Friday, September 07, 2018

Everything you always wanted to know about ACA marketplace enrollment 2018

Narrow focus curse: I've sliced 2018 ACA marketplace enrollment  so many ways I've lost track myself and too often go rooting around this blog for some half-remembered breakout. For my own sake, then, here is an index, omitting some redundant or not particularly illuminating posts.

The main takeaway for this year is pretty obvious: huge premium hikes, largely induced by Republican sabotage, sharply reduced unsubsidized enrollment while leaving subsidized enrollment relatively stable.

A second important takeaway that I've spotlighted more than once is less obvious: among the subsidized, enrollment dropped pretty sharply for those with incomes in the 100-200% FPL range; stayed more or less flat at 200-300% FPL, and rose sharply at 300-400% FPL.  A post I co-wrote with David Anderson, running in Health Affairs today, tells that story and draws conclusions about the crosswinds created by various Republican actions.

13* Ways of looking at enrollment 2018

* Okay, a few more than 13. Poetic license and all that.

National enrollment

Small enrollment shifts are not so small - 8/25/18
For example, a 1% shift in the percentage of all enrollees on who are unsubsidized masks a 10% drop in enrollment among the unsubsidized -- exacerbated by heavy attrition in February.

GAO highlights the silver load offset to HHS sabotage - 8/24/18
The GAO report on HHS actions that depressed marketplace enrollment also shows a key effect of silver loading: average premiums at each metal level. This post matches that with shifts in metal level choice at different income levels, e.g. a massive shift out of silver at 200-400% FPL.

Silver loading vs. sabotage in non-expansion states - 8/14/18
Compares 2018 enrollment gains and losses by income group in states that refused to expand Medicaid with those recorded for as a whole and in California

Unsubsidized on-exchange enrollment is also shrinking fast - 8/8/18
An unsurprising effect of massive premium hikes

Unsubsidized, but in subsidy range, in the ACA marketplace - 8/5/18
85% of enrollees via were subsidized, but 90% have incomes in the 100-400% FPL range. Why the gap?

Shifts in the enrollment population in the ACA marketplace in 2018 - 8/2/18
Subsidized enrollees on average are a bit more affluent and a bit older than in past years.

A CMS misinformation byte is getting into the woodwork - 7/31/18
CMS shorted effectuated enrollment in 2017 so they could tout first-month attrition. This year, they flipped the script and used last year's undercount to claim a nonexistent net increase in 2018.

Covered California's silver-loading enrollment boost mirrors's - 7/26/18
The corroboration that enabled today's Health Affairs post

Some CMS-y data for the ACA marketplace - 7/12/18
Flagging an error in California data, confirmed to me in this post, and fixed three weeks later

Unsubsidized ACA marketplace enrollees drop out early - 7/5/18
It's not just this year: first-quarter attrition among the unsubsidized has been sharp since 2016.

Hispanic enrollment on up 8% in 2018 - 6/29/18
Kind of counterintuitive, no? Is it statistical noise?

ACA marketplace enrollment 2018: Answers and questions - 6/25/18
Why was enrollment down among those eligible for strong CSR?

Actuarial value in the ACA marketplace: Down a bit in 2018 - 6/24/18
Mainly an effect of a  drop in enrollment at 100-200% FPL

Trump's CSR cutoff boosted ACA enrollment at 300-400% FPL - 5/27/18
More people in this income bracket are subsidy-eligible than in past years, and silver loading increased the value of those subsidies.

Will Trump's CSR cutoff boost enrollment by 2-3 million, per CBO? - 5/5/18
I peg this year's gain from silver loading at somewhere north of 342,000.

If Seema Verma bans silver loading, how many marketplace enrollees will suffer?  - 4/12/18
Spoiler: a bit less than 2 million. A precursor of my share of a prior Health Affairs post.

"Strong" CSR takeup dropped only slightly on in 2018 - 4/3/18
A first look at CMS's full breakout of 2018 enrollment

State snapshots

Silver loading yields some gold dividens in Kansas - 5/1/18

Rational choice in the ACA marketplace, Pennsylvania edition - 4/26/18
A free silver plan with a $0 deductible - what's not to like? (PA) - 4/24/18

How Trump's cutoff of CSR funding affected Maryland enrollment (3/31/18)
A downside to silver loading: CSR takeup drops in Maryland (3/28/18)
Who'd be hurt by restored federal CSR funding? A snapshot from Maryland (3/18/18)
Choosing a metal level in the CSR-addled Maryland marketplace (1/12/18)
Subsidized ACA marketplace enrollment rose 2% in Maryland in 2018 (1/11/18)
Maryland ACA enrollment spotlights effects of Trump's CSR sabotage (1/8/18)

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