Insurance Exchanges

The ACA gave states a number of choices in how to implement the broad coverage changes it required. As such, health reform looks different from state to state, and the impact of the ACA may or may not differ because of these state decisions. This brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their potential impact on enrollment rates to date.

This guidance details the special enrollment periods for consumers to enroll in Marketplace coverage after open enrollment closes on March 31. These special enrollment periods include special enrollment periods the Federally-Facilitated Marketplace (FFM) is currently processing that allow a consumer to select a plan outside of the open enrollment period, including life changes, benefit display errors, misrepresentation and some exceptional circumstances.

This brief compares ACA Marketplace enrollment as of March 1, 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 March 1, the Marketplaces had enrolled 61 percent of projected 2014 enrollment of subsidized and unsubsidized individuals. They had enrolled 63 percent of the subsidized population expected to enroll in 2014. Collectively, State-Based Marketplaces (SBMs) have been more successful in reaching projected enrollment than the Federally Facilitated Marketplaces (FFMs), with SBMs overall also having significantly higher rates of subsidized enrollment than FFMs.
 

This issue brief offers an early look into how competitive the health insurance marketplaces are under the Affordable Care Act in selected states. Through analysis of enrollment data released by seven states (California, Connecticut, Minnesota, New York, Nevada, Rhode Island, and Washington), this brief finds that exchange markets in California and New York are shaping up to be more competitive than their individual markets were in 2012 while those of Connecticut and Washington show less competition. In several states, market shares of individual insurers have shifted significantly compared to the individual market prior to the ACA, pointing to the potential for greater price competition in the future and the influence of new entrants to the market.

The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.