Measuring Marketplace Enrollment Relative to Enrollment Projections: Update

Brief

Measuring Marketplace Enrollment Relative to Enrollment Projections: Update

This brief compares Affordable Care Act Marketplace enrollment as of April 19, 2014 (the most recent state-specific data) to projected enrollment for 2014 and 2016 and estimates of the number of people eligible for subsidies. Nationally, by April 19, the Marketplaces had enrolled 115 percent of projected 2014 enrollment. Collectively, both State-Based Marketplaces (SBMs) and Federally Facilitated Marketplaces (FFMs) exceeded projected enrollment. However, there is considerable variation across the states within each group.

This brief updates information provided in early April that assesses how reported Affordable Care Act (ACA) marketplace enrollment compares to 2014 enrollment totals projected by the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), using the Congressional Budget's Office's (CBO) initial marketplace projection of 7 million for 2014. The earlier brief drew on enrollment data as of March 1, 2014. The tabulations presented here cover enrollment during the initial open enrollment period that ended on March 31, 2014 and enrollment through April 19, 2014 during the special enrollment period based on information released May 1, 2014 by the United States Department of Health and Human Services. This period accounted for people who were "in line" because had started their applications by March 31, 2014, as well as those who experienced a qualifying life event or a complex situation related to applying for coverage in the Marketplaces. It is important to note that the final enrollment totals for 2014 will likely differ from these numbers for two reasons. On the one hand, some people will not pay their premiums and as such will not be covered by Marketplace plans during 2014. On the other hand, others will enroll in Marketplace plans after April 2014 because of special enrollment periods.

AT A GLANCE:

  • As of April 19, 2014, the Affordable Care Act's (ACA) Health Insurance Marketplaces had enrolled 115 percent of 2014 projected nationwide enrollment of subsidized and unsubsidized individuals, as derived from the Urban Institute's Health Insurance Policy Simulation Model (Table 1). On May 1, 2014, the Department of Health and Human Services released a report indicating that enrollment had surpassed 8 million nationally, exceeding CBO projections for the year. By April 19, 2014, 26 states had exceeded 2014 Marketplace enrollment projections for their state.
  • Marketplace enrollment grew from 61 percent of projected enrollment as of March 1, 2014 to 115 percent of projected enrollment as of April 19, 2014 (Figure 1).
  • State-Based Marketplaces (SBMs) and Federally Facilitated Marketplaces (FFMs) had both exceeded Marketplace projections for 2014 by April 19: SBMs had enrolled 121 percent of the enrollment projected to occur by December 31, 2014, compared to 113 percent for FFMs (Table1). The gap relative to projected enrollment between these two groups closed considerably between March 1 and April 19, 2014.
  • Within SBM and FFM categories, enrollment relative to projections varies tremendously across states (Figure 1).
  • As of April 19, Marketplaces had enrolled 46 percent of projected 2016 enrollment and 25 percent of the entire target population (pre-reform nongroup insurance enrollees and uninsured individuals ineligible for public insurance or affordable employer-based coverage; Table 1).

Exhibit 1
Exhibit 1

Copyright© April 2014. The Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute.

About the Authors and Acknowledgements
Linda Blumberg is a senior fellow, John Holahan is an Institute Fellow, Genevieve Kenney is a co-director and a senior fellow, Matthew Buettgens is a senior research associate, Nathaniel Anderson and Hannah Recht are research assistants, and Stephen Zuckerman is a co-director and a senior fellow at the Urban In-stitute's Health Policy Center. This study was funded by the Robert Wood Johnson Foundation. The au-thors are grateful to Bowen Garrett and Lisa Clemans-Cope for their input into revisions of the Health Insurance Policy Simulation Model (HIPSM).

About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national culture of health that will enable all Ameri-cans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter www.rwjf.org/twitter or Facebook www.rwjf.org/facebook.

About the Urban Institute
The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic and governance problems facing the nation. For more information, visit www.urban.org. Follow the Urban Institute on Twitter www.urban.org/twitter or Facebook www.urban.org/facebook. More information specific to the Urban Institute's Health Policy Center, its staff, and its recent research can be found at www.healthpolicycenter.org.

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