Insurance Exchanges

The Affordable Care Act's drafters envisioned a continuing, significant role for brokers in the reformed nongroup insurance markets, but circumstances limited their active participation in the first year of marketplace enrollment. This analysis delineates the early barriers to brokers' full engagement, highlights the main concerns with their having a more prominent role and offers options for making them more effective in enrolling the uninsured. The information presented in this brief is based upon interviews conducted with stakeholders (e.g., providers, insurers, consumer advocates, navigators, assisters, brokers) in 21 states and the District of Columbia during the first half of 2014.

The Supreme Court will hear the King v. Burwell case, in which the plaintiff argues that the ACA prohibits payment of premium tax credits and cost-sharing reductions to people in states without state-managed Marketplaces. This report estimates that a victory for the plaintiff would increase the number of uninsured by 8.2 million people and eliminate $28.8 billion in tax credits and cost-sharing reductions in 2016 ($340 billion over 10 years) for 9.3 million people. With lower cost individuals leaving the market, average nongroup premiums in 34 states would increase by 35 percent, affecting those purchasing inside and outside those Marketplaces.

During this second year of open enrollment in marketplaces, states are renewing current enrollees for the first time, in addition to enrolling new customers. Renewing coverage for existing enrollees is essential to avoid coverage gaps, but state approaches to renewals and re-enrollment in marketplace coverage vary. This chart looks at how states are handling Advanced Premium Tax Credits (APTC) and plan renewals for consumers already enrolled in a plan through the marketplace, as well as some of the resources states have produced to educate consumers.

To achieve enrollment targets for 2015, the health insurance marketplaces must rely on millions of consumers renewing their current marketplace health plans. This is no small effort, and the marketplaces are constrained by information technology capacity, a short enrollment time frame, and limited resources for outreach and consumer assistance. This report examines the efforts of six state-based marketplaces (California, Colorado, Kentucky, Maryland, Rhode Island and Washington) to successfully renew health coverage for millions of marketplace enrollees.
 

The end of the ACA’s first open enrollment period has seen better-than-expected participation and a significant drop in the number of uninsured, particularly in states that expanded Medicaid. However, many eligible uninsured have not yet signed up. This paper focuses on one factor that has emerged as a challenge to marketplace enrollment: namely, consumers’ perception that, even with federal subsidies, Qualified Health Plans are not affordable. The paper begins by analyzing how this factor played out during the open enrollment season for 2014, and then describes promising practices implemented by particular states to improve the affordability of coverage.