The federal government cheered the 2016 open-enrollment period as more than 12.7 million Americans signed up for health insurance, but a closer look at the data reveals that many individual counties recorded precipitous annual declines in plan selections.
That's not entirely worrisome news though, because people may have picked up health insurance from Medicaid, employers or other sources. Those numbers also show how closely linked state Medicaid programs and the Affordable Care Act's individual marketplaces are, given that many exchange enrollees are low income.
“When we think about it, a decline in marketplace enrollment isn't necessarily bad on its face,” said Molly Warren, a senior policy analyst at Enroll America, a group that helps consumers sign up for coverage and supports the ACA. “We're concerned if people are losing coverage.”
Approximately 9.63 million people selected a health plan or were automatically re-enrolled in their previous plan in the 38 states that used HealthCare.gov this year, compared with the 8.84 million people in the 37 HealthCare.gov states in 2015.
Modern Healthcare analyzed HHS data from 2015 and 2016 that broke down ACA exchange plan selections by county. The data included only those states that used the federally operated marketplace. As expected, enrollment increased almost everywhere from 2015 to 2016. HHS targeted Chicago, Houston, Miami and other large metropolitan areas for sign-ups, and indeed, the counties that contain those cities all experienced significant upticks in exchange membership.
But there were two notable outliers—Indiana and Pennsylvania—that had exceptionally poor showings.
Marion County, Indiana's most populous county, which includes the state capital of Indianapolis, saw 20% fewer exchange enrollees year over year. Only eight of Indiana's 92 counties recorded enrollment gains in the federal ACA exchange this year, and the entire state posted a 10.5% reduction in plan selections.
In Pennsylvania's Philadelphia County, there were 15,915 fewer ACA plan selections in 2016, a 21% decline from 2015, by far the biggest drop of any county in the country. Counties in western Pennsylvania also posted lower sign-up figures.