Officials in the administration of President Donald Trump may not be thrilled with the Affordable Care Act (ACA) public exchange system, but they seem to be doing a pretty good job keeping it running.
The Centers for Medicare and Medicaid Services (CMS), the division of the U.S. Department of Health and Human Services responsible for overseeing the ACA exchange system, has published data supporting that conclusion in a collection of three new batches of data.
CMS has posted an analysis of the data, and links to the data files, here.
In spite of big increases in 2017 coverage premiums, and Trump administration efforts to cool marketing efforts in January 2017, overall enrollment fell just 10%, to 13 million people.
Because of big increases in the full cost of coverage, the number of full-pay enrollees fell 20%, to 5 million.
But, thanks to the effects of the ACA subsidy system, the number of subsidized enrollees fell just 3%, to 8 million.
Seema Verma, the CMS administrator, put out a statement emphasizing how poorly the system was performing when Trump became president.
“As the Trump administration took office, there were warning signs that we were dealing with a crisis in the individual health insurance market and Obamacare was failing its consumers,” Verma says in the statement.
Verma says the new reports show that the plans on the individual market are unaffordable, especially for middle-class consumers.
But the CMS analysis and the three data files suggest that CMS staff members are still working hard to try to keep the exchange system going.
Here’s a look at five weird facts from the new collection of CMS documents.
1. ACA exchange enrollment in 2018 has been pretty good.
Health insurers announced another wave of big premium increases for 2018 coverage. But the ACA subsidy system helped clear away most of the effect of those increases on out-of-pocket costs for enrollees earning less than 400% of the federal poverty level.
The 400% of FPL cut-off is $47,520 for an individual, and $97,200 for a household, in most of the country.
Total paid-up exchange plan enrollment was 10.6 million in February, up 3% from the total recorded a year earlier.
The average total premium per month increased 27%, to about $597 per month.
At the state level, average unsubsidized premiums ranged from $383 per month, in Massachusetts, to about $973 per month, in Wyoming.
2. The price the typical exchange plan enrollee pays out of pocket is pretty low.
In February, ACA subsidies reduced the average cost an enrollee paid for coverage out of pocket to about $77, down from an average of about $97 per month in 2017.
At the state level, average out-of-pocket monthly costs ranged from about $12, in Tennessee, to about $245, in New York state.
3. Some state exchange programs have had better luck with full-pay enrollees than others.
CMS has posted more complete full-pay enrollment figures for 2017 than for 2018.
But the preliminary figures for 2018 show that exchange plans in Alaska, Arizona, Connecticut, Indiana and Minnesota are all getting a higher percentage of their business from full-cost enrollees this year.
Between 2016 and 2017, the number of full-pay enrollees increased in six jurisdictions, in spite of the Trump administration’s lack of enthusiasm for the exchange system: Arkansas, New Jersey, New Hampshire, the District of Columbia, Maine and Rhode Island.
In Rhode Island, the strongest state for full-pay enrollment, full-pay enrollment increased 9% between 2016 and 2017, to 19.657.
4. CMS is trying to collect more data that might help agents and brokers sell more individual coverage.
Exchange plan issuers in many states have stopped paying agent commissions or enrollment fees, especially outside of the open enrollment period.
But, in case any agents are still out there, CMS has some data on users of HealthCare.gov, the system that CMS and its parent, HHS, set up to serve states without their own exchange plan enrollment and account administration systems.
Here is the document with the data on what HealthCare.gov users were thinking.
The exchange system uses an “open enrollment period” system, or limits on when people can buy coverage without showing they have what the government classifies as a good excuse to buy coverage, to keep people from waiting until they get sick to pay for coverage.
CMS has now published data on why people who did get coverage through “special enrollment periods” qualified for their SEPs.
Loss of minimum essential coverage was the most common reason for a SEP. About 60% of SEPs were due to people’s loss of access to other coverage.
Moving to a new service accounted for 5% of SEPs, and a change in household size due to a marriage, a birth or an adoption accounted for 4% of SEPs.
CMS has also broken out HealthCare.gov open enrollment period enrollees and SEP enrollees by age.
About 32% of the SEP enrollees are in the prized 18-34 age group, compared with just 27% of the open enrollment period enrollees.
5. CMS is talking, openly, about the needs of agents and brokers.
The same document that includes the HealthCare.gov user data offers some agent-broker data.
The number of producers registered to participate in the HealthCare.gov enrollment process fell 25% this year, to 49,100.
The number of producer-assisted open-enrolllment-period enrollments fell 1%, to about 3.7 million.
The average number of HealthCare.gov open-enrollment-period enrollments per registered producer increased 32%, to 75 per registered producer, according to computations based on CMS figures.
About half of the registered producers who enrolled any consumers in HealthCare.gov exchange plan coverage for 2018 enrolled at least 20 people, officials say.
If the median producer handled about 20 enrollments for 2018, and the average for all producers is 75, that suggests that the top 5,000 HealthCare.gov producers handled an average of roughly 500 enrollments each.
Producers’ share of HealthCare.gov open-enrollment-period enrollments increased to 42% this year, from 40% for the open enrollment period for 2017.
“Issuer exits, rising coverage costs for consumers, and lack of compensation from issuers have contributed to decreasing agent and broker participation,” officials say in an analysis of producer participation. “However, as these statistics show, consumers who seek assistance are increasingly turning to agents and brokers, and those agents and brokers who continue to participate in federal platform exchanges have demonstrated their ability to effectively meet this need.”
CMS attracted 5,300 HealthCare.gov agents and brokers to a “Help On Demand” referral program for the 2018 plan year.
About 89% of the producers who are participating in the program have said they intend to participate again for the 2019 plan year, officials say.
Producers cited lack of availability of HealthCare.gov plans as a more serious barrier to participation than compensation: About 70% cited lack of plans to offer as a reason to leave the exchange this year, compared with 65% who cited lack of commissions.
Producers also told CMS they continue to have problems with the HealthCare.gov application and enrollment process, and with a lack of HealthCare.gov support services aimed at producers, officials say.
CMS says it’s trying to take steps to improve its systems and processes for 2019.
— Read Trump’s Team Asks Court to Let ACA Underwriting Rules Die in 2019, on ThinkAdvisor.