We have updated the Insured Medical Consumer Model to include the increasingly important ACA Marketplace exchanges. We are using Treasury outlay data for Advanced Premium Tax Credits and Cost-sharing subsidies because, even with the 2021 expansion of eligibility, the vast majority of Exchange consumers receive subsidies to purchase plans. It appears that about 353M people were enrolled in a health plan the government would find satisfactory. Our model does not include active duty servicemen/women and veterans
The overwhelming majority of Americans with health insurance are the result of All Time High enrollment in exchange plan subsidies, slow-to-disenroll-Medicaid and stable unemployment. The growth of Medicare eligible individuals is slowing but nearly everyone is covered by a Part A & B or a Medicare Advantage plan.
In short, if you don't have health insurance you probably represent that tiny portion of the population that is unreachable in many different ways.
That begs a very important question long term question, "from whence will come enrollment growth?"
In normal times, we would expect it to come from population growth, specifically immigration and births. Birth rates remain in decline and immigration - let's just call it hotly debated. In the current environment we are probably looking at share gains and consolidation. See CI's sale of their MA business. Without the anti-competitive tricks of years past, Blues plans will probably be reduced in number. An ICHRA strategy could also pull members out of employer-sponsored plans into ACA exchanges.
More remote, could Medicaid-expansion states reconsider in light changes to the family glitch issue which makes Exchange plans more viable and less expensive for states? Sounds crazy but all it would take would be a change in the political environment and a budget crisis.
Let me know what you think.
Emily Evans
Managing Director – Health Policy
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