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Compare Apples to Apples When Evaluating Marketplace Enrollment Totals

The Centers for Medicare & Medicaid Services’ (CMS) final count of people selecting health coverage through the Affordable Care Act’s (ACA) individual marketplace for 2020 is expected soon. Accurately assessing this year’s sign-ups will require some adjustment: this year’s sign-ups will match last year’s if they total roughly 8.34 million, about 110,000 below the 8.45 million reported in last year's final snapshot report.

This adjustment is needed for two reasons:

  • Nevada now administers its own marketplace. The CMS snapshot no longer reflects Nevada’s marketplace enrollment because the state shifted this year from the federal government’s marketplace platform to its own. Removing Nevada’s sign-ups lowers last year’s total by roughly 84,000.
  • Maine and Virginia expanded Medicaid in 2019. Once states expand Medicaid, people with incomes between 100 to 138 percent of the federal poverty line are eligible for Medicaid rather than marketplace coverage. Data from states that expanded Medicaid in late 2015 and 2016 (Alaska, Louisiana, and Montana) show that it can take several years for marketplace sign-ups to fully reflect these transitions. Based on these other states’ experiences, we estimate that Medicaid expansion will lower Maine and Virginia’s 2020 sign-ups by about 30,000, with some continuing decline in future years. sign-ups will likely fall somewhat below even the adjusted totals. And they will certainly be lower than they would’ve been without Trump Administration and congressional actions undermining the marketplace, including outreach funding cuts, expanded availability of substandard plans, a climate of fear that deters eligible immigrant families from obtaining coverage, and repeal of the ACA’s individual mandate penalty. Consumers also experienced challenges accessing on the first day of open enrollment and on the December 15 deadline, although the Administration extended the deadline through December 17 in recognition of these issues. But in comparing sign-ups from year to year, it’s important to compare apples to apples.