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.