Strong Demand Expected for Marketplace Open Enrollment, Despite Administration Actions
End Notes
[1] Centers for Medicare & Medicaid Services, “Health Insurance Exchanges 2018 Open Enrollment Period Final Report,” April 3, 2018, https://www.cms.gov/newsroom/fact-sheets/health-insurance-exchanges-2018-open-enrollment-period-final-report.
[2] See “Sabotage Watch: Tracking Efforts to Undermine the ACA,” Center on Budget and Policy Priorities, updated September 12, 2018, https://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca.
[3] Rabah Kamal et al., “An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges,” Kaiser Family Foundation, August 10, 2017, https://www.kff.org/health-reform/issue-brief/an-early-look-at-2018-premium-changes-and-insurer-participation-on-aca-exchanges/.
[4] Rabah Kamal et al., “How Repeal of the Individual Mandate and Expansion of Loosely Regulated Plans are Affecting 2019 Premiums,” Kaiser Family Foundation, October 26, 2018, https://www.kff.org/health-costs/issue-brief/how-repeal-of-the-individual-mandate-and-expansion-of-loosely-regulated-plans-are-affecting-2019-premiums/.
[5] Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, “2019 Health Plan Choice and Premiums in HealthCare.gov States,” October 26, 2018, https://aspe.hhs.gov/system/files/pdf/260041/2019LandscapeBrief.pdf.
[6] See Rachel Fehr, Cynthia Cox, and Larry Levitt, “Individual Insurance Market Performance in Mid-2018,” Kaiser Family Foundation, October 5, 2018, https://www.kff.org/health-reform/issue-brief/individual-insurance-market-performance-in-mid-2018/ and Matthew Fiedler, “How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?” USC-Brookings Schaeffer Initiative for Health Policy, August 2018, https://www.brookings.edu/wp-content/uploads/2018/08/Individual-Market-Premium-Outlook-20191.pdf.
[7] Sarah Lueck, “Key Flaws of Short-Term Health Plans Pose Risks to Consumers,” Center on Budget and Policy Priorities, September 20, 2018, https://www.cbpp.org/research/health/key-flaws-of-short-term-health-plans-pose-risks-to-consumers.
[8] Linda J. Blumberg, Matthew Buettgens, and Robin Wang, “Updated: The Potential Impact of Short-Term Limited-Duration Policies on Insurance Coverage, Premiums, and Federal Spending,” Urban Institute, March 2018, https://www.urban.org/sites/default/files/publication/96781/2001727_updated_finalized.pdf.
[9] Congressional Budget Office, “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028,” May 2018, https://www.cbo.gov/system/files?file=2018-06/53826-healthinsurancecoverage.pdf.
[10] Sara R. Collins et al., “First Look at Health Insurance Coverage in 2018 Finds ACA Gains Beginning to Reverse: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, Feb.-Mar. 2018,” To the Point, Commonwealth Fund, May 1, 2018, https://www.commonwealthfund.org/blog/2018/first-look-health-insurance-coverage-2018-finds-aca-gains-beginning-reverse?redirect_source=/~/media/b404ef047f9e4858b22305756550caf0.ashx.
[11] Congressional Budget Office, “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028.”
[12] Beth Fritchen and Kurt Giesa, “Oliver Wyman Survey: The Affordable Care Act’s Stabilization,” Oliver Wyman, June 20, 2018, https://health.oliverwyman.com/2018/06/aca_survey.html.
[13] For a general discussion, see Kurt Giesa, “Analysis: Market Uncertainty Driving ACA Rate Increases,” Oliver Wyman, June 4, 2017, https://health.oliverwyman.com/2017/06/analysis_market_unc.html. An example of insurers’ aggressive response to the loss of the mandate in their 2018 rates occurred in Pennsylvania, where UPMC received state approval for a rate increase of 41.15 percent, or more than five times the expected growth in medical costs (7.01 percent). See https://www.insurance.pa.gov/Consumers/HealthInsuranceFilings/Documents/2018%20ACA/UPMC%20HO%20-%20IND%20-%202018%20Rate%20Decision%20Summary%20Final.pdf.
[14] Ariel Cohen, “CMS Not Increasing ACA Marketing and Outreach Budget for 2019,” Inside Health Policy, September 21, 2018, https://insidehealthpolicy.com/daily-news/cms-not-increasing-aca-marketing-and-outreach-budget-2019. See, for example, Sarah E. Gollust et al., “TV Advertising Volumes Were Associated with Insurance Marketplace Shopping and Enrollment in 2014,” Health Affairs, June 2018, https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1507.
[15] Covered California, “Fiscal Year 2018-2019 Budget,” June 15, 2018, https://hbex.coveredca.com/financial-reports/PDFs/CoveredCA_2018-19_Budget-6-15-18.pdf.
[16] Karen Pollitz, Jennifer Tolbert, and Maria Diaz, “Data Note: Further Reductions in Navigator Funding for Federal Marketplace States,” Kaiser Family Foundation, September 24, 2018, https://www.kff.org/health-reform/issue-brief/data-note-further-reductions-in-navigator-funding-for-federal-marketplace-states/. See also Halley Cloud, “In Latest ACA Sabotage, Administration Nearly Eliminates Marketplace Enrollment Assistance Funds,” Center on Budget and Policy Priorities, July 13, 2018, https://www.cbpp.org/blog/in-latest-aca-sabotage-administration-nearly-eliminates-marketplace-enrollment-assistance-funds.
[17] Centers for Medicare & Medicaid Services, “Grants Awarded for the Federally-Facilitated Exchange Navigator Program,” September 12, 2018, https://www.cms.gov/newsroom/press-releases/grants-awarded-federally-facilitated-exchange-navigator-program.
