Payers selling ACA plans on see stable enrollment

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Trine K. Tsouderos HRI Regulatory Center Leader, PwC US January 31, 2020


During the 2019 open enrollment period, 8.3 million Americans chose an Affordable Care Act (ACA) plan on, down slightly from 2018, when 8.4 million people selected a plan on the federal exchange, according to data released this month by CMS. The 1.5% year-over-year drop is due, in part, to Nevada abandoning, which is now used by 38 states, and launching its own exchange.

Still, ACA enrollment via has declined significantly from its peak of 9.6 million enrollees in 2016. 

The greatest number of 2020 total enrollees live in Southern states, including Florida (1.9 million), Texas (1.1 million), North Carolina (0.5 million) and Georgia (0.5 million). CMS will publish a final report in March that incorporates state-based exchange enrollment. 

HRI impact analysis

In a tweet, Seema Verma, the CMS administrator, characterized enrollment as “remarkably stable” and noted that part of the decline on was due to Nevada’s launch of its own exchange and Maine’s expansion of Medicaid under the ACA. Verma said the moves accounted for 90,000 fewer enrollees on the federal platform.

Despite the relatively stable year-over-year figures, the number and percentage of uninsured Americans have increased since 2016, when they hit their lowest numbers (that is also the year the number of people enrolled in ACA plans on the federal exchange hit its peak), according to census data. The erosion in coverage gains, while modest, likely will have an impact on providers, especially in states, such as Texas, with relatively high rates of uninsured residents.

This trend is occurring alongside a crisis in affordability as consumers with insurance struggle with high deductibles and other cost sharing, which has grown dramatically over the past decade (see page 6 of HRI’s report, Medical cost trend: Behind the numbers 2020). Providers are feeling pressure as more patients walk through their doors unable to pay for their share of their care. Solutions such as suing patients for the unpaid bills have resulted in sharp public rebukes.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

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