Charles Gaba's blog

Originally posted 1/02/25

Kansas has around 200,000 residents enrolled in ACA exchange plans, 94% of whom are currently subsidized. I estimate they also have another ~6,000 unsubsidized off-exchange enrollees.

Combined, that's ~206,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be down to more like 192,000 statewide.

Originally posted 12/14/24

Kentucky has around 97,000 residents enrolled in ACA exchange plans, 86% of whom are currently subsidized. I estimate they also have another ~6,800 unsubsidized off-exchange enrollees.

Combined, that's 104,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 97,000 statewide.

Originally posted 12/09/24

Indiana has around 359,000 residents enrolled in ACA exchange plans, 90% of whom are currently subsidized. I estimate they also have another ~6,700 unsubsidized off-exchange enrollees

Combined, that's 5.3% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Indiana, however, that would knock the current enrollment down to more like 341,000 statewide.

Originally posted 12/11/24

Iowa has around 136,000 residents enrolled in ACA exchange plans, 88% of whom are currently subsidized. I estimate they also have another ~9,600 unsubsidized off-exchange enrollees.

Combined, that's over 146,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be down to more like 136,000 statewide.

The Centers for Medicare & Medicaid Services (CMS) has posted an official update to the enrollment data for ACA Medicaid expansion through December 2024.

According to the new report, total enrollment from September through December actually increased by just a hair (5,377) and still remained at over 20.7 million nationally, so it doesn't look like the Trump Admin has started cooking these particular books, at least not yet.

I've been able to cobble together more recent ACA expansion enrollment for about half of the 40 states (+DC) which participate in the program:

Originally posted 12/31/24

Hawaii has around 26,000 residents enrolled in ACA exchange plans, 83% of whom are currently subsidized. I estimate they also have perhaps another ~1,700 unsubsidized off-exchange enrollees.

Combined, that's 1.8% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Hawaii, however, that would knock the current enrollment down to more like 24,000 statewide.

Originally posted 12/18/24

Idaho has around 117,000 residents enrolled in ACA exchange plans, 86% of whom are currently subsidized. I estimate they also have another ~9,000 unsubsidized off-exchange enrollees, although the actual rate filings (summarized later in this post) put the off-exchange total at a much higher ~47,000.

Combined, that's 6.2 - 8.0% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Idaho, however, that would knock the current enrollment down to more like 118,000 statewide.

Originally posted 1/10/2025

Alabama has around 477,000 residents enrolled in ACA exchange plans, 96% of whom are currently subsidized. I estimate they also have perhaps another ~33,000 unsubsidized off-exchange enrollees.

Combined, that's 9.9% of their total population.

Assuming the national average 6.6% net enrollment attrition rate thru April reported by the Centers for Medicare & Medicaid Services applies to Alabama, however, that would knock the current enrollment down to more like 477,000 statewide.

Originally posted 6/06/25

Tennessee ACA exchange carriers were instructed to provide two sets of rate filings for 2026: One which assumes CSR reimbursement payments won't be reinstated, one which assumes they are reinstated. In addition, both sets of filings assume that IRA subsidies won't be extended; all but one carrier clarified how much extending the IRA subsidies would impact 2026 premium changes.

Alliant Health Plans: Alliant is requesting a nominal 0.3% increase next year if CSR payments aren't reinstated and a 1.0% drop if they are. In both cases, premiums would be 2.8% lower if IRA subsidies were to be extended by Congress:

Originally posted 7/21/25; See important updates below.

It's a little awkward to try & pull quotes from Georgia's actuarial memos because they're heavily redacted (see attachments below), but fortunately I also have access to other "just the facts" filing documents which include the hard data I need to compile my weighted averages. These forms--officially called "Rate Filing Transmittal Form LH-T1" and "Unified Rate Review" forms--include, among lots of other numbers, the preliminary avg. rate change being requested for the carrier's individual (or small group) market plans, as well as the number of current effectuated enrollees they have.

In addition, I have alternate rate filings for Georgia individual market carriers which specifically state what their requested rate changes would be if the enhanced premium tax credit subsidies provided by the American Rescue Plan Act & Inflation Reduction Act were to be extended for at least one more year, providing a clear apples to apples comparison.