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5. NEBRASKA: -29%, to 146,000
4. IOWA: -31%, to 133,000
3. MINNESOTA: -35%, to 149,000
2. LOUISIANA: -36%, to 133,000

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1. ARIZONA: -37%, to 147,000

Worst changes in enrollment, based on CMS billable month data. (We divided the billable month figures by 12.)

To see more ACA exchange enrollment data cards, click on the arrow on the right side of the gallery box above.

For more of our individual major medical market coverage, see our Trump’s ACA World archive.

It’s official: The market for individual major medical coverage that complies fully with the Affordable Care Act went through an economic carwash in 2017.

Total enrollment fell about 11%, and the typical monthly premium that an issuer charged increased about 21%.

The Centers for Medicare and Medicaid Services has told the story in a new batch of data.

The Data

CMS prepares the individual major medical data every year, to run the ACA risk-adjustment program. The program uses cash from issuers that end up with low-risk enrollees to compensate issuers that end up with more than their fair share of the high-risk enrollees.

Annual CMS spreadsheets give each state’s average monthly premium, and each state’s total “billable months.” (A user can convert the billable month total into an annual enrollment figure by dividing that number by 12.)

CMS has published comparable risk-adjustment data for both 2016 and 2017 for the District of Columbia, and for all states but Hawaii, Massachusetts and Vermont.

CMS has actually published 2017 data for Hawaii, although comparable data was missing in the 2016 spreadsheet: Hawaii had average monthly premiums of $477 in 2017, and annualized individual major medical enrollment of about 33,000.

The premium figures represent the full amounts that the issuers actually charge. The figures do not include the effects of any ACA premium  tax credit subsidies or other subsidies that might have cut the enrollees’ out-of-pocket premium spending.

The version of the spreadsheet on the CMS website gives data produced by the federal government. Because the federal government produced the data, and posted it on a public website, agents, insurers and others can use the data in their own reports, articles and social media posts without worries about copyright restrictions.

What CMS Found

CMS found that:

  • Total individual major medical enrollment in the jurisdictions included fell 11%, to about 12.7 million.
  • The enrollment decrease ranged from a drop of 37%, in one state, to an increase of 2%, in Arkansas and Delaware.
  • The typical state’s average monthly premium increased 21%. Half had increases about the size or lower, and half had increases about that size or lower.
  • The average premium change ranged from a low of close to zero, in North Dakota, to a high of 99%, in Arizona.
  • The median statewide average monthly premium was $466.
  • State’s statewide average monthly premiums ranged from $336 in Utah, to $1,048, in Alaska.

(Related: Web Health Broker Gives Peek at Per-Enrollee Commissions)

We posted a collection of data cards above that show the states with the five most dramatic drops in individual major medical enrollment.

Look below for a table showing what happened in all of the jurisdictions included in both the 2016 and 2017 spring risk-adjustment market data spreadsheets.

Non-Grandfathered Individual Major Medical Coverage:  Premiums and Enrollment

2018   2017      
  AVERAGE MONTHLY PREMIUMS ANNUALIZED ENROLLMENT AVERAGE MONTHLY PREMIUMS ANNUALIZED ENROLLMENT CHANGE IN PREMIUMS CHANGE IN ENROLLMENT
Alabama $574 189,575 $415 204,804 38% -7%
Alaska $1,048 15,863 $869 17,519 21% -9%
Arizona $630 146,505 $317 233,036 99% -37%
Arkansas $390 337,510 $369 332,251 6% 2%
California $440 2,072,021 $398 2,131,989 11% -3%
Colorado $439 228,489 $375 264,328 17% -14%
Connecticut $537 143,218 $439 171,183 22% -16%
Delaware $366 16,815 $324 16,411 13% 2%
District of Columbia $573 26,019 $472 34,446 21% -24%
Florida $461 1,533,948 $402 1,594,269 15% -4%
Georgia $443 483,761 $381 568,381 16% -15%
Idaho $432 98,329 $355 114,345 22% -14%
Illinois $522 381,227 $368 493,915 42% -23%
Indiana $432 165,909 $409 200,993 6% -17%
Iowa $541 55,505 $406 80,497 33% -31%
Kansas $466 110,139 $342 130,293 36% -15%
Kentucky $406 92,840 $357 104,091 14% -11%
Louisiana $560 133,212 $447 208,761 25% -36%
Maine $520 75,631 $412 81,088 26% -7%
Maryland $435 214,474 $335 247,279 30% -13%
Michigan $410 358,046 $389 398,972 6% -10%
Minnesota $557 149,216 $386 228,650 44% -35%
Mississippi $466 80,687 $401 90,289 16% -11%
Missouri $480 233,244 $398 285,697 21% -18%
Montana $581 55,609 $396 72,372 47% -23%
Nebraska $619 74,427 $401 104,367 55% -29%
Nevada $382 113,009 $356 127,965 7% -12%
New Hampshire $412 96,060 $364 95,086 13% 1%
New Jersey $492 338,702 $484 335,892 2% 1%
New Mexico $385 64,823 $318 71,737 21% -10%
New York $525 306,037 $475 326,260 11% -6%
North Carolina $676 474,978 $501 528,849 35% -10%
North Dakota $429 38,731 $427 39,377 0% -2%
Ohio $422 247,116 $399 270,735 6% -9%
Oklahoma $620 128,952 $358 168,400 73% -23%
Oregon $446 205,553 $356 221,051 25% -7%
Pennsylvania $518 489,991 $380 566,746 36% -14%
Rhode Island $383 42,973 $377 45,419 2% -5%
South Carolina $521 200,171 $409 215,517 27% -7%
South Dakota $529 35,053 $398 38,140 33% -8%
Tennessee $579 225,240 $389 295,415 49% -24%
Texas $421 1,037,404 $347 1,241,699 21% -16%
Utah $336 181,649 $284 192,578 18% -6%
Virginia $413 399,108 $364 426,925 13% -7%
Washington $404 279,732 $373 310,998 8% -10%
West Virginia $694 33,346 $513 43,316 35% -23%
Wisconsin $528 226,558 $455 243,033 16% -7%
Wyoming $620 26,029 $574 25,828 8% 1%
AVERAGE $501 263,822 $406 296,691 24% -11%
Source: Census Bureau

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