The Affordable Care Act public exchange system did better at retaining existing users this year but had trouble attracting new users.
The Centers for Medicare & Medicaid Services has posted numbers supporting that assessment in a batch of exchange system activity data for the system's open enrollment period for 2017.
About 12.2 million people either had exchange plan coverage in place at the end of the 2017 open enrollment period, or had selected plans and were on track to have coverage in place once they paid their premiums.
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The total number of people signed up for coverage was 3.9 percent lower than the comparable total for the 2016 open enrollment period.
The number of people signed up who were new to the exchange system plunged 22 percent, to 3.8 million.
But the number of enrollees who had exchange coverage last year and are continuing to use exchange coverage this year increased 7.7 percent, to 8.4 million.
The open enrollment period for 2017, or time of year when people can buy individual major medical coverage without having what the government classifies as a good excuse to be shopping for coverage, started Nov. 1 and ended Jan. 31.
CMS is an arm of the U.S. Department of Health and Human Services. HHS set up the exchange system to provide ACA exchange services for states that were unwilling or unable to do that job themselves.
Thirty-nine states used the HealthCare.gov enrollment system this year. Eleven states and the District of Columbia ran their own enrollment systems.
HealthCare.gov, and the insurers selling plans through HealthCare.gov, had a much harder time attracting new customers than the state-based exchanges this year, but HealthCare.gov and its issuers did much better at holding on to 2016 customers.
ACA exchange data | |||
| SIGNUP ACTIVITY | |||
| HealthCare.gov, the state exchanges and the D.C. exchange | |||
| (millions of lives) | |||
| 2017 | 2016 | 2015 | |
| New plan selectors | 3.8 | 4.9 | 4.6 |
| Returning enrollees | 8.4 | 7.8 | 4.2 |
| Automatic re-enrollees | 2.8 | 2.8 | 2.0 |
| TOTAL SIGNUPS | 12.2 | 12.7 | 11.7 |
| MONEY | |||
| Costs and subsidies for HealthCare.gov users | |||
| 2017 | 2016 | 2015 | |
| Share of enrollees getting advance premium tax credit subsidy | 84% | 85% | 87% |
| Share of enrollees getting cost-sharing reduction subsidy | 58% | 59% | 60% |
| Average monthly premium | $489 | $396 | $364 |
| Average monthly premium tax credit subsidy | $383 | $290 | $263 |
| Average APTC user monthly coverage bill | $106 | $106 | $101 |
| Sources: HHS Office of the Assistant Secretary for Planning and Evaluation for 2015 and 2016 (including the 2016 addendum). CMS for 2017. | |||
New sales v. retention
The number of new signups sank about 25 percent, to 3 million, at HealthCare.gov. At the state-based exchanges, the number of new users fell about 10 percent, to about 800,000.
The picture was different for enrollee retention.
The number of enrollees retained held steady at about 2.8 million for the state-based exchanges.
At HealthCare.gov, the number of enrollees retained rose 11 percent, to 6.2 million.
CMS also provided some information about premiums and subsidies for the HealthCare.gov states.
The average monthly premium for HealthCare.gov issuers' coverage climbed 23 percent, to $489. But the average premium tax credit subsidy rose 32 percent, to $383.
Because of the big increase in the monthly subsidy amount, the average amount HealthCare.gov users are paying out of their pockets each month for coverage held steady at $106.
The open enrollment period for 2017 was the last to begin under the presidential administration of Barack Obama.
Seema Verma, President Donald Trump's CMS administrator, took the oath of office Tuesday.
CMS did not include a statement from Verma in the exchange activity announcement.
Verma might have more ideas about the strengths and weaknesses of the CMS exchange system than the typical federal official, because the consulting firm she ran before joining CMS had the contract to train Indiana's HealthCare.gov navigators.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
