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Regulation and Compliance > State Regulation

Public exchanges have 10.2 million paid enrollees

By Allison Bell

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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
National Total 10,187,197 8,656,210 85.00% 5,850,936 57.40%
Alaska 18,320 16,583 90.50% 9,877 53.90%
Alabama 145,763 132,253 90.70% 106,231 72.90%
Arkansas 52,784 48,100 91.10% 30,813 58.40%
Arizona 165,026 126,506 76.70% 91,875 55.70%
California 1,364,659 1,204,662 88.30% 701,049 51.40%
Colorado 122,976 68,027 55.30% 33,042 26.90%
Connecticut 98,269 77,114 78.50% 41,730 42.50%
District of Columbia 14,960 1,492 10.00% 391 2.60%
Delaware 22,397 19,128 85.40% 10,155 45.30%
Florida 1,415,981 1,324,516 93.50% 998,137 70.50%
Georgia 452,815 412,385 91.10% 305,705 67.50%
Hawaii 8,200 4,860 59.30% 2,745 33.50%
Iowa 39,090 34,172 87.40% 19,344 49.50%
Idaho 84,987 69,060 81.30% 52,974 62.30%
Illinois 293,661 232,371 79.10% 137,872 46.90%
Indiana 180,529 159,802 88.50% 90,537 50.20%
Kansas 85,490 69,979 81.90% 47,836 56.00%
Kentucky 92,372 63,975 69.30% 34,563 37.40%
Louisiana 149,954 137,940 92.00% 88,225 58.80%
Massachusetts 124,010 82,665 66.70% 64,767 52.20%
Maryland 114,559 78,110 68.20% 53,635 46.80%
Maine 68,037 60,939 89.60% 39,703 58.40%
Michigan 293,843 228,388 77.70% 162,206 55.20%
Minnesota 52,169 25,809 49.50% 7,866 15.10%
Missouri 219,953 197,663 89.90% 128,846 58.60%
Mississippi 80,011 75,613 94.50% 61,079 76.30%
Montana 49,140 41,766 85.00% 25,295 51.50%
North Carolina 492,014 458,738 93.20% 321,961 65.40%
North Dakota 16,222 14,115 87.00% 6,894 42.50%
Nebraska 63,380 56,910 89.80% 32,234 50.90%
New Hampshire 45,607 29,996 65.80% 16,839 36.90%
New Jersey 208,467 172,345 82.70% 108,314 52.00%
New Mexico 44,085 33,244 75.40% 21,149 48.00%
Nevada 62,944 52,900 84.00% 35,834 56.90%
New York 361,340 253,758 70.20% 212,194 58.70%
Ohio 188,867 161,011 85.30% 82,427 43.60%
Oklahoma 106,392 87,136 81.90% 64,543 60.70%
Oregon 102,253 79,946 78.20% 48,235 47.20%
Pennsylvania 427,454 348,823 81.60% 244,919 57.30%
Rhode Island 30,416 25,847 85.00% 17,079 56.20%
South Carolina 170,948 154,221 90.20% 109,429 64.00%
South Dakota 19,004 16,811 88.50% 12,272 64.60%
Tennessee 182,893 155,753 85.20% 117,491 64.20%
Texas 966,412 832,334 86.10% 573,862 59.40%
Utah 128,220 86,330 67.30% 79,857 62.30%
Virginia 335,033 285,938 85.30% 186,979 55.80%
Vermont 34,923 22,449 64.30% 11,073 31.70%
Washington 159,124 124,505 78.20% 67,623 42.50%
Wisconsin 183,155 166,142 90.70% 107,324 58.60%
West Virginia 29,862 26,145 87.60% 16,221 54.30%
Wyoming 18,228 16,937 92.90% 9,685 53.10%

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