On September 8, 2015, the Centers for Medicare and Medicaid Services (CMS) released its second quarter 2015 effectuated enrollment data for the federal and state marketplaces. As of June 30, 2015, 9.9 million had effectuated marketplace coverage, 7.2 million in the 37 federally facilitated marketplace states, 2.7 million through the state-based marketplaces.
This is down slightly from 10.2 million effectuated enrollments at the end of March, but well within the target of 9.1 million effectuated enrollments that CMS had projected by the end of 2015. Some individuals, who are no longer enrolled, may have lost their coverage, but others have undoubtedly moved to employer coverage or Medicaid.
Premium Tax Credits
Approximate 84 percent (8.3 million) enrollees received premium tax credits averaging $270 per month. Average tax credits ranged from $534 per month in Alaska to $159 per month in Arizona. Fifty-six percent of enrollees receive cost-sharing reduction payments, which make actual health care as well as health insurance affordable to enrollees with incomes below 200 percent of the federal poverty level, but are being challenged in the House v. Burwell litigation.
Nationally, 1 percent of enrollees were enrolled in catastrophic plans, 21 percent in Bronze plans, 68 percent in silver plans, 7 percent in gold plans, and 3 percent in platinum plans.
Income Data Matching
During 2015, CMS is taking action on a monthly basis regarding the eligibility of applicants who have been unable to resolve data matching issues. Questions concerning citizenship or immigration status must be resolved within 95 days or the enrollee is removed from coverage. Questions regarding household income must be resolved within 90 days, or their premium tax credits and cost-sharing reduction payments will be revised based on available tax data.
As of June 30, CMS had terminated 2015 coverage for 423,000 consumers based on citizenship or immigration issues and adjusted financial assistance for about 967,000 others based on income data matching issues. Enrollees who have been terminated for data matching issues are not included in the effectuated enrollment totals.
The effectuated enrollment totals do include, however, the 950.000 enrollees who enrolled between the end of the 2015 open enrollment period in February and June 30, 2015.
Contraceptive Mandate
On September 3, 2015, a majority of the judges of the Tenth Circuit Court of Appeals declined to offer a rehearing en banc (by the whole court) of an earlier two-to-one decision of a three judge panel refusing to enjoin the enforcement of the most recent contraceptive mandate accommodation at the request of several religious organizations.
Five of the 12 Tenth Circuit judges dissented, contending that the religious beliefs of the organizations prohibited them from signing the forms that the accommodation requires them to sign to inform the government of their religious beliefs—not just from providing the contraceptives themselves—and that the accommodation substantially burdens this belief.
Therefore, the dissenters argued, the plaintiffs should have been granted a rehearing to determine if the accommodation met the other requirements of the Religious Freedom Restoration Act: was it the least restrictive means to serving a compelling governmental interest?
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