HHS Update on Health Insurance Marketplace

HHS Issues a Briefing on the Health Insurance Marketplace


May 1, 2014:  ASPE Issue Brief from DHHS


HHS took stock of the Health Insurance Marketplace (HIX), reflecting activity through April 19, 2014.   With all the speculation and political spin reported, depending on the biases of the source, it is good to have some reliable statistics on what has transpired so far.   While it is still premature to make any iron-clad predictions, the preliminary information gives us something more concrete than the assumptions used to create the product offerings in the first place. The key enrollment stats cited are:

  • Over 8 million have selected a plan through the HIX marketplace
  • 28% are young adults between 18 and 34, and 34% are from zero to age 34
  • The march enrollment surge accounted for nearly 3.8 million

This study parses out how much enrollment came through the state-based market HIX versus the federally facilitated HIX (roughly, 1/3 and 2/3, respectively).  The next question people usually ask is about how many have effectuated their insurance coverage by paying their premiums.  While not definitive, the data from the large carriers range from 80% to 90%, which is a good start.

Still there are some important issues that must be addressed in order to gauge how successful the first round of ACA-driven changes will be in achieving the public policy goals that originally spawned the legislation. 

  • Is the proportion of subsidized enrollees close to what was assumed?
  • How many people were previously uninsured and now have coverage?
  • How many of the enrollees switched out of employer-based coverage to individual plans on the HIX marketplace?
  • What is the verdict on the affordability of coverage so far?
  • Have the enrollments conformed to the assumptions about which metal levels would be chosen? 
  • Is the proportion of younger membership fitting the projections needed to make the economics of the whole program work?

Take-aways:  Inside the Marketplace versus Off-Market

The thing I find most interesting is that the proportion of people enrolling in HIX plans that are subsidy-eligible is around 85% (consistent with assumptions), while a large number of people that are NOT eligible for subsidies enrolled in “off-market” plans.  The report cites the Blues Association number of off-market enrollments as 1.7 million, which just accounts for Blues affiliate plans.  The Congressional Budget Office estimates the total off-market volume as 5.0 million, which when combined with the 8.0 million HIX marketplace number, totals 13.0 million. 

Three different surveys (Gallup, Urban Institute and RAND Corporation) give estimates of the drop in the rate of uninsured (ages 18 to 65) at 2.7%, 3.0% and 4.7%.  That translates into a reduction of uninsured level by 5.4 million, 7 million and 9.3 million. These off-market plans must be ACA compliant and their finances are all factored into the state-level risk pools so as to avoid selection bias between the marketplace and the off-marketplace plans. 

Finally, among those selecting plans on the marketplace HIX, only 25% of members went with the bronze level and 65% went with silver plans.  However, those numbers skew towards higher percentages with silver plans for those with federal subsidies, and more towards bronze plans for those without. 

Smart Money Bets for 2015 HIX Marketplace

The clever people I have interviewed among conference speakers expect a few things to be true for 2015:

  • There will likely be pricing and products that look a lot like 2014 plans since there is little credible claims data available upon which to price for 2015 bid deadlines, apart from pharmacy claims.  So pricing is likely to be driven by book rates and overall product positioning strategy
  • There is going to be an even larger enrollment than 2014 coming into the individual marketplace, whether on the HIX market or off-market
  • Risk adjustment is going to take center stage in the pricing and product design disciplines, more so than in Medicare Advantage
  • The first year that products can be priced using claims experience is 2016, so whatever true-up that needs to occur with happen in the 2016 cycle year


Tags: Health Insurance Exchanges, HIX, ACA, Individual Marketplace

Log on to Your Rise Account

Forgot your password?
Create an Account

Association Sponsors

Latest Posts

It’s not Obamacare anymore. It’s our national health-care system.

By Drew Altman and Larry Levitt July 29 Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation. Larry Levitt is senior vice president of the Kaiser Foundation. Republicans failed to repeal and replace the Affordable Care Act early Friday because of divisions within their own ranks, and because they tried not only to repeal and replace the ACA but also to cut and cap the Medicaid program, generating opposition from many red-state governors and their senators. But most of all, they failed because they built their various plans on the false claim — busted by the Congressional Budget Office — that they could maintain the same coverage levels as the ACA and lower premiums and deductibles, while at the same time slashing about a trillion dollars from Medicaid and ACA subsidies and softening the ACA’s consumer protection regulations. Had they succeeded, they would have won a big short-term victory with their base, which strongly supports repeal, but suffered the consequences in subsequent elections as the same voters lost coverage or were hit with higher premiums and deductibles. ...
Read More

Where to Now? True North Again

By Kevin Mowll, Executive Director of the RISE Association The failure of the Republicans to repeal, replace, or wreck ObamaCare is a wakeup call for everyone, not just Republicans. While the RISE Association steers away from purely political commentary, the lesson of this protracted political mess needs to be called out for the sake of putting our priorities straight around public policy regarding healthcare reform. In the attached Wall Street Journal article, which suggests that bipartisan solutions are the only remaining way forward, the author proffers hope that the blistering truth will be obvious to all the participants in the 7-year-long fracas around repeal and replace. The bloodied players may still brood in frustration that their political wills were not enough to win, but the author wonders if cooler heads will prevail. I, for one, am not so sanguine; yet I can only hope. https://www.wsj.com/articles/republicans-search-for-answers-can-they-find-any-across-the-aisle-1501259286 The lesson I take away from the many years of wrangling is that the ObamaCare political football games demonstrates that political wills are not the way forward. They lose sight of the True North issue at hand. Rather, the failures of both political parties in arriving at a bipartisan solution signals the fact that what is good for America is good healthcare policy, not political prowess over rivals. Governing from the fringe is not sustainable in a democracy. ...
Read More

Upcoming Conference


RISE West 2017 

Featuring three pre-conference workshops, and five tracks covering 20+ in-depth session topics, this event is an extraordinary value-proposition you don’t want to miss. Hear from industry thought leaders, as well as health plan and provider group experts who will share practical insights and updated lessons learned from the trenches on critical topics in risk adjustment, quality improvement, data management, coding compliance & more!


Upcoming Webinar

The Encounter Management Best Practices Playbook

What encounter best practices can managed care plans put into place to help them manage the pace of change in formats, rules and regulations? What do managed care plans have to stop doing if they want to ensure business continuity with their encounter operations in the face of change and bleeding revenue? What can you do to make sure your plan isn’t one of the ones that figured these things out too late? Join us to get answers to these questions and more on September 12th.


Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.