Insurance Exchanges

This report reveals significant collaboration between Arkansas's public and private sectors to expand health care coverage through the Health Care Independence Program (commonly known as the "private option") and the federally facilitated marketplace partnership. The political environment in Arkansas that led to decisions related to the ACA are detailed in the report, along with the fluid status of the state’s pioneering decisions in light of recent leadership transitions and uncertainty at the federal level.

The Supreme Court is expected to issue a ruling by the end of June in King v. Burwell, a case challenging the legality of health insurance subsidies provided to low- and middle-income people in the 34 states where the federal government is operating the insurance Marketplace under the Affordable Care Act. This map and table show for each state: the number of people now receiving premium subsidies who would lose them if the Court finds for the challengers; the total amount of federal subsidy dollars; the average premium tax credit that subsidized enrollees have qualified for; and the average increase in premiums that subsidized enrollees would face if the subsidies are disallowed.

Approximately 14.1 million previously uninsured Americans gained health insurance between the beginning of open enrollment in October 2013 and March 4, 2015. Some of the greatest declines in uninsured rates were for lower- and middle-income consumers, including those eligible for tax credits to help pay their premiums for plans in the health insurance marketplaces. But simply having health insurance is no guarantee that consumers can afford to pay for health care. Unfortunately, this study shows that, for many Americans with non-group coverage, deductibles and other out-of-pocket costs are prohibitively high, and are associated with many of these insured consumers forgoing needed health care.

This survey reports on the views and experiences of people purchasing health insurance coverage in the non-group market. Over the past few years, the ACA has had a significant impact on this group, as new rules took effect that standardized coverage, guaranteed coverage for those with pre-existing conditions, and established income-based federal financial assistance to those buying insurance through new health insurance Exchanges or Marketplaces. Starting on January 1, 2014, all coverage newly purchased either through a Marketplace or directly from an insurance company had to follow new rules under the ACA (i.e. “ACA-compliant”).

The ACA created the Small Business Health Options Program (SHOP) Marketplaces to help small businesses provide health insurance to their employees. This study compares the numbers of carriers and plans and premium levels in 2014 for plans offered through SHOP Marketplaces with those of plans offered only outside of the Marketplaces. An average of 4.3 carriers participated in each state’s Marketplace, offering a total of forty-seven plans. Premiums for plans offered through SHOP Marketplaces were, on average, 7 percent less than those in the same metal tier offered only outside of the Marketplaces. Lower premiums and the participation of multiple carriers in most states are a source of optimism for future enrollment growth in SHOP Marketplaces. Lack of broker buy-in in many states and burdensome enrollment processes are major impediments to success.

This guidance describes the alternative procedures for eligibility redetermination for enrollment in a qualified health plan through the Marketplace and insurance affordability programs for benefit year 2016. These procedures incorporate some modifications from the alternative procedures specified by the Secretary for benefit year 2015, and will be implemented by each Federally-facilitated Marketplace (FFM). Like the alternative procedures for benefit year 2015, the alternative procedures preserve a core feature of the annual redetermination process, namely that an enrollee may take no action and retain coverage for 2016, which is important in promoting continuity of coverage while limiting administrative burden for enrollees, issuers, and Marketplaces.

To develop this dataset, researchers collecting data simulated a typical shopping experience on healthcare.gov. The dataset captures 25 design aspects of the marketplace websites, which include, but are not limited to, whether websites ask for pregnancy and disability status and whether consumers can view quality ratings for certain plans. This dataset is featured in the data brief entitled, "Window Shopping on Healthcare.gov and the State-Based Marketplaces: More Consumer Support is Needed."

People may purchase subsidized health insurance through the ACA exchanges with premiums based on projected future income. However, if actual income is higher than estimated, they may be required to repay part or all of the subsidy when they file tax returns. This "reconciliation" process could raise taxes substantially for many ACA participants. However, analysis of income tax return data suggests that for most lower-income filers, the reconciliation will reduce the refund they receive rather than require them to remit additional tax because their refunds exceed the reconciliation amount. This paper also includes a discussion of ways in which the reconciliation process could be improved.