Implementing Health Reform. On January 7, 2016 the Department of Health and Human Services (HHS) Assistant Secretary for Evaluation and Planning (ASPE) released data on marketplace enrollment for both the states that used the Healthcare.gov enrollment platform and the 13 state-based marketplaces that used their own enrollment platform for the period of November 1 to December 26, 2015. (Data from Massachusetts extends through December 28.)
As of December 26, 11.3 million individuals had selected or had been reenrolled in a marketplace plan, including 3 million new consumers and 8.2 million reenrollees. Of these, 8.5 million people had selected plans or were automatically reenrolled through HealthCare.gov; enrollment was 2.7 million in the 13 states (including D.C.) with state-based enrollment.
Approximately 35 percent of these enrollees were under the age of 35 (3.9 million) and 26 percent were between 18 and 34 (3 million). Twenty-seven percent (3 million) were between the age of 55 and 64. More than half of the 8.2 million who reenrolled were active reenrollees (4.2 million).
Of active reenrollees in the HealthCare.gov states, 60 percent switched to different plans than they were enrolled in during 2015. Nearly 7.1 million individuals (83 percent) who selected a plan or were automatically reenrolled in a 2016 plan through HealthCare.gov qualified for an advance premium tax credit with an average value of $294 per person per month. Fifty-seven percent of HealthCare.gov enrollees received cost-sharing reduction payments (which are currently being challenged in the House v. Burwell case). An additional 818,000 applicants were assessed by HealthCare.gov to be eligible for Medicaid or the Children’s Health Insurance Plan (CHIP).
African-Americans constituted 11 percent of total HealthCare.gov plan selections and 14 percent of new enrollees, while Latinos made up 14 percent of HealthCare.gov plan selections and 15 percent of new enrollees. Eighteen percent of HealthCare.gov plan selections and 17 percent of new enrollees were from rural areas. Seventy-one percent of plan selections in HealthCare.gov were for silver plans and 21 percent for bronze plans. Sixty-four percent of enrollees in HealthCare.gov states had incomes below 200 percent of the federal poverty level and 12 percent had incomes above 300 percent of the federal poverty level.
State-based marketplaces that used their own enrollment platforms tended to have a lower-percentage of new enrollees (18 percent versus 29 percent for HealthCare.gov states) and higher percentages of automatic reenrollees (50 percent versus 28 percent for HealthCare.gov). Their enrollees tended to be more male (52 versus 55 percent), were more likely to select bronze plans (27 percent), less likely to select silver (60 percent), and less likely to receive financial assistance (77 percent) than those enrolled through HealthCare.gov.
Enrollment in the marketplaces for 2016 is up substantially from enrollment during the 2015 open enrollment period, when 9.5 million selected plans or reenrolled in coverage by January 15, 2015. HealthCare.gov enrollment is up more dramatically (from 7.1 million for 2015) than enrollment in state-based marketplaces using their own enrollment platforms (from 2.4 million for 2015).
For 2016, however, 38 instead of 37 states are using the HealthCare.gov platform and Minnesota and New York are moving their enrollees with incomes below 200 percent of poverty from the marketplace to their basic health program plans. Also some of the state marketplaces ramped up more quickly than HealthCare.gov in the first two years of the program and have plateaued; indeed in some of the state-based marketplace states there are comparatively few individuals who remain uninsured.
The percentage of enrollees aged 18 to 35 for 2016 is comparable to the percentage for 2015, but the number is up sharply (from 1.9 million), and more younger enrollees are expected to enroll. The percentage of Latino enrollees is up sharply from 10 percent for 2015 (although this is in part due to a change in the methodology for identifying Latinos) but the percentage of African-American enrollees is down sharply from 2015 (when it was 14 percent). It should be noted that data on race and ethnicity is self-reported and over one third of enrollees do not provide these data.
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