- Roughly 1.5 million Americans lost their marketplace health coverage between February and March as national exchange enrollment fell from 11.7 million to nearly 10.2 million, the Obama administration reported Tuesday.
Officials expect the enrollment to fall to 9.1 million throughout the year as people drop coverage for a variety of reasons, including nonpayment of premiums, relocation and changes in employment and marital status.
The U.S. Department of Health and Human Services said the 10.2 million enrollees through March is consistent with their target enrollment goals for 2015.
The Congressional Budget Office had originally projected marketplace enrollment would reach 13 million in 2015, 24 million in 2016 and a “steady rate” of 25 million in 2017 as the program is fully implemented.
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That aggressive growth assumed a significant decline over the next two years in both employer-based insurance and non-marketplace individual coverage. But a subsequent HHS analysis found the CBO projections were unrealistic.
Senior administration officials said there was “mixed evidence” and “considerable uncertainty” about the CBO’s expectation of a large two-year movement away from job-based coverage and individual coverage purchased outside the marketplace.
In 2014, 8.1 million people initially signed up for marketplace coverage during the extended enrollment period that ended in May. But total enrollment fell to 6.3 million by the end of the year.
Of the 10.2 million plan members in 2015, about 85 percent, or 8.7 million, are receiving federal subsidies, or tax credits, to help pay for their coverage. The average 2015 tax credit was $272 per month, HHS reported.
The 11 states with the highest rate of low- and middle-income consumers receiving tax credits were: Mississippi (94.5 percent); Florida (93.5 percent); North Carolina (93.2 percent); Wyoming (92.9 percent); Louisiana (92 percent); Arkansas (91.1 percent); Georgia (91.1 percent); Alabama and Wisconsin (90.7 percent); Alaska (90.5 percent) and South Carolina (90.2 percent).
None of these states, except Arkansas, has used the Affordable Care Act to expand eligibility for Medicaid coverage to low-income adults.
Of the 7.3 million plan members in the 34 states that use the federal marketplace, nearly 6.4 million, or 87 percent, received tax credits to help purchase their coverage at HealthCare.gov.
The U.S. Supreme Court will decide later this month whether consumers in those 34 states can continue to receive the tax credits.
Plaintiffs in the King v. Burwell case argue that the subsidies can only go to consumers in the 16 states that operate their own marketplaces. They cite a section of the health care law that says the tax credits can only be applied to coverage purchased “through an exchange established by the State.”
The Obama administration maintains that a full reading of the health law makes clear that Congress intended to provide the tax credits in all states. The Internal Revenue Service, therefore, used a broad interpretation of the law to authorize the subsidy for coverage purchased on the state and federal marketplaces.
A victory for plaintiffs and the loss of the tax credits would cause 6.3 million people to lose their health coverage in 2016, according to estimates by the Urban Institute, a centrist research center.
To read the HHS report, go to go.cms.gov/1JnEdcu