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Congressional Budget Office
November 14, 2015
Forecasting Enrollment and
Subsidies in the ACA Exchanges
Roundtable: Forecasting the Effects of
Public Policies on Budgets and People
Association for Public Policy Analysis and Management
Miami, Florida
Jessica S. Banthin, Deputy Assistant Director
Health, Retirement, and Long-Term Analysis Division
Slide 1
Relevant CBO Reports
■ Cost estimate for H.R. 4872, Reconciliation Act of 2010 (Final Health
Care Legislation) (March 20, 2010), www.cbo.gov/publication/21351.
■ Estimates for the Insurance Coverage Provisions of the
Affordable Care Act Updated for the Recent Supreme Court
Decision (July 24, 2012), www.cbo.gov/publication/43472.
■ Updated Budget Projections: Fiscal Years 2013 to 2023
(May 14, 2013), www.cbo.gov/publication/44172.
■ Updated Estimates of the Effects of the Insurance Coverage
Provisions of the Affordable Care Act (April 14, 2014),
www.cbo.gov/publication/45231.
■ Updated Budget Projections: 2015 to 2025 (March 9, 2015),
www.cbo.gov/publication/49973.
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CBO’s Estimates of Exchange Enrollment and Subsidies
■ CBO usually updates its baseline projections three times a year;
the spring baseline is the major update for the Affordable Care
Act (ACA) Exchange.
■ Types of changes
– Changes in law
– Changes in the economic forecast
– Technical changes from new information, data, regulations, and
changes in modeling assumptions
■ This presentation focuses on five of those baseline estimates
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–
–
–
–
March 2010, initial ACA estimate
July 2012, updated for the Supreme Court decision
May 2013, spring baseline
April 2014, spring baseline
March 2015, spring baseline
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Main Challenges in Forecasting Exchange Enrollment
■ New program
■ Duration of the phase-in period
■ Effect of the individual mandate
■ Supreme Court decision regarding Medicaid expansion
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CBO’s Projections of Subsidized Exchange Enrollment
■ Many people who obtain insurance through the exchanges
receive federal subsidies, but some do not.
■ The following figures focus on the number of subsidized enrollees.
■ CBO’s estimates of subsidized exchange enrollment are
presented as average annual enrollment for the year.
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CBO’s Projections of Subsidized Exchange
Enrollment in 2014 (Average for the year)
Millions of People
8
7
7
7
Average Subsidized
Exchange Enrollment,
Calendar Year 2014
6
6
5
5
4
3
2
1
0
March 2010
July 2012
May 2013
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April 2014
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CBO’s Projections of Subsidized Exchange
Enrollment in 2015 (Average for the year)
Millions of People
14
12
12
11
11
10
10
8
8
6
4
2
0
March 2010
July 2012
May 2013
April 2014
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March 2015
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CBO’s Projections of Subsidized Exchange
Enrollment in 2019 (Average for the year)
Millions of People
25
22
20
20
19
19
17
15
10
5
0
March 2010
July 2012
May 2013
April 2014
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March 2015
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Subsidized Exchange Enrollment Projections
Millions of People
23
July 2012
21
19
April 2014
17
15
March 2015
March 2010
13
11
9
7
5
2014
2015
2016
2017
2018
2019
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2020
2022
2024
8
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Main Challenges in Forecasting Exchange
Premiums and Subsidies
■ Health status of new enrollees
■ Continued slowdown in health care cost growth
■ Extent of insurer participation in new program
■ Characteristics of plans offered
■ Income and age distribution of enrollees, which determines
aggregate subsidies
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CBO’s Projections of Exchange Premium
Tax Credits and Cost-Sharing Subsidies in 2014
Billions of Dollars
35
30
30
25
20
23
19
15
15
Fiscal Year 2014
Amount for
Exchange
Subsidies
10
5
0
March 2010
July 2012
May 2013
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April 2014
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CBO’s Projections of Exchange Premium
Tax Credits and Cost-Sharing Subsidies in 2015
Billions of Dollars
70
59
60
50
50
44
40
36
28
30
20
10
0
March 2010
July 2012
May 2013
April 2014
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March 2015
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CBO’s Projections of Exchange Premium
Tax Credits and Cost-Sharing Subsidies in 2019
Billions of Dollars
160
137
140
120
123
113
107
100
83
80
60
40
20
0
March 2010
July 2012
May 2013
April 2014
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March 2015
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Exchange Premium Tax Credits and Cost-Sharing Subsidies
Billions of Dollars
180
160
140
March 2010
July 2012
May 2013
April 2014
120
March 2015
100
80
60
40
20
0
2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
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