Chart: Change in Q1 ACA enrollmentThe number of people who have to buy health insurancecoverage on the individual market and fork over the whole costthemselves has decreased by some 651,000 (five percent) in the wakeof the repeal of the individual mandate penalty for the AffordableCare Act.

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A new Kaiser Family Foundation analysis finds that all of the losses occurredin the off-exchange market, where people are not eligible for taxcredits. Marketplace plans, on the other hand, saw their enrollmenthold steady at 10.6 million during the first quarter of this year;that includes 9.3 million low- and moderate-income enrollees who doreceive tax credits as an assist to pay for plan premiums.

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Related: Unsubsidized ACA enrollment down by more than amillion

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According to the Centers for Medicare and Medicaid, thenumber of new consumers signing up for plans in 2019 dropped by 16percent, from 3.2 million to 2.7 million. KFF says that thedecrease in new signups could be a result of severalfactors, including ”reductions in outreach andconsumer assistance, repeal of the individual mandate penalty, orbroader economic factors that may make people less likely to comeinto the market.”

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Unsubsidized enrollment has fallen as subsidized enrollment hasrisen, with KFF theorizing that in Q1 2019 more than two thirds ofindividual market enrollees are getting a premium subsidy.

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Individual market enrollment declines, says KFF, could resultfrom numerous factors that include “rising premiums forACA-compliant coverage; the expansion of loosely regulated plansthat may not be considered individual market coverage yet couldattract customers away from the individual market; the effectiverepeal of the individual mandate; and broader economic trends, likegains in employment, which could lead to more people havingjob-based coverage.” It can’t yet be determined, however, whetherthe 2019 decline means that those people no longer have coverage orwhether they were able to get coverage through other sources.

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The individual market lost numerous enrollees in 2017 aftermajor premium increases—early rates were set too low when insurersunderestimated how sick the new risk pool would be—and also lostinsurers that exited the market over profitability concerns.However, the remaining insurers began to show profits, and premiumswere expected to hold fairly steady in 2018 without the substantialprice hikes that were put in place in 2017.

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But then uncertainty over ACA repeal debates in Congress and theTrump administration’s termination of cost sharing payments drovepremiums up further in 2018. In 2019 the individual mandate penaltywent away against a background of mostly flat premium costs, andsubsidized enrollment held fairly steady, the report says.

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It adds, “We estimate enrollment in unsubsidized off-exchangeACA-compliant plans declined by about 400 thousand from 2018 to2019 (corresponding with the effective repeal of the individualmandate penalty but also relatively flat premium growth), which issmaller than previous declines in this part of the market thatcorresponded with steep increases in premiums.”

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The KFF report continues that “given continued strong financialperformance by individual market insurers and enrollment thatremains higher than before the ACA, there do not appear to be anysigns of market collapse so far in the absence of the individualmandate penalty.”

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.