The Patient Protection and Affordable Care Act (PPACA) public exchange system ended up with 10.2 million paid individual enrollees as of March 31.
The HealthCare.gov exchanges operated by the U.S. Department of Health and Human Services (HHS) and the state-based exchanges came out with about as many enrollees as HHS Secretary Sylvia Burwell had predicted before open enrollment started, but fewer than some exchange program backers had hoped, according to data posted by the Centers for Medicare & Medicaid Services (CMS), the HHS division in charge of the exchange program.
The second PPACA open enrollment period started Nov. 15, 2014, and officially ended Feb. 15. Broad enrollment period extensions, closed around the end of April in most of the country.
HHS announced in March that the individual exchange qualified health plans (QHPs) had received plan selection information for 11.7 million people. During the first PPACA open enrollment period, for 2014 coverage, the percentage of plan selectors who actually paid for coverage appeared to be about 85 percent. This year, the effectuation rate was 85 percent.
Burwell estimated in November that the exchanges might have about 9 million to 9.9 million “effectuated,” or paid, 2015 QHP enrollees. Officials say the exchange system had 6.3 million 2014 enrollees at the end of 2014.
The Congressional Budget Office (CBO) originally predicted that the exchange system would have 13 million QHP enrollees in 2015, and some observers were thinking that improvements in the exchange enrollment system and an increased consumer familiarity with the exchange program could help the QHP issuers reach or exceed that target.
CMS released the data as the Supreme Court is preparing to rule on King vs. Burwell (Case Number 14-114), a case that could affect whether states with exchanges set up or managed by HHS can offer access to the PPACA premium subsidy tax credits to exchange plan users.
QHP users with incomes under 400 percent of the federal poverty level and over a limit that differs from state to state can get the “advance premium tax credit” (APTC) support.
Users with incomes from the state minimum to 250 percent of the federal poverty level can get additional “cost-sharing reduction” subsidies that help cut enrollee spending on deductibles, co-payments and coinsurance amounts.
About 86 percent of the 2015 QHP enrollees are getting premium subsidies, and about 58 percent are getting cost-sharing reduction (CSR) subsidies.
HHS exchanges had 7.5 million of the effectuated enrollees, and state-based exchanges had 2.7 million. California and New York accounted for about two-thirds of the state-based exchange enrollment
A Supreme Court decision blocking the HHS exchanges from offering PPACA subsidies could have an especially big effect on states with HHS-established exchanges and a high percentage of enrollees using the premium subsidies.
In the HHS exchange states, the percentage of QHP users using subsidies ranges from about 66 percent in New Hampshire to about 95 percent in Mississippi.
For a table that shows individual QHP paid enrollment data for all 50 states and the District of Columbia, read on.
Total Effectuated Enrollment and Financial Assistance by State
As of March 31, 2015
|State||Total Enrollment||APTC Enrollment||Percentage of Enrollment with APTC||CSR Enrollment||Percentage of Enrollment with CSR|
|District of Columbia||14,960||1,492||10.00%||391||2.60%|