New Marketplace Research: Off-Marketplace Consumers and How Marketplace Enrollees Fare in Expansion and Nonexpansion States

By Karina Wagnerman, Georgetown University Center for Children & Families

Two new reports released this month on the Marketplace have sparked our interest. The first, a brief from the Office of the Assistant Secretary for Planning and Evaluation, examined the population currently purchasing off-marketplace coverage. The authors estimate that about 6.9 million individuals purchase health insurance in the off-Marketplace individual market. About 2.5 million of these individuals would qualify for tax credits, allowing them to potentially reduce their premiums if they purchased a plan through the Marketplace. Many consumers may not be aware of the tax credits available through the Marketplace and some consumers who did not qualify for tax credits in previous years may qualify if premiums increase.

The brief includes a 50-state table with the estimated number of individuals enrolled in off-Marketplace coverage who could qualify for Marketplace tax credits. California, Florida, Illinois, North Carolina, Pennsylvania and Texas each have over 100,000 individuals in this category. Of the 6.9 million individuals purchasing health insurance in the off-Marketplace individual market, about 1.9 million of them have incomes that would qualify for Medicaid or put them in the coverage gap or have an immigration status that makes them ineligible for Marketplace coverage.

The second study, authored by Urban Institute researchers, compared nonelderly adult enrollees in the Marketplaces in Medicaid expansion and nonexpansion states. The authors found that the share of nonelderly adults with Marketplace coverage from 2014 to 2015 increased from 2.6% to 4.2% in expansion states and 2.7% to 5.0% in nonexpansion states. Marketplace enrollees in nonexpansion states in 2015 were more likely than those in expansion states to have incomes between 100-138% FPL because of the coverage gap.

Overall, Marketplace enrollees reported improvements since 2014: the percent of enrollees reporting an unmet need due to cost decreased from about 15% in 2014 to about 10% in 2015 and the percent reporting problems paying medical bills decreased from about 23% in 2014 to about 18% in 2015. However, Marketplace enrollees in nonexpansion states reported higher rates of problems paying medical bills and unmet health care needs than enrollees in expansion states. The authors conclude that Marketplace enrollees in nonexpansion states are more prone to gaps in coverage if their incomes drop below the threshold of eligibility for Marketplace subsidies and expanding Medicaid could improve the continuity of coverage in nonexpansion states.

Editor’s Note: This post was originally published on the Center for Children & Families’ Say Ahhh! Blog and lightly edited for content.

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