The ACA Marketplace Surge: Analyzing the Impact of Policy Changes on HealthCare.gov Enrollments
The Affordable Care Act (ACA), also known as Obamacare, is a landmark health reform law that aims to expand health insurance coverage, improve health care quality, and reduce health care costs in the United States. One of the key components of the ACA is the creation of health insurance marketplaces, or exchanges, where consumers can compare and purchase qualified health plans (QHPs) that meet certain standards of benefits, affordability, and consumer protection.
Since the launch of the ACA marketplaces in 2014, millions of Americans have gained access to health insurance through these platforms, especially those who are eligible for subsidies or tax credits to lower their premiums and out-of-pocket costs. However, the marketplaces have also faced various challenges and uncertainties over the years, such as technical glitches, legal battles, political opposition, premium increases, insurer exits, and enrollment declines.
In 2020, the COVID-19 pandemic added another layer of complexity and urgency to the health care situation in the country, as millions of people lost their jobs, incomes, and health insurance due to the economic and public health crisis. To address this unprecedented challenge, the Biden-Harris administration implemented several policy changes to make health insurance more accessible and affordable for Americans through the ACA marketplaces, especially HealthCare.gov, which serves 32 states that use the federal platform.
These policy changes include:
1. Extending the open enrollment period for 2021 coverage from November 1, 2020 to August 15, 2021, giving consumers more time and opportunity to sign up for health insurance.
2. Providing an additional $50 million for outreach and enrollment assistance, increasing awareness and support for consumers who need help navigating the marketplace and applying for coverage.
3. Expanding eligibility and increasing the amount of subsidies and tax credits for consumers, reducing their premiums and out-of-pocket costs, as part of the American Rescue Plan Act of 2021.
4. Establishing standardized plan options for 2022 coverage, simplifying the consumer shopping experience and increasing the value and quality of health plans offered on the marketplace.
The impact of these policy changes on HealthCare.gov enrollments has been remarkable and unprecedented. According to the latest data from the Centers for Medicare & Medicaid Services (CMS), nearly 16 million people have signed up for 2021 individual market health insurance coverage through the marketplaces since the start of the 2021 open enrollment period, a 33% increase from the year before. This includes 4.6 million plan selections in the 32 states using HealthCare.gov for the 2022 plan year, through November 18, 2021, and 11.3 million plan selections in the 17 states and the District of Columbia with state-based marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through November 11, 2021.
Of the total nationwide plan selections, 3.7 million consumers (23% of total) are new to the marketplaces for 2021, and 12.2 million consumers (77% of total) have active 2020 coverage and returned to their respective marketplaces to renew or select a new plan for 2021. The number of new consumers is especially noteworthy, as it indicates that the policy changes have successfully attracted and enrolled more people who were previously uninsured or underinsured, or who had lost their coverage due to the pandemic.
The policy changes have also made health insurance more affordable for consumers, as the average monthly premium after applying subsidies and tax credits has decreased by 40% from $117 in 2020 to $70 in 2021 for consumers who selected a plan through HealthCare.gov. Moreover, 4 out of 5 consumers who selected a plan through HealthCare.gov can find a plan for $10 or less per month after applying subsidies and tax credits.
The record-breaking ACA marketplace enrollment numbers demonstrate the positive and significant impact of the policy changes on HealthCare.gov enrollments, as well as the strong and sustained demand for health insurance among Americans. These policy changes have also improved health care access and quality for millions of people, especially those who are most vulnerable and in need of health care services during the pandemic.
However, there are still challenges and opportunities to further enhance and expand the ACA marketplaces, such as increasing consumer awareness and education, addressing health disparities and social determinants of health, fostering competition and innovation among insurers and providers, and ensuring the stability and sustainability of the marketplaces in the long term.
Trends and Characteristics of Individual Market Enrollment
The policy changes have not only affected the ACA marketplaces, but also the overall individual market, which includes both on- and off-Marketplace enrollment. According to a report by KFF3, the individual market has grown by 3.7 million people (17%) from mid-2020 to mid-2022, reaching a total of 25.5 million people. This growth is largely driven by the increased enrollment in the ACA marketplaces, which account for 63% of the individual market as of mid-2022, up from 54% in mid-2020. The off-Marketplace enrollment, which includes people who buy coverage directly from insurers or brokers, has declined by 1.2 million people (13%) from mid-2020 to mid-2022, reaching a total of 8.4 million people.
The report also shows that the share of individual market enrollment in ACA compliant plans, which meet the minimum standards of benefits and consumer protections established by the law, has increased to 93% in mid-2022, compared to 71% in mid-2015. This indicates that more people are choosing to enroll in plans that offer comprehensive coverage and financial assistance, rather than plans that may have lower premiums but also lower benefits and higher risks.
