Now that Republicans have failed in their bid to repeal the Affordable Care Act, attention has turned to the fate of the law's individual exchanges.
In the aftermath of the demise of the American Health Care Act, both President Donald Trump and House Speaker Paul Ryan had dire predictions for the ACA, with Trump saying he thinks "Obamacare will unfortunately explode." Political rhetoric aside, the most recent enrollment data include some important clues about the current state of the marketplaces.
According to data from the Centers for Medicare & Medicaid Services, the total number of consumers who signed up for coverage through the federal and state-based marketplaces this year shrunk slightly compared to 2016, even as the marketplaces welcomed more than 3.8 million new consumers.
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That means, of course, that a greater number dropped out of the marketplaces, either because they got insurance elsewhere (through a job, a spouse, Medicare or Medicaid) or because they dropped insurance altogether—and took the ensuing tax penalty.
Breaking down that data by the state level shows considerable regional variation. Some states saw dramatic net losses in their exchanges between the 2016 and 2017 open enrollment periods, while others were able to hold on to their enrollees and include a greater total number.
Interestingly, these data did not correspond with a state's likelihood to welcome new enrollees. Some states that saw the highest percentages of new enrollees in their exchanges, such as Washington state and Maryland, also had huge net losses in those exchanges, meaning the intensity of people leaving the exchanges was even greater.
Under the Obama administration, CMS did acknowledge that customer churn was a challenge faced by the marketplaces, and noted it was striving to ensure its own processes weren't contributing to the issue. Despite those efforts, a recent report from the Department of Health and Human Services’ Office of Inspector General found that the federal marketplace continues to have problems resolving inconsistencies between information reported by enrollees and other data used to verify their eligibility for coverage and financial assistance.