CMS: Unsubsidized ACA exchange population declined by 45% over 4 years

The population on the Affordable Care Act’s (ACA's) exchanges that do not get subsidies declined by 45% from 2016 to 2019, a new report from the Trump administration found.

The report, released Friday (PDF) from the Centers for Medicare & Medicaid Services (CMS), argues that people who don’t qualify for income-based subsidies to lower the cost of insurance are being priced out of the exchanges.

“While premiums have stabilized, middle class Americans can’t afford Obamacare’s expensive premiums,” said CMS Administrator Seema Verma in a statement Friday.

A large majority of ACA enrollees get tax credits. Last year, 87% (approximately 9.3 million) of exchange enrollees who selected a plan through got an advance tax credit.

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But this is the third consecutive year in a row it has been on a decline. Last year, unsubsidized enrollment dropped by more than 300,000 beneficiaries.

“From 2016 to 2019, unsubsidized enrollment declined by 2.8 million people, representing a 45-percent drop nationally,” CMS said in a release. “Though unsubsidized enrollment continues decreasing, the rate of decline dropped to 9% in 2019—down from a 20% drop in 2017 and a 24% drop in 2018.”

CMS said the lower rate of decline mirrors a relatively stable period of premiums on the exchanges.

Meanwhile, enrollment among the subsidized portion of the exchanges continues to grow.

“The subsidized portion of the market was 140% larger than the unsubsidized portion in 2019, up from 122% larger in 2018 and 61% in 2017,” the report said.

Overall, enrollment in the ACA exchanges has remained stable. Last year, an average 10.2 million individuals had paid for their coverage, a slight decline from 2018.