Thursday, January 11, 2018

Subsidized ACA marketplace enrollment ROSE 2% in Maryland in 2018

ACA marketplace enrollment in Maryland for 2018 was down only slightly (2.6%) in 2018 That's a strong performance, as I noted earlier this week, "given the shortened enrollment period, radically cut federal funding for enrollment outreach and advertising, and general confusion generated by administration sabotage."

I also speculated that the drop-off may have been concentrated in unsubsidized prospective enrollees -- the only ones materially hurt by the state's enormous premium spikes (which actually benefited subsidized enrollees by inflating subsidies).  That is in fact the case.

In 2018, 32,171 enrollees in on-exchange private plans in Maryland were unsubsidized, according to numbers sent to me by the Maryland Health Connection (the state's ACA marketplace). That's out of 153,584 total enrollees (21%). In 2017, as of the end of Open Enrollment, 38,903 were unsubsidized out of a total of 157,832 enrolled (25%), according to Public Use Files published by CMS.*

That is, subsidized enrollment for 2018 was up about 2% -- to 121,413, compared to 118,928 in 2017. That jibes with the Maryland exchange's reporting that African American enrollment was up 12%, Hispanic enrollment up 10%, and rural enrollment up about 10%.

Unsubsidized enrollment on-exchange was down 17%. That decrease may have been partly offset by enrollment off-exchange. In response to Trump's cutoff of federal reimbursement to insurers for Cost Sharing Reduction subsidies, Maryland enabled insurers to concentrate the cost of CSR in silver plans sold on-exchange only and sell cheaper silver plans off-exchange. But premium increases were steep by any measure, and off-exchange relief was likely to be limited.

On exchange, all-but-free bronze plans were widely available. In Montgomery County, the county with the highest enrollment, a 40 year-old with an income of $25,000 could get a bronze plan for $3 per month; a 50 year-old earning $30,000 could get one for $9 per month. Gold was also available at a discount, costing just slightly more than the cheapest silver plan, and the cheapest silver plan was also available at a modest discount compared to the benchmark, against which subsidies are set.The same deals were on offer in Baltimore County and Baltimore City. In rural areas, as I noted last week, free gold and silver plans were also widely available, thanks to an enormous price spread between the cheapest and benchmark (second cheapest) silver plan.

As similar anomalous deals were on offer this year to subsidized buyers in much of the country, and as enrollment overall was down about 5% or less from 2017, it's likely that in the country as a whole, subsidized enrollment is up, or barely down.

Maryland enrollees' metal level choices reflect the anomalous pricing. As the exchange noted in its press release, gold plan enrollment was up almost fourfold. Bronze was up more modestly, 11%, and silver, historically the dominant choice among the subsidized, was down 26%. Here are the totals, kindly supplied by the exchange:

Metal Level Selection in Maryland, 2017-2018








   + 895

  + 3,545

 - 4,248

In a followup post, I'll have something to say about silver selection among those eligible for Cost Sharing Reduction, which is available only with silver plans. Preview: It's down, but fairly modestly. UPDATE: here's the post on metal level selection.

* The Maryland Health Connection's annual report shows 57,654 enrollees, or 37%, with incomes over 400% FPL, which would make them subsidy ineligible (p. 33). I believe that's a mistake, as the CMS percentage is more in line with past years, and reiterated in a June 2017 update reflecting first quarter attrition. In fact, based on an income breakout Maryland sent me in 2015, reproduced here, I'm pretty sure the 57,654 figure combines 300-400% FPL and over 400% FPL.  I'm seeking clarification on this point.

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