As the second Open Enrollment period came to an end, nearly 11.7 million Americans selected, or were automatically reenrolled into, a 2015 health insurance plan through the Health Insurance Marketplaces that were set up under the Affordable Care Act (ACA). More than 8.84 million people chose plans through the federal exchange, which is being used for enrollment in 37 states; nearly 2.8 million were enrolled in the 14 states that are using a state-based platform.
Around 1.2 million renewing enrollees (29%) elected to switch plans, which indicates that those who are using the Marketplaces are price conscious. This may help to keep competitive pressure on insurers. Of those enrolled through the federal exchange, 21% chose a bronze plan, 69% a silver plan, 6% a gold plan, 3% a platinum and 1% a catastrophic plan. The numbers were similar for those enrolled through a state-based exchange, with 24.9% choosing a bronze plan, 60.6% a silver plan, 7.8% a gold plan, 5.6% a platinum plan and 1.2% a catastrophic plan.
Approximately 87% of individuals who chose a plan through the federal exchange will qualify for a federal subsidy, with an average value of $263 per person per month. This will leave them with an average monthly premium of around $101. Overall, more than 55% of the 8.8 million people enrolled through the federal exchange will have a monthly premium of $100 or less. "The figures released today tell a story of health coverage consumers rely on for financial and health security," HHS Secretary Sylvia Mathews Burwell said in a statement. "Millions of marketplace consumers in HealthCare.gov states qualified for tax credits to make their coverage affordable and accessible."
If the Supreme Court rules that it is illegal to pay subsidies to those who are using the federal exchange, approximately 7.7 million people stand to lose their subsidies, and ultimately their health insurance if they cannot afford to pay their premiums on their own. The law that is in question states that subsidies can be paid to customers in exchanges that are established "by the state."
This could be a huge blow to hospitals, many of which are benefitting financially from the ACA. Hospitals are reporting that now that more people are insured, they're seeing fewer unpaid medical bills. HCA reported a decline of nearly 9% in "same facility self-pay and charity admissions" during the fourth quarter of 2014. "These represent 7.2% of our total admissions compared to 8.3% last year and has continued to turn favorable for the company," HCA chief financial officer William Rutherford told analysts.
The Obama administration has no plan to mitigate the damage to the health care system if the Supreme Court rules that the subsidies are illegal. "If they rule against us, we'll have to take a look at what our options are. But I'm not going to anticipate that. I'm not going to anticipate bad law," President Obama told Reuters.