Detailed Obamacare Blue Cross Enrollment–About Half the Enrollment Doesn’t Get a Subsidy!


First, the administration keeps telling the press that 85% of exchange participants get a subsidy.
That is technically correct but awfully misleading. I have been arguing
for years that about half of the Obamacare individual market does not
get a subsidy when you include all of those customers that purchase
their individual health insurance policies off the exchange.

As an administration spokesperson put it
a couple of weeks ago, “Even in a scenario where all plans saw
double-digit rate increases, the vast majority of consumers would
continue to have affordable plans.” If you believed that line, you will
be quite surprised by what Davis found.

Then there are all of the Obamacare supporters like Kliff. Apparently, the millions of middle class people who have no choice but to be in the Obamacare health insurance market are invisible to them and it’s just fine that they have no choice but to get their health insurance from a safety net program “offering limited services to a predominantly low-income population.”

Consumers who do not get a subsidy pay
the full premium, absorb all of the big rate increases, as well as the
full deductible and co-pay increases.

So, how many individual health insurance policyholders are there that don’t get a subsidy?

Davis surveyed a number of Blue Cross plans by calling them and asking that question and here is what he found:

Anthem: 784,550
with a subsidy and 1,015,450 without a subsidy. “The publicly traded
company, which operates in 14 states, ended the second quarter of 2016
with 1.8 million members in the individual market. About 923,000
are covered by policies purchased through an exchange, the company
reported July 27. The remaining 877,000 are covered by an individual
policy purchased outside of an exchange…Using CMS’ estimate that 85% of people who purchased coverage through an exchange qualified for federal subsidies, for Anthem that would translate to about 784,550 people with a subsidy…That
leaves a little more than 1 million people––138,450 on the exchange and
877,000 off the exchange–who won’t get a subsidy.”

Health Care Service Corp: 881,000 members with a subsidy and 818,550 without a subsidy.
“HCSC operates Blues plans in Illinois, Oklahoma, Montana, New Mexico,
and Texas. As of December 31, 2015, HCSC says 61% of its 1.7 million
individual members in five states purchased their coverage through the
exchange. That works out to a little more than 1 million lives. But if
15% of those members don’t qualify for a subsidy–and the other 663,000
purchased ACA compliant coverage outside the exchange–818,550
individual members won’t have a federal subsidy.”

Arkansas Blue Cross and Blue Shield:
“As of July 1, 215,271 individuals were enrolled in on-exchange
metallic plans [presumably 15% or 32,291 did not get a
subsidy]…Another 59,915 individuals are enrolled in non-ACA-compliant
insurance policies purchased outside the exchange.”

BlueCross Blue Shield of Kansas:
46% of non-group members purchased coverage outside the exchange and
54% purchased coverage on the exchange [presumably 15% of those did not
get a subsidy]. Of the off exchange plans, 56% are in non-compliant plans.

Blue Cross Blue Shield of Louisiana: Of the 206,793 people covered by an individual health plan, and assuming 85% of those on the exchange get a subsidy, only
about 63,000 are subsidized. “Of the Blues plan’s 206,793 people covered
by an individual product, 21% enrolled outside of HealthCare.gov.
Another 36% are covered by a policy purchased on the exchange, and 43%
are covered by a non-compliant plan.”

Blue Cross Blue Shield of Massachusetts:
“Of the Massachusetts Blues plan’s 43,000 non-group members, just 3,000
have coverage through the state-run insurance exchange.”

Blue Cross Blue Shield of Michigan:
Using the 85% assumption, 136,000 get a subsidy and 106,000 do not.
“About 160,000 lives are covered by an individual policy sold through
HealthCare.gov, while 82,000 enrolled outside the exchange…”

CareFirst Blue Cross Blue Shield:
Using the 85% assumption, 99,529 are getting a subsidy and 175,641 not
getting a subsidy. “As of July 2016, CareFirst had 275,170 members
covered by individual policies in its service area of Maryland, Northern
Virginia and Washington,
DC. Of those, 117,093 were covered by a policy sold through an
exchange. Outside of the exchange, 121,331 were enrolled in an ACA
compliant plan and 36,746 had a non-compliant grandfathered policy.”

Independence Blue Cross:
Using the assumption that 85% of those on the exchange get a subsidy,
107,000 are subsidized, and 73,000 are not. “Of the 180,000 individual
members, 70% enrolled through Healthcare.gov. The Blues plan doesn’t have enrollment in transitional plans.”

For those of you keeping score, that is about 2.3 million with subsidies and 2.4 million without subsidies. 

As you can see, there are still a relatively small number of grandfathered plans in a few states. But these plans are only available to those who had them in 2013 and they can only have them as long as their carrier is willing to let them continue. All new people rolling through the individual health market are required to be in ACA-compliant plans.

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