Tuesday, December 29, 2020

The ACA as pandemic safety net

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In the New York Times Upshot, Margot Sanger-Katz, Sarah Kliff and Quocktrung Bui report that the health insurance safety net as bolstered by the ACA, patchy though it is, appears to have held the uninsured rate close to steady during the pandemic months. In brief: Medicaid enrollment in the ACA expansion category is up more than 20% since February; ACA marketplace enrollment in 36 HealthCare.gov states is up 6.6% for 2021, and losses of employer-sponsored health insurance appear relatively modest.

I have been tracking these developments as they unfold. Some of the posts below corroborate the core findings cited in Upshot, and some supplement those findings. In reverse chronological order:

  • ACA marketplace enrollment was already up by more than 6% year-over-year by June 2020
  • Medicaid enrollment among those rendered eligible by the ACA Medicaid expansion is up more than 20% since February and likely exceeds 18 million.

  • In states that have so far refused to enact the ACA Medicaid expansion, the ACA marketplace has picked up some slack: in nonexpansion states, marketplace enrollment is up 10% in 2021.

  • Total Medicaid enrollment nationally has increased by more than 10% since February -- that is by about 8 million. Total enrollment is close to 79 million. I will post a November update soon [update here].
  • Longer term, about 45 million Americans have accessed the ACA marketplace at some point since launch. 

  • In states that have enacted the ACA Medicaid expansion, about three times as many people are insured via the expansion as through the private plan marketplace.
  • While California's ACA marketplace has taken the lead in aggressive promotion and enrollment growth during the pandemic, growth in the golden state's Medicaid enrollment has mysteriously lagged, holding steady at about half the national growth rate.

  • The uninsured rate appears not to have spiked dramatically.

To step back: at present, about 18.5 million people enrolled in Medicaid fit ACA expansion criteria, and about 10 million people as of Jan. 1 will be subsidized in the ACA marketplace. Not all of these people would be uninsured had Republicans succeeded in repealing the ACA, but about two thirds of them probably would be.

And finally, out of sequence: a mid-pandemic assessment of the ACA.

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