10.2M Enrolled in, Paid for ACA Plans in Second Enrollment Period

On Tuesday, HHS announced that 10.2 million U.S. residents who enrolled in exchange coverage during the Affordable Care Act's second open enrollment period have paid their first month's premiums, effectively activating their coverage and completing the enrollment process, the Washington Times reports (Howell, Washington Times, 6/2).

That number is down from the 11.7 million individuals HHS had said selected or were automatically re-enrolled in plans through ACA exchanges as of March 9 (Armour, Wall Street Journal, 6/2). According to HHS, the figure is lower because some individuals did not pay their premiums and others dropped their coverage (Adams, CQ News, 6/2).

However, the figure is still greater than the Obama administration's target of enrolling 9.1 million U.S. residents in exchange coverage during the second open enrollment period (Alonso-Zaldivar/Vineys, AP/Miami Herald, 6/2). Still, it is fewer than the 11 million enrollees the Congressional Budget Office in March projected would enroll in ACA coverage (Ferris, The Hill, 6/2).

The 10.2 million figure accounts for all individuals who enrolled in ACA coverage and paid for their premiums as of March 31 (AP/Miami Herald, 6/2). The figure accounts for those who enrolled both in state and federal exchanges. According to HHS, 2.9 million of the enrollees signed up for coverage through state-run exchanges, including those run in partnership with the federal exchange. Meanwhile, 7.3 million enrollees used the federal exchange to sign up for ACA plans.

In addition, the enrollment data noted that almost 70% of the enrollees selected silver-tier plans through the exchanges. In comparison, about 20% of enrollees selected bronze-tier plans, which was the next most frequently selected plan level (Wall Street Journal, 6/2).

According to the AP/Miami Herald, the enrollment numbers could continue to fluctuate throughout the year as some individuals gain coverage through their employers and others decide to forgo their exchange plans (AP/Miami Herald, 6/2). Further, HHS said that on March 31 it terminated coverage for 117,000 individuals who had not provided documentation of their citizenship or immigration statuses (Pear, New York Times, 6/2).

Majority of Enrollees Receive Subsidies

Meanwhile, HHS said 8.7 million of the enrollees received subsidies to help them purchase coverage, including 6.4 million who enrolled through the federal exchange. The monthly subsidies averaged $272, according to HHS (Washington Times, 6/2).

The states with the highest numbers of individuals receiving the subsidies were:

• Alabama;
• Alaska;
• Arkansas;
• Florida;
• Georgia;
• Louisiana;
• Mississippi;
• North Carolina;
• South Carolina; and
• Wyoming (New York Times, 6/2).

According to The Hill, the 10 states with the highest numbers of residents receiving the subsidies rely on the federal exchange for enrollment (The Hill, 6/2). Individuals receiving the subsidies for coverage purchased through the federal exchange could be at risk of losing the credits if the Supreme Court rules to strike down the subsidies in the upcoming case King v. Burwell, according to the Washington Times (Washington Times, 6/2). A decision in the case is expected late this month (AP/Miami Herald, 6/2).

Reaction

HHS Secretary Sylvia Mathews Burwell said the updated enrollment numbers show that the ACA exchanges "are working." She added, "Thanks to the [ACA], millions of Americans now rely on the health and financial security that comes from affordable coverage through the marketplaces" (Washington Times, 6/2).

However, Caroline Pearson, a senior vice president at Avalere Health, cautioned against celebrating the enrollment figures. She said, "Enrollment has been lower and slower than what most people projected" (AP/Miami Herald, 6/2). She added that the industry should "scale back expectations" for future ACA enrollment.

Joel Ario, managing director of Manatt Health Solutions and former director of the HHS Office of Insurance Exchanges, also recognized that exchange "[e]nrollment isn't growing as rapidly as people would have liked" but noted the signups are "moving forward." He said, "The individual market is approaching reliability."

Meanwhile, Gary Claxton, vice president and director of the Kaiser Family Foundation's health care exchange project, said the enrollment numbers show how ruinous a Supreme Court ruling striking down the law's subsidies could be for the ACA. He noted that if individuals in states that rely on the federal exchange could no longer receive the subsidies, "the market would fall apart in those states" (Wall Street Journal, 6/2).