ACA Exchanges Face Challenges Retaining Existing Enrollees

Health insurance exchanges created under the Affordable Care Act have helped millions enroll in health insurance, but they face challenges retaining customers, the New York Times reports.

Between the end of the ACA's most recent open enrollment season in February and June, the number of U.S. residents enrolled in state or federal exchange plans dropped by about 15%, from 11.7 million to 9.9 million.

According to the Times, comprehensive data about why exchange customers lose or drop their plans are not available, but enrollment counselors, providers and consumers say costs could be a factor. For example, exchange enrollees might drop or lose coverage because:

• Their incomes decreased;
• They lost their jobs;
• They realized they could not afford coverage after they enrolled; or
• The subsidies they received to help them purchase exchange coverage under the ACA were cut back or eliminated because the federal government could not verify their incomes or determined their incomes exceeded certain thresholds for the subsidies.

According to CMS, about 967,000 households in states that use the federal exchange had their subsidies recalculated because of "income inconsistencies." While the subsidies could have increased for some households, other residents had their subsidies reduced or eliminated, according to the Times.

In addition, experts say confusion could also cause some exchange enrollees to lose or drop coverage. For example, consumers might drop or lose coverage because:

• They did not understand what personal information they needed to provide to stay enrolled in the plans; or
• They were confused about premium payment requirements.

As of June 30, about 423,000 residents in states that use the federal exchange had lost coverage because they had not provided appropriate citizenship or immigration status documentation, according to CMS.

Meanwhile, some exchange enrollees might drop coverage because they acquire jobs that offer health coverage benefits, according to the Times.  Larry Levitt, a senior vice president at the Kaiser Family Foundation, said, "This market is always going to be a temporary way station for some people until they get a job with health benefits." He added, "Where I would get worried is if there starts to be evidence that people are dropping out because their insurance is becoming unaffordable, or they just don't feel it offers them good value" (Goodnough, New York Times, 10/11).