Kill the Cliff

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It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things 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.

In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also 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.

Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:

Originally posted 1/01/25

Louisiana has around ~293,000 residents enrolled in ACA exchange plans, 96% of whom are currently subsidized. I estimate they also have another ~13,000 unsubsidized off-exchange enrollees.

Combined, that's 306,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 286,000 statewide.

Originally posted 12/06/24

Maryland has around 247,000 residents enrolled in ACA exchange plans, 76% of whom are currently subsidized. I estimate they also have another ~73,000 unsubsidized off-exchange enrollees.

Combined, that's 320,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 300,000 statewide.

Originally posted 12/13/24

Michigan has around 531,000 residents enrolled in ACA exchange plans, 91% of whom are currently subsidized. I estimate they also have another ~64,000 unsubsidized off-exchange enrollees.

Combined, that's 595,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 556,000 statewide.

Originally posted 12/04/24

Massachusetts has around 390,000 residents enrolled in ACA exchange plans, 83% of whom are currently subsidized. I estimate they also have another ~27,000 unsubsidized off-exchange enrollees.

Combined, that's ~417,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to perhaps ~400,000.

Originally posted 1/09/25

Maine has around 64,000 residents enrolled in ACA exchange plans, 85% of whom are currently subsidized. I estimate they also have another ~4,500 unsubsidized off-exchange enrollees.

Combined, that's around 70,000 people, although it could be somewhat lower due to net enrollment attrition since January.

Originally posted 12/03/24

Minnesota has around 151,000 residents enrolled in ACA exchange plans, 61% of whom are currently subsidized. I estimate they also have another ~62,000 unsubsidized off-exchange enrollees.

Combined, that's ~213,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 200,000 statewide.

Originally posted 1/02/25

Kansas has around 200,000 residents enrolled in ACA exchange plans, 94% of whom are currently subsidized. I estimate they also have another ~6,000 unsubsidized off-exchange enrollees.

Combined, that's ~206,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be down to more like 192,000 statewide.

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.

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