The federal government has not reported any complete data on nationwide enrollment since that grace period ended. In a normal year, the next such report would be published in July. But reports from states that run their own marketplaces are already showing larger declines. Even among those states, the impact of the lost funding has been uneven.
Some states have reported increased coverage, but those outliers are places where state programs are making up the lost federal financing or where unemployment has increased and more people need to buy their own coverage. New Mexico, which passed legislation to pay extra insurance subsidies to replace the lost federal payments, has been a particular bright spot for enrollment. Marketplace coverage has also increased in Washington, D.C., where around 220,000 federal workers lost their jobs last year.
Insurers have begun reporting enrollment declines in their quarterly earnings reports. Centene, which offers marketplace coverage in 29 states, told investors this week that it had two million fewer customers at the end of March than it did a year ago, a drop of more than a third. Other insurers, including UnitedHealth, also reported significant drops. Some of those declines could come from customers switching carriers. Cigna, a smaller player, announced on Thursday that it would leave the market altogether next year.
A recent survey by KFF, the health research firm, found that 22 percent of people who had marketplace coverage last year had found another source of health insurance. Nine percent had become uninsured.
Coverage could continue to erode throughout the year. Some people who are paying premiums now may stop if they encounter financial difficulties. Others who might qualify for coverage midyear, by losing a job or getting married, for example, may decide against it. Movement in and out of the marketplaces happens every year, but some analysts worry there may be more attrition than usual with the higher prices.
“I think we haven’t seen the full impact of all of these changes,” said Hemi Tewarson, the executive director of the National Academy for State Health Policy, which recently convened a meeting of state marketplace leaders.
Alicia Parlapiano contributed reporting.
