Nearly all analysts predicted that marketplace enrollment would increase by the end of the 2015 open enrollment period, but projections varied. The Congressional Budget Office projected 13 million enrollees, the Department of Health and Human Services revised its projection downward in November 2014 to 9 million enrollees, and Citi Investment Research projected around 11 million enrollees. Using the Urban Institute's Health Insurance Policy Simulation Model, based on historical take-up, we project that 11 million individuals would be enrolled at the close of 2015 open enrollment. According to the latest figures, 11.7 million people have selected marketplace plans. It is not known how many of them have actually paid their premiums and should be counted as enrolled, so we distinguish between enrollment and plan selections throughout this presentation.
To better compare marketplace success across states, our projections assume that all marketplaces would be equally successful in enrollment, given differences in the target populations across states. Both the Urban Institute and Congressional Budget Office projections use detailed models based on a representative population of the United States to estimate the impact of the Affordable Care Act when fully implemented. New health coverage programs generally take several years to reach their full enrollment levels as individuals continue to learn about the availability of new coverage options. Consequently, we assume a “ramp-up” in enrollment from 2014 to 2016: one-third of full enrollment in 2014, two-thirds of full enrollment in 2015; and full enrollment in 2016. The Congressional Budget Office also assumes that it will take three years for enrollment to reach its long-term level.
Sources: Plan selections from the US Department of Health and Human Services, Addendum to the Health Insurance Marketplace Summary Enrollment Report for the Initial Open Enrollment Period, 2014; US Department of Health and Human Services, Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report, 2015; and state-based marketplaces. Projections from HIPSM-ACS 2015, Urban Institute.Note: M = million.
Thirteen states and Washington, DC, currently operate their own marketplaces and websites. For 2015 enrollment, healthcare.gov handles enrollment for 34 federally facilitated marketplaces and 3 state-based marketplaces.
In a 2014 report, we found that enrollment relative to projections was higher for state-based marketplaces than for federally facilitated marketplaces. This year, however, marketplaces using healthcare.gov, whether they are state-based or federally facilitated, tended to have made larger relative gains. Plan selections in these marketplaces increased, in aggregate, 61 percent from the 2014 open enrollment period and are now at 116 percent of our 2015 projection. State-based marketplaces not using healthcare.gov have, in aggregate, increased enrollment only 13 percent and are now at 89 percent of our 2015 projection. These figures are not final: nearly all state-based marketplaces and healthcare.gov have announced extensions for those who find out that they are liable for a tax penalty because they did not have insurance coverage in 2014.
Sources: Plan selections from the US Department of Health and Human Services, Addendum to the Health Insurance Marketplace Summary Enrollment Report for the Initial Open Enrollment Period, 2014; US Department of Health and Human Services, Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report, 2015; and state-based marketplaces. Projections from HIPSM-ACS 2015, Urban Institute.Note: Massachusetts' enrollment, not shown, increased 356 percent from 2014 to 2015 because of difficulties with the 2014 enrollment process.
State-based marketplaces that enrolled large numbers of people in 2014 relative to projections generally also enrolled large numbers of people in 2015 relative to projections. Vermont; Washington, DC; Idaho; Connecticut; and New York enrolled more than we projected in both 2014 and 2015. Though Vermont showed a decline in enrollment from 2014 to 2015, its 2014 enrollment was so high that its current enrollment remains above our expectations for this year. Rhode Island's enrollment is approximately equal to our 2015 projection. Enrollment levels in California and Kentucky are slightly lower than our projections, but the final enrollment figures could change that.
Washington and Colorado, however, are both at roughly two-thirds of our 2015 projections. Final enrollment figures are not yet available, but it appears that these two states experienced enrollment setbacks in 2015. We do not show the Massachusetts’s enrollment increase because 2014 enrollment in that state was particularly low; this was caused by the temporary extension of the Commonwealth Care program until January 31, 2015. Commonwealth Care enrollees had to switch to marketplace plans in 2015. Marketplace enrollment levels in Maryland, Nevada, Oregon, and New Mexico were all between 70 and 80 percent of our projections both for 2014 and 2015. Minnesota and Hawaii both experienced increases in enrollment between 2014 and 2015, but both ended up at only 44 percent of our 2015 projections.
Among all federally facilitated marketplaces, Florida and North Carolina had the highest enrollment relative to our projections both in 2014 and 2015. Maine, Virginia, and Georgia also had high levels of enrollment relative to projections in 2014 and made additional progress in 2015. On the other hand, Michigan and New Hampshire had high 2014 enrollment levels in 2014 but experienced relatively small increases in enrollment in 2015. Enrollment in both states, however, is still above our 2015 projections. North Dakota, South Dakota, and Iowa had the lowest enrollment relative to our projections in both 2014 and 2015.
Select a state from the drop-down menu in the figure below to see more-detailed enrollment data. The first bar shows the number of plan selections in the selected state after the 2014 open enrollment period, distinguishing those who were eligible for premium tax credits from those who were not. The second bar shows the number of plan selections in the selected state thus far for 2015. The third bar shows our projected 2015 marketplace enrollment based on our microsimulation model. The number of people who have selected plans will be somewhat higher than the number who pay their first month’s premium, thus actually enrolling and maintaining coverage. The fourth bar shows our estimate of the total number of people in the selected state who are eligible for premium tax credits (not everyone eligible will enroll). There is considerable variation across states in marketplace enrollment levels and enrollment growth.
Sources: Plan selections from the US Department of Health and Human Services, Addendum to the Health Insurance Marketplace Summary Enrollment Report for the Initial Open Enrollment Period, 2014; US Department of Health and Human Services, Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report, 2015; and state-based marketplaces. Projections from HIPSM-ACS 2015, Urban Institute.Notes: M = million, k = thousand. Enrollment data is not broken down by tax credit status in all states.
© Copyright Urban Institute andRobert Wood Johnson Foundation, 2015
Research: Matthew Buettgens, Hannah Recht, and Linda BlumbergWeb Development: Hannah RechtWeb Design: Adrienne Hapanowicz and Tim Meko
The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. This interactive was funded by the Robert Wood Johnson Foundation. Funders do not determine research findings or influence scholars’ conclusions. The team thanks Genevieve Kenney and Steve Zuckerman for their helpful feedback. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.