The individual health insurance marketplace experienced a 12 percent decline in enrollment during the first quarter of 2018 compared to the same time period last year, according to an analysis from the Kaiser Family Foundation. Rising premium rates in 2017 and 2018 contributed to the decline.
The marketplace enables individuals who don’t receive healthcare coverage through work to purchase insurance and has expanded since the passage of the Affordable Care Act (ACA) added exchanges. Health insurance coverage quickly jumped 64 percent—a total of 17.4 million people—in 2015 once the exchange went live, but enrollment has tapered off since then.
In 2017, enrollment dropped to 15.2 million. As of the first quarter of 2018, there were 14.4 million people enrolled, according to the Kaiser Family Foundation, compared to 10.6 million people in 2013—before the ACA went fully into effect.
The majority of the decline came from the off-exchange market, which does not cover enrollees who are eligible for federal premium subsidies and were not shielded from large premium increases over the last two years, according to KFF. From the first quarter of 2017 to the same three months in 2018, enrollment in this market dropped 38 percent.
Subsidized enrollees increased 3 percent, or 313,000 people, during the same time period. In the first quarter of 2018, nearly two-thirds of enrollees in the individual market were subsidized.
Higher premiums also impacted enrollment numbers, KFF found. Insurers early on in the exchanges underestimated the cost of the new risk pool and originally set premiums too low to cover claims. At the same time as insurers were raising premiums, a number of providers left the market. 2018 increases were also more related to the rising uncertainty about the enforcement of the individual mandate and the termination of cost sharing payments. Continued uncertainty around the individual mandate will also likely impact premium rates in 2019, as well as the possibility of short-term health plans that could siphon off healthy enrollees.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."