APTC

Originally posted 12/13/24

Michigan has around 531,000 residents enrolled in ACA exchange plans, 91% of whom are currently subsidized. I estimate they also have another ~64,000 unsubsidized off-exchange enrollees.

Combined, that's 595,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 556,000 statewide.

How did we get here?

Originally posted 1/21/25

California has ~1.98 MILLION residents enrolled in ACA exchange plans, over 88% of whom are currently subsidized. They also have an estimated ~470,000 off-exchange enrollees. Combined, that's over 2.4 million people, or 6.2% of their total population.

Originally posted 1/29/25

Pennsylvania has around ~496,000 residents enrolled in ACA exchange plans, 87% of whom are currently subsidized. I estimate they also have another ~103,000 unsubsidized off-exchange enrollees.

Combined, that's 600,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 560,000 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 12/23/24

Arkansas has around 166,000 residents enrolled in ACA exchange plans, 92% of whom are currently subsidized. I estimate they also have perhaps another ~11,000 unsubsidized off-exchange enrollees.

Combined, that's 5.7% 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 Arkansas, however, that would knock the current enrollment down to more like 477,000 statewide.

Originally posted 1/01/25

8/31/25: SEE IMPORTANT UPDATE BELOW!

10/08/25: SEE 2ND IMPORTANT UPDATE BELOW!

New Mexico has around ~70,000 residents enrolled in ACA exchange plans, 85% of whom are currently subsidized. I estimate they also have another ~8,000 unsubsidized off-exchange enrollees.

Combined, that's 78,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 70,000 statewide.

Twelve years ago, the Wall St. Journal ran a story about the impact of the American Taxpayer Relief Act of 2012, a sweeping tax bill signed into law by President Obama which locked in the Bush tax cuts for lower & middle-class households while allowing them to expire on schedule for wealthier Americans:

A compromise measure, the Act gives permanence to the lower rate of much of the Bush tax cuts, while retaining the higher tax rate at upper income levels that became effective on January 1 due to the expiration of the Bush tax cuts. It also establishes caps on tax deductions and credits for those at upper income levels. It does not tackle federal spending levels to a great extent, rather leaving that for further negotiations and legislation. The American Taxpayer Relief Act passed by a wide majority in the Senate, with both Democrats and Republicans supporting it, while most of the House Republicans opposed it.

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.

(with apologies to “Weird Al” Yankovic)

Back in July, I warned that my original projections from earlier in the year of how much net ACA enrollee premiums will increase starting in January 2026 in all 50 states +DC if the enhanced premium tax credits are allowed to expire would have to be revised & updated due to two major changes which had taken place since then:

Almost exactly 10 years ago, The Onion published one of their classic headlines:

Company’s HR Manager Really Pushing Infinite-Deductible Health Care Plan

During a meeting with new hires Wednesday to discuss employee benefits, Radian Analytics human resources manager Ellen Schultz is said to have strongly pushed the company’s infinite-deductible health care option.

According to sources in attendance, Schultz described the low-premium, infinite-deductible plan as the simplest and most convenient choice available to employees, and said it works the same whether plan members need to visit their primary care physician, fill a prescription, or be admitted to a hospital, allowing them in each case to pay 100 percent of the incurred medical expenses.