[18] U.S. Government Accountability Office, “Health Insurance Exchanges: HHS Should Enhance its Management of Open Enrollment Performance,” July 2018, https://www.gao.gov/assets/700/693362.pdf.
[19] Amy Goldstein, “Trump’s claim that ‘core of the disastrous Obamacare’ is gone,” Washington Post, January 30, 2018, https://www.washingtonpost.com/politics/2018/live-updates/trump-white-house/fact-checking-and-analysis-of-trumps-state-of-the-union-2018-address/trumps-claim-that-core-of-the-disastrous-obamacare-is-gone/?utm_term=.daaa4904aa52.
[20] See, for example, Michael Ollove, “Health Insurance Premiums Are Stabilizing, Despite GOP Attacks,” Stateline, August 16, 2018, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/08/16/health-insurance-premiums-are-stabilizing-despite-gop-attacks.
[21] Letter from the Office of the Attorney General, Department of Justice, to Speaker of the House of Representatives Paul Ryan, June 7, 2018, https://www.justice.gov/file/1069806/download.
[22] Six of the 12 states that operate their own enrollment platform (California, Colorado, District of Columbia, Massachusetts, Minnesota, and New York) extend their open enrollment period beyond the federal minimum. For a list of open enrollment deadlines in state-based marketplaces, see Louise Norris, “What’s the Deadline to get Coverage during Obamacare’s Open Enrollment Period?” healthinsurance.org, October 10, 2018, https://www.healthinsurance.org/faqs/what-are-the-deadlines-for-obamacares-open-enrollment-period/.
[23] Katherine Swartz and John Graves, “Shifting the Open Enrollment Period for ACA Marketplace Could Increase Enrollment and Improve Plan Choices,” Health Affairs, July 2014, https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.0007.
[24] Centers for Medicare & Medicaid Services, “Early 2018 Effectuated Enrollment Snapshot,” July 2, 2018, https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/2018-07-02-Trends-Report-1.pdf.
[25] Sara R. Collins, Munira Z. Gunja, and Michelle M. Doty, “Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March-June 2017,” Commonwealth Fund, September 2017, https://www.commonwealthfund.org/publications/issue-briefs/2017/sep/following-aca-repeal-and-replace-effort-where-does-us-stand.
[26] Ashley Kirzinger et al., “Kaiser Health Tracking Poll – March 2018: Non-Group Enrollees,” Kaiser Family Foundation, April 3, 2018, https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march-2018-non-group-enrollees/.
[27] Centers for Medicare & Medicaid Services, “Health Insurance Exchanges 2018 Open Enrollment Period Final Report.”
[28] Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, “2019 Health Plan Choice and Premiums in HealthCare.gov States.”
[29] Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, “Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange,” October 30, 2017, https://aspe.hhs.gov/system/files/pdf/258456/Landscape_Master2018_1.pdf.
[30] Centers for Medicare & Medicaid Services, “Health Insurance Exchanges 2018 Open Enrollment Period Final Report”; Centers for Medicare & Medicaid Services, “Health Insurance Marketplaces 2017 Open Enrollment Period Final Open Enrollment Report,” March 15, 2017, https://www.cms.gov/newsroom/fact-sheets/health-insurance-marketplaces-2017-open-enrollment-period-final-enrollment-report-november-1-2016.
[31] Centers for Medicare & Medicaid Services, “Early 2018 Effectuated Enrollment Snapshot.”
[32] Linda J. Blumberg et al., “Characteristics of the Remaining Uninsured: An Update,” Urban Institute, July 2018, https://www.urban.org/research/publication/characteristics-remaining-uninsured-update/view/full_report.
[33] Department of Health and Human Services, Assistance Secretary for Planning and Evaluation, “About 2.5 Million People Who Currently Buy Off-Marketplace May Be Eligible for ACA Subsidies,” October 4, 2016, https://aspe.hhs.gov/system/files/pdf/208306/OffMarketplaceSubsidyeligible.pdf. In addition, McKinsey analysts estimated that about 70 percent of consumers across the entire individual market have incomes below 400 percent of the poverty level. McKinsey Center for U.S. Health Reform, “Exchanges three years in: Market variations and factors affecting performance,” May 2016, https://healthcare.mckinsey.com/exchanges-three-years-market-variations-and-factors-affecting-performance.
[34] David Anderson et al., “Implications of CMS Mandating a Broad Load of CSR Costs,” Health Affairs blog, May 15, 2018, https://www.healthaffairs.org/do/10.1377/hblog20180511.621080/full/.
[35] Ashley Semanskee, Gary Claxton, and Larry Levitt, “How Premiums are Changing in 2018,” Kaiser Family Foundation, November 29, 2017, https://www.kff.org/health-reform/issue-brief/how-premiums-are-changing-in-2018/.
[36] Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, “2019 Health Plan Choice and Premiums in HealthCare.gov States.”
[37] Ibid.
[38] Andrew Sprung and David Anderson, “Mining the Silver Lode,” Health Affairs blog, September 7, 2018, https://www.healthaffairs.org/do/10.1377/hblog20180904.186647/full/.
[39] Ashley Semanskee, Gary Claxton, and Larry Levitt, “How Premiums are Changing in 2018,” Kaiser Family Foundation, November 29, 2017, https://www.kff.org/health-reform/issue-brief/how-premiums-are-changing-in-2018/.
[40] Centers for Medicare & Medicaid Services, “Average Monthly Premiums for Second-Lowest Cost Silver Plan and Lowest Cost Plan for States Using the HealthCare.gov Platform, 2016-2019,” data as of September 28, 2018, https://www.cms.gov/sites/drupal/files/2018-10/10-11-18%20Average%20Monthly%20Premiums%20for%20SLCSP%20and%20LCP%202016-2019.pdf.