Every year around this time I start my annual individual & small group market rate filing analysis project. This involves spending months painstakingly tracking every insurance carrier rate filing for the upcoming year to determine just how much average insurance policy premiums on the individual market are projected to change.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need.
The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier: How many effectuated enrollees they have in ACA-compliant policies this year; the average projected rate change for those policies; and, ideally, a breakout of the rationale behind the changes.
Usually the reasons given are fairly vague things like "increased morbidity" (ie, a sicker risk pool) or the like. Sometimes, however, there's a very specific reason given for some or all of the premium changes. Major examples of this include:
The first official press release from the Centers for Medicare & Medicaid Services (CMS) under the Trump 2.0 Administration is out, and not only is it pretty innocuously worded...it's actually complimentary of the Inflation Reduction Act, which is noteworthy given that the IRA was passed & signed into law exclusively by Democrats & President Biden:
CMS Statement on Lowering the Cost of Prescription Drugs
Lowering the cost of prescription drugs for Americans is a top priority of President Trump and his Administration. In accordance with the statutory requirements of the Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) released the list of 15 drugs selected for the second cycle of the Medicare Drug Price Negotiation Program on January 17, 2025.
Vulnerable House Republicans warn leaders against cutting Obamacare
The group of centrists also said the party needed to be careful about deep cuts to social safety net programs.
House Republicans in competitive districts warned GOP leaders Thursday: We could lose our seats if you gut Obamacare to pay for a massive border, energy and tax bill.
A group of about a dozen centrist Republicans...worry GOP efforts to pare back the Affordable Care Act could pour fuel on the fire.
...Instead, they argued, Republicans needed to embrace the GOP’s role as the working class party. Leaders would counter that message by slashing programs working Americans rely on, they said. GOP lawmakers in the room included Rep. Brian Fitzpatrick (Pa.), Young Kim (Calif.), David Valadao (Calif.), Andrew Garbarino (N.Y.), Tom Barrett (Mich.) and Don Bacon (Neb.).
Texas has ~3.9 MILLION residents enrolled in ACA exchange plans, 95% of whom are currently subsidized. I estimate they also have perhaps ~67,000 unsubsidized off-exchange enrollees.
Combined, that's over 4.0 MILLION Texans, although although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like ~3.8 million statewide.
I don't want to get out over my skis here; a single Senator saying that she supports something in an interview is a far cry from them actually voting to do so, especially when you'd need several more members of both the House and Senate (including the leadership of both chambers) to even hold that vote.
Even so, this is still a pretty significant development, given how thin the odds are of the improved subsidies included by the IRA getting extended are at the moment.
Nathaniel Herz: On the specific issue of the enhanced tax credits for the premiums for the individual marketplace health insurance plans — it seems like there is a real question about whether those continue...
In August 2022, President Biden signed the Inflation Reduction Act (passed with into law with purely Democratic votes).
While the IRA included a long list of landmark provisions, in addition to the critical upgraded ACA premium subsidieswhich are unfortunately set to expire at the end of 2025, other healthcare-related ones include:
South Carolina has around ~632,000 residents enrolled in ACA exchange plans, 95% of whom are currently subsidized. I estimate they also have another ~36,000 unsubsidized off-exchange enrollees.
Ohio has around ~583,000 residents enrolled in ACA exchange plans, 91% of whom are currently subsidized. I estimate they also have another ~25,000 unsubsidized off-exchange enrollees.
Florida has over ~4.7 MILLION residents enrolled in ACA exchange plans, 97% of whom are currently subsidized. I also estimate they have perhaps ~112,000 unsubsidized off-exchange enrollees.
Combined, that's over 4.8 million people, or a stunning 20.3% of their total population. 1 in 5 Floridians are enrolled in ACA exchange healthcare coverage (assuming CMS's 6.6% net national attrition rate applies to Florida specifically, the actual number of current enrollees is more like 4.5 million, or 19% of the state population).
Wisconsin has around ~293,000 residents enrolled in ACA exchange plans, 98% of whom are currently subsidized. I estimate they also have another ~19,000 unsubsidized off-exchange enrollees.
