Charles Gaba's blog

Originally posted 12/14/24

Kentucky has around 97,000 residents enrolled in ACA exchange plans, 86% of whom are currently subsidized. I estimate they also have another ~6,800 unsubsidized off-exchange enrollees.

Combined, that's 104,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 97,000 statewide.

Originally posted 12/09/24

Indiana has around 359,000 residents enrolled in ACA exchange plans, 90% of whom are currently subsidized. I estimate they also have another ~6,700 unsubsidized off-exchange enrollees

Combined, that's 5.3% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Indiana, however, that would knock the current enrollment down to more like 341,000 statewide.

The Centers for Medicare & Medicaid Services (CMS) has posted an official update to the enrollment data for ACA Medicaid expansion through December 2024.

According to the new report, total enrollment from September through December actually increased by just a hair (5,377) and still remained at over 20.7 million nationally, so it doesn't look like the Trump Admin has started cooking these particular books, at least not yet.

I've been able to cobble together more recent ACA expansion enrollment for about half of the 40 states (+DC) which participate in the program:

Originally posted 12/31/24

Hawaii has around 26,000 residents enrolled in ACA exchange plans, 83% of whom are currently subsidized. I estimate they also have perhaps another ~1,700 unsubsidized off-exchange enrollees.

Combined, that's 1.8% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Hawaii, however, that would knock the current enrollment down to more like 24,000 statewide.

Originally posted 1/10/2025

Alabama has around 477,000 residents enrolled in ACA exchange plans, 96% of whom are currently subsidized. I estimate they also have perhaps another ~33,000 unsubsidized off-exchange enrollees.

Combined, that's 9.9% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Alabama, however, that would knock the current enrollment down to more like 477,000 statewide.

Originally posted 6/06/25

Tennessee ACA exchange carriers were instructed to provide two sets of rate filings for 2026: One which assumes CSR reimbursement payments won't be reinstated, one which assumes they are reinstated. In addition, both sets of filings assume that IRA subsidies won't be extended; all but one carrier clarified how much extending the IRA subsidies would impact 2026 premium changes.

Alliant Health Plans: Alliant is requesting a nominal 0.3% increase next year if CSR payments aren't reinstated and a 1.0% drop if they are. In both cases, premiums would be 2.8% lower if IRA subsidies were to be extended by Congress:

Originally posted 8/08/25

Overall preliminary rate changes via the SERFF database, New Hampshire Insurance Dept. and/or the federal Rate Review database.

Anthem Health Plans of NH (BCBS)

(Unfortunately, Anthem has redacted their current enrollment total; see below)

This is a rate filing for the Individual market ACA-compliant plans offered by Anthem Health Plans of New Hampshire, Inc., also referred to as Anthem. The policy forms associated with these plans are listed below. The proposed rates in this filing are for a new HMO product that will be effective for the 2026 plan year beginning January 1, 2026, and apply exclusively to off-exchange plans.

It was just a couple of weeks ago that the official (if preliminary) 2026 ACA individual market rate filings for Wyoming insurance carriers went live on the federal rate review website.

I published a writeup about these just 3 days ago; unlike some states, Wyoming was pretty easy to break out as they only have three carriers on the indy market, all of which also made their current enrollment data easy to find.

The landscape isn't pretty: BCBS is seeking average rate increases of 20.7%; UHC wants 29.1%, and Mountain Health Co-Op, which has around 9,600 enrollees, was asking for a whopping 32% average premium hike.

Keep in mind that Wyoming already has among the most expensive individual market policies in the country, with premiums averaging over $1,000/month.

Originally posted 2/2/25

Wyoming has ~46,000 residents enrolled in ACA exchange plans, 95% of whom are currently subsidized. They also have an unknown number of off-exchange enrollees (likely only a few thousand at most). Combined, that's around 8% of their total population.

(Note, however, that the official actuarial rate filings for the 3 carriers offering coverage in the Wyoming individual market only report a combined total of around 39,000 enrollees as of spring 2025, or 6.6% of the total population).

Originally posted 2/05/25

Alaska has around ~28,000 residents enrolled in ACA exchange plans, 88% of whom are currently subsidized. They also have an unknown number of off-exchange enrollees in ACA-compliant individual market policies. Overall, including net attrition, I estimate their total enrollment both on & off exchange to be perhaps ~27,000 or so.