Subsidy-eligible, but unsubsidized

Updated 1/22 with California discussion corrected - please see note 2 at bottom.

Reading about Gallup's latest finding that 3.2 million more Americans were uninsured in 2017 than in 2016, I wondered about a particular (small) group of ACA marketplace enrollees: those with incomes in subsidy range who are nevertheless unsubsidized. Such people might be expected to have a particularly hard time with the steep premium increases of 2017 (not to say 2018 and 2019), as premiums take a huge share of their income.

I wanted to look at this group because Gallup's findings raised some riddles. Gallup found the sharpest increases in the uninsured among people with incomes under $36,000 -- but also found no change in the percentage of people insured by Medicaid. Among types of insurance obtained, the sharpest drop was among those who say they bought their own insurance (although Gallup's numbers for this population are weirdly inflated).  In the ACA marketplace the large majority (84%) who obtained premium subsidies were largely insulated from the year's steep premium hikes -- though reduced competition may have made choices less viable for some. Overall,  marketplace enrollment was down about 5%, or 500,000 in 2017.

The drop in off-marketplace individual market enrollment was doubtless steeper.  But most of those who buy off-exchange are presumably more affluent. It doesn't all seem to quite add up -- hence my interest in the almost invisible low-income unsubsidized individual market enrollees.

Notes on Gallup's latest health insurance status polling

Gallup announced today that the U.S  uninsurance rate, as reflected in its daily surveying, fell to its lowest rate yet recorded in the first quarter of 2016, 11.0% for all adults. Gallup has been conducting this survey in partnership with Healthways since 2008.

Just for the hell of it, I'm going to try a few I'm notes from my phone [updated 4/8/16]:

1. While Gallup headlines a drop from Q1 2015 (11.9%) to Q1 2016 (11.0%), a better contrast is probably with Q2 2015 (11.4%). In 2015, open enrollment did not end until the third week in February; this year it was over on Jan. 31. By Q4 of last year Gallup found that the uninsurance rate had ticked up to 11.9%. There will probably be some attrition this year as well -- though perhaps a bit less, as the ACA marketplace this year for the first time recorded no-pays and terminations more or less as they happened during open enrollment.

The Census on health insurance gains: who got what and how?

This week the Census reported on changes in Americans' health insurance rates from 2013 to 2014, based on results of its two yearly surveys, the Current Population Survey and the American Community Survey. The two together show what is probably the most dramatic drop in the percentage of people without insurance since Medicare and Medicaid were implemented. The drop in the ranks of uninsured was steepest among the roughly one third of the population living in households with incomes under 200% of the Federal Poverty Level (FPL) -- where lack of insurance is most concentrated.

In my grand personal tradition of burying the lead, I discuss an apparent oddity in the data under the second subhead below. Feel free to skip! If you're well-versed in these matters, it may be no mystery to you.

The near-poor gain most

The ranks of the uninsured dropped more steeply for the near-poor than for those below the poverty line, and for the part-time employed than for the nonworking population,  The pattern does not hold for educational level: the uninsured rate dropped most for those without a high school diploma and next most for high school grads, with smaller drops at each level of educational attainment.