ACA Enrollment Round-Up – How Many Have Paid Premiums; How Many Were Already Insured Last Year; How Their Health Compares to Employer-Sponsored Beneficiaries’


As of Thursday April 10th roughly 7.5 million persons have selected plans on the health insurance exchanges (HIEs); of these roughly 86 percent have paid (or are likely to pay) premiums; this points to a total of 6.5 million HIE enrollees

Best available evidence indicates that only 35 percent of these 6.5 million persons were uninsured in 2013, making the net gain in coverage as a result of the HIEs 2.3 million

The young (18-34) are underrepresented on the HIEs (28% of adult HIE enrollees as compared to 38% of the adult population); even if the HIE enrollees were of normal health for their age (which they’re not – see immediately below), the skew in age-mix to older enrollees appears large enough to result in adverse selection

Early prescription claims (January/February) show that HIE beneficiaries are significantly more likely than other commercial beneficiaries to consume prescriptions indicative of significant chronic disease – i.e. the early prescription claims indicate the HIE beneficiaries are on average sicker, and to a greater degree than would be expected simply because of their higher average age

Net gains in Medicaid enrollment year on year are 5.7 million; 3.6 million of whom were uninsured in 2013. Total reduction in un-insured is thus 5.9 million persons, 2.3 million on the HIEs and 3.6 million on Medicaid

It bears emphasizing that an additional 9.1 million persons would enter Medicaid if the non-participating states expanded the income eligibility cut-off to 100 FPL – which we believe they will do if HHS will pay enhanced federal matching rates on the new beneficiaries. Former Secy Sebelius refused to do this under a policy that expires at the end of 2016; her replacement could gain a larger percentage of these 9.1 million Medicaid beneficiaries by reversing that policy. We have no direct indication she intends to do so in the near term, but we continue to believe allowing these states to expand to 100 FPL is the most likely outcome. This of course augurs well for the Medicaid HMOs, which we favor

For our full research notes, please visit our published research site.

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