Individual market enrollment and ACA subsidies update

Following the introduction of the Patient Protection and Affordable Care Act (ACA), the individual health insurance marketplace has experienced continuous change. To support understanding of the condition and stability of the individual market, Milliman consultants Paul Houchens, Jason Clarkson, and Zachary Fohl prepared the third annual profile of the individual health insurance market for each state along with the District of Columbia.

These state profiles summarize insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2019 open enrollment period and estimated 2019 effectuated enrollment. 

Aggregate premium assistance expenditures materially increased between 2017 and 2018, but are estimated to slightly decrease from 2018 to 2019. These changes are primarily attributable to national composite subsidy benchmark premiums increasing by 34% in 2018, but declining by (1%) in 2019. Assuming stable marketplace enrollment, federal premium assistance expenditures for 2020 are likely to continue to decline as a result of a (3%) subsidy benchmark premium decrease. Premium rate decreases for 2019 and 2020 are partially attributable to several states implementing state-based reinsurance programs.

All of this information is vital to state, federal, and insurer stakeholders for a number of reasons, including the 1332 State Innovation Waiver, insurer stability, marketplace enrollment, and marketplace premium.

To read more and see the interactive map, please click here.

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