Key Features and Highlights of the Marketplace 2022 Open Enrollment Period
The policy changes have also resulted in several improvements and innovations in the Marketplace 2022 Open Enrollment Period, which started on November 1, 2021 and will end on January 15, 2022. According to a fact sheet by CMS, some of the key features and highlights of this enrollment period are:
● Increased and enhanced enrollment assistance: CMS has invested $80 million in the Navigator program, which provides free, unbiased, and local assistance to consumers who need help with enrolling in health insurance. This is the largest funding amount ever for the program, and it supports 1,500 Navigators across the country. CMS has also launched a new call center feature that allows consumers to schedule appointments with Navigators or certified application counselors.
● Improved access to coverage through outreach and education: CMS has launched a national advertising campaign with a budget of $50 million to raise awareness and encourage enrollment in health insurance. The campaign includes TV, radio, digital, and social media ads, as well as partnerships with community organizations, media outlets, and influencers. CMS has also created new educational materials and resources for consumers, such as videos, webinars, fact sheets, and FAQs, to help them understand their options and benefits.
● Streamlined sign-up process: CMS has simplified and modernized the HealthCare.gov website and mobile app, making it easier and faster for consumers to find and enroll in health insurance. The website and app now offer a personalized and dynamic shopping experience, with features such as a plan comparison tool, a savings calculator, a provider and prescription drug lookup, and a plan quality rating system. The website and app also support multiple languages, including Spanish, Chinese, Vietnamese, Korean, and Tagalog.
Policy Innovations Adopted by the ACA Marketplaces
The policy changes have also inspired some of the ACA marketplaces, especially the SBMs, to adopt their own policy innovations to remove known obstacles to accessing the comprehensive, affordable coverage available through the marketplaces and support health and financial well-being. According to a brief by the Commonwealth Fund. some of the policy innovations adopted by the ACA marketplaces are:
● Reducing enrollment barriers: Some of the SBMs have extended their open enrollment periods beyond the federal deadline, allowing consumers more time to enroll in health insurance. Some of the SBMs have also implemented special enrollment periods (SEPs) for specific events or circumstances, such as natural disasters, public health emergencies, or loss of employer-sponsored insurance. Some of the SBMs have also streamlined the eligibility and enrollment process, by using data matching, auto-enrollment, or auto-renewal mechanisms.
● Simplifying plan choice: Some of the SBMs have introduced standardized plan designs, which require insurers to offer plans with the same benefits, deductibles, copayments, and coinsurance across different metal levels. This makes it easier for consumers to compare plans based on price, quality, and network. Some of the SBMs have also created tiered networks, which group providers based on their quality, cost, and value. This helps consumers choose providers that offer high-quality and low-cost care.
● Promoting market competition: Some of the SBMs have leveraged their purchasing power and regulatory authority to negotiate with insurers and providers on behalf of consumers. This helps lower premiums, increase plan choices, and improve plan quality. Some of the SBMs have also encouraged new entrants or expansions of existing insurers or providers in the market, creating more competition and diversity. Some of the SBMs have also implemented public options, which are government-sponsored or administered plans that compete with private plans on the marketplaces.
● Increasing health equity: Some of the SBMs have taken steps to address health disparities and social determinants of health among their populations, especially those who are disproportionately affected by the pandemic. This includes expanding coverage and benefits for low-income, uninsured, or underinsured individuals and families, such as immigrants
● Increasing health equity: Some of the SBMs have taken steps to address health disparities and social determinants of health among their populations, especially those who are disproportionately affected by the pandemic. This includes expanding coverage and benefits for low-income, uninsured, or underinsured individuals and families, such as immigrants, Native Americans, and people of color. This also includes providing culturally and linguistically appropriate outreach and enrollment assistance, as well as addressing social needs such as food, housing, transportation, and education.
Conclusion
The ACA marketplaces have experienced a remarkable surge in enrollment, thanks to the policy changes implemented by the Biden-Harris administration and the state-based marketplaces. These policy changes have made health insurance more accessible, affordable, and valuable for millions of Americans, especially those who need it most during the pandemic. However, there are still challenges and opportunities to further improve and expand the ACA marketplaces, such as increasing consumer awareness and education, addressing health disparities and social determinants of health, fostering competition and innovation among insurers and providers, and ensuring the stability and sustainability of the marketplaces in the long term.
If you are interested in enrolling in health insurance through the ACA marketplaces, you can visit HealthCare.gov or your state's marketplace website to find out more information and apply for coverage. You can also call 1-800-318-2596 or use the Find Local Help tool to get free, unbiased, and local assistance from Navigators or certified application counselors. The open enrollment period for 2022 coverage ends on January 15, 2022, so don't miss this opportunity to get covered and stay healthy.
