Kill the Cliff

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 12/18/24

Idaho has around 117,000 residents enrolled in ACA exchange plans, 86% of whom are currently subsidized. I estimate they also have another ~9,000 unsubsidized off-exchange enrollees.

Combined, that's 6.2% 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 Idaho, however, that would knock the current enrollment down to more like 118,000 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 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, or roughly 4% of the total state population.

Originally posted 12/07/24

Arizona has around 423,000 residents enrolled in ACA exchange plans, 88% of whom are currently subsidized. I estimate they also have perhaps another ~8,000 unsubsidized off-exchange enrollees.

Combined, that's 5.6% 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 Arizona, however, that would knock the current enrollment down to more like 477,000 statewide.

Originally posted 1/06/25

In early 2021, Congressional Democrats & President Biden passed the American Rescue Plan Act (ARPA), which dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. They then extended the subsidy upgrade out by another 3 years via the Inflation Reduction Act.

In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the upgrade eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.

Originally posted 12/23/24

In early 2021, Congressional Democrats & President Biden passed the American Rescue Plan Act (ARPA), which dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. They then extended the subsidy upgrade out by another 3 years via the Inflation Reduction Act.

In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the upgrade eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.

Originally posted 12/23/24

Arkansas has around 166,000 residents enrolled in ACA exchange plans, 92% of whom are currently subsidized. I estimate they also have perhaps another ~11,000 unsubsidized off-exchange enrollees.

Combined, that's 5.7% 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 Arkansas, however, that would knock the current enrollment down to more like 477,000 statewide.