On Tuesday, the Centers for Medicare and Medicaid Services released a detailed report on Health Insurance Marketplace enrollment numbers. As of February 22, the end of the "in-line" special enrollment period for 2015 Open Enrollment for individual market coverage, 11.7 million Americans had selected plans. By March 31, about 10.2 million consumers had "effectuated" coverage, which means they paid for their coverage and still have an active policy in the applicable month.
Of those who have effectuated coverage, 69,877 have catastrophic coverage, 2,164,213 have bronze coverage, 6,903,699 have silver coverage, 707,576 have gold coverage and 341,832 have platinum coverage.
Lower than expected
Although the enrollment numbers are lower than the experts were predicting when the Affordable Care Act was first signed into law, they're consistent with HHS' effectuated target for the end of 2015. "The Health Insurance Marketplaces are working," said HHS Secretary Sylvia Burwell. "Thanks to the Affordable Care Act, millions of Americans now rely on the health and financial security that comes from affordable coverage through the Marketplaces. We've seen a historic reduction in the uninsured and consumers are finding the coverage they need at a price they can afford."
Six months ago, 19 health wonks predicted the number of Obamacare signups this year. Some of us wildly overestimated. pic.twitter.com/URmRApeGRI
— Dan Diamond (@ddiamond) June 2, 2015
An uncertain future
At risk in 34 states in the King v. Burwell case: 6.4 million people receiving subsidies. $272/month per person. $1.7 billion per month.
— Larry Levitt (@larry_levitt) June 2, 2015
All that could change with the Supreme Court's ruling in King vs. Burwell, which is expected to be handed down later this month. Of the approximately 10.2 million consumers who had effectuated Marketplace enrollments at the end of March 2015, 85% or about 8.7 million consumers were receiving an advanced premium tax credit to make their premiums more affordable. If the Supreme Court rules against the government in this case, subsidies would be cut off for those who live in states with federal, rather than state exchanges. According to the Kaiser Family Foundation, this could result in a loss of subsidies for more than 7.5 million people, the majority of which would not be able to afford health insurance without the subsidies.
If you were wondering what the new enrollment numbers mean for King, @aliciaparlap made a map. http://t.co/5v66dD8JRW pic.twitter.com/xS437lYYF0
— Margot Sanger-Katz (@sangerkatz) June 2, 2015
The Kaiser Family Foundation says the loss of subsidies would destabilize the individual insurance markets in states with federal exchanges because insurers would still be required to guarantee access to coverage regardless of health status and also be prohibited from charging sick people more than healthy people. This would result in substantial premium increases. "Because this may all happen very quickly, it is possible that many or all insurers would choose to exit the individual markets in these states rather than facing significant losses in a quickly shrinking market," the Foundation says. "Insurers that remain in the market risk being one of the only carriers continuing to guarantee access to coverage to people in poor health (since people who lose coverage from exiting insurers have special enrollment periods to choose new coverage)."
If the Supreme Court rules in favor of the plaintiffs, Congress will likely take some sort of action to preserve the subsidies, at least temporarily. But whether or not they can agree on legislation quickly enough to prevent widespread market disruption remains to be seen. Early last month, officials from impacted states met in Chicago for a secret 24-hour meeting to discuss contingency plans in the event the Supreme Court rules against the subsidies. According to The Wall Street Journal, "Over the course of an evening reception, a day's presentations and a Mexican buffet at the O'Hare International Airport’s Hilton hotel, some of those officials concluded their options are likely unworkable."