylvania Department of Insurance’s efforts to promote enrollment in the ACA’s health insurance marketplace.

For more information, contact Jolene Calla, HAP’s vice president, health care finance and insurance.

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