CMS releases reports showing declining enrollment for the unsubsidized population

Aug. 13, 2019
Data highlights enrollment remained largely unchanged since 2017 while affordability continues to be problematic for those without tax subsidies.

The Centers for Medicare & Medicaid Services (CMS) has announced the release of two reports it says provides information on the stability of the individual health insurance market during the 2018 plan year as well as offering preliminary insights into the market for 2019.:

·  “The Early 2019 Effectuated Enrollment Report” provides a full year of Exchange enrollment data for 2018 and a snapshot of the February Exchange enrollment for 2019, including information on premiums and the portion of Exchange enrollees who receive advance payments of the premium tax credit (APTCs). 

· “Trends in Subsidized and Unsubsidized Enrollment Report” provides 2018 enrollment data for the entire individual health insurance market, including enrollment in both on- and off-Exchange plans, for people who purchase coverage both with and without APTCs in the individual market.

CMS says enrollment on the Exchanges remained steady in both 2018 and 2019, while average 2019 premiums declined by a small amount—the first drop in premiums since the Exchanges began operating. State markets continue to face challenges in covering people who do not qualify for APTC and must pay the entire premium themselves. In the space of two years, between 2016 and 2018, 2.5 million unsubsidized people left the market, a 40 percent drop.

The Effectuated Enrollment Report: The Effectuated enrollment data is a measure of the number of people who have not only selected a plan during Open Enrollment but taken the additional steps necessary to keep their coverage in effect, by paying their monthly premiums.

Together, the 2018 data and early look at the 2019 data indicates consistent enrollment through the Exchanges. The report shows that 2018 average monthly enrollment through the Exchanges increased by one percent over 2017, while the early 2019 data shows that 10.6 million consumers had effectuated coverage in February 2019—about one percent lower than at the same time last year.

The report also shows that the average total monthly premium for Exchange enrollees in February 2019 decreased by one percent from the prior year.   In part, actions taken by the Trump Administration to promote more stability, including the finalization of the Market Stabilization Rule in 2017 and rulemaking to give states new tools and flexibility in regulating their insurance markets have helped to lower premiums and increase choice. As a result of increased efficiency, the administration also reduced the user fee charged to issuers on the Federally Facilitated Exchanges  beginning with the 2020 plan year, a reduction that will be passed on to consumers in the form of lower premiums next year.

The Trends in Subsidized and Unsubsidized Enrollment Report: The report shows that people who do not qualify for APTC continue to be priced out of the market. Following a decline of 1.3 million unsubsidized people in 2017, another 1.2 million unsubsidized people left the market in 2018. These enrollment declines among unsubsidized enrollees coincided with increases in average monthly premiums of 21 percent in 2017 and 26 percent in 2018.

The decline began in 2016, as 23 states saw decreases from 2015 to 2016 among unsubsidized enrollees. Forty-three states saw decreases in unsubsidized enrollment from 2016 to 2017, and 47 states saw a decline from 2017 to 2018. During this most recent year, nine states including, Iowa, Georgia, Nebraska, Tennessee, Virginia, Kentucky, Missouri, Kansas and West Virginia, lost more than 40 percent of their unsubsidized enrollment.

While data from the Effectuated Enrollment report shows stability in Exchange enrollment and premium trends, affordability remains a significant challenge for people who do not qualify for Exchange subsidies. These reports place a spotlight on the millions of Americans priced out of the market by the high premiums that quickly emerged after the Affordable Care Act’s main regulations took effect in 2014.  The Trump Administration remains firmly committed to helping those harmed and providing every American with more affordable healthcare options.