Under the Affordable Care Act (ACA), states have had the opportunity to decide if and how they expand their Medicaid programs and to what extent they have a hand in the administration of health insurance exchanges.
Today, 31 states and the District of Columbia have opted to expand their Medicaid programs, three states are discussing the possibility of expansion and 16 are decidedly not expanding at this time. In addition, 16 states and the District of Columbia run their own exchanges. Four of them – New Mexico, Nevada, Oregon and Hawaii – are considered “federally-supported” state-based exchanges because they rely on the federal government’s IT infrastructure: HealthCare.gov. The remaining states are in the federal marketplace, though some have a “partnership” with the federal government that permits them to administer consumer assistance and outreach functions.
Three years into open enrollment under the ACA, carriers are refining their exchange portfolios – both in terms of what products they sell and how much they sell them for. Benchmark premiums – those for the second-lowest-cost silver plans – increased more dramatically in 2016 than in 2015. In 2016, there were 20 states where the benchmark premium in the most populous county grew by double digits. In comparison, just five states experienced such increases in 2015. Eleven states did see decreases in the benchmark premium in 2016, but this is down from 25 states in 2015.
Ultimately, rate changes vary widely depending on individual states, geographic areas, companies, network types and enrollee demographics. And, despite instances of significant rate hikes, overall growth of these benchmark premiums has been modest. Between 2014 and 2016, benchmark premiums increased, on average, 4.0%, according to HRI analysis.
For more data and analysis on the ACA exchanges, please see HRI's report, Three years in, the ACA marketplace shows modest premium growth, fewer plan options and continued competition.
Select a year range, then a state to view details on state ACA participation and benchmark premiums in the most populous county.
Percent change in benchmark premium in the most populous county
1. State participation information as of January 2016.
2. State-based exchanges using the HealthCare.gov technology platform.
Benchmark premium 2014
Benchmark premium 2015
Benchmark premium 2016
Benchmark premium increase ‘14-’15
Benchmark premium increase ‘15-’16