TAHP Announces Report Shedding New Light on Texas ACA Enrollment Trends

TAHP-Commissioned Survey By National Research Firm Milliman Provides Fresh Numbers On ACA Impact in Texas

The Affordable Care Act (ACA) was signed into law in March of 2010. The ACA includes sweeping changes to the nation’s health care coverage system and specifically, to state insurance markets and their public health programs. The goal of the legislation was to expand access to insurance, reduce the rising costs of health insurance, improve the quality and efficiency of the health care delivery system, increase wellness and prevention initiatives, and expand consumer protections. All health insurance companies in Texas must now follow ACA regulations, and all Texans have been impacted by the new coverage requirements. A new survey commissioned by the Texas Association of Health Plans and conducted by national research and consulting firm Milliman examines enrollment trends and figures in Texas since key provisions of the ACA were implemented in 2014.

Below you will find highlights from the study, including a number of infographics. Please also find links to TAHP’s press release, a Texas Tribune piece highlighting the findings, as well as coverage in today’s Morning Briefing by Kaiser Health News.

Help us share these important new findings on social media! Below are suggested tweets and Facebook/LinkedIn posts for you to copy and share.

For Facebook & LinkedIn:

  • The number of insured Texans has increased by 20 percent in the health insurance market under the Affordable Care Act according to a new study commissioned and released by the Texas Association of Health Plans this week. http://bit.ly/1Mlmlwh
  • A new study commissioned by the Texas Association of Health Plans shows the impact of the Affordable Care Act on Texas health coverage. Read it here: http://bit.ly/1OcmxiI
  • Prior to the Affordable Care Act, 3.73 million individuals were covered in the health insurance market. That number has increased to 4.49 million in 2015. Read the full TAHP commissioned study here: http://bit.ly/1OcmxiI

For Twitter:

Texas Enrollment in Traditional Commercial Insurance Market Up

20%The Milliman study found that the ACA has had a significant impact on enrollment in Texas in the traditional fully-insured commercial insurance market, with a 20 percent increase in the number of individuals covered since implementation of the ACA’s key provisions in January of 2014. Prior to the ACA, 3.73 million individuals were covered in the traditional insurance market in Texas. The Milliman report found that that figure has increased by 760,000 individuals to a total of 4.49 million people covered in 2015.

Texas Individual Market Has Grown By 115%

The most dramatic change in Texas has occurred in the individual market, which has grown by 115 percent and now makes up 33 percent of the fully insured market, as shown in the graph below. Prior to the ACA, the individual market’s share of the fully insured market was less than 19 percent. The dramatic growth in the individual market has changed the landscape of commercial health insurance in Texas.

Small Business Market Drops By 10%

Also notable is the decline in the fully insured small group market, which decreased by 10.3 percent from 2013 to 2015 (or 1.1 million individuals to 991,072 individuals), as shown below. The Milliman study only examines the fully insured market, so it is unclear if there is an overall decline in individuals receiving insurance through small employers, or if small employers are increasingly taking on more risk and shifting to the self-funded market. In 2015 alone, the small employer market declined by 16 percent.

Texans Increasingly Buying Individual Health Insurance Through the ACA Exchange

In the first year of the ACA marketplace (2014), a majority of Texans (54 percent) seeking coverage in the individual market chose to purchase that coverage outside of the federal ACA marketplace exchange. Overall, 40 percent of individuals stayed with the same coverage they had prior to the ACA’s implementation.

This trend shifted in 2015, with approximately 60 percent of individuals purchasing plans through the ACA exchange. The number of these individuals who have chosen to remain with their pre-ACA coverage has declined by more than 50 percent, with only 17 percent of individuals in Texas currently remaining enrolled in their pre-ACA plans.

Small Business Trends

Small businesses are still predominately purchasing plans outside of the small employer marketplace or the Small Business Health Options Program (SHOP) (99.7%). Even though small employers are not purchasing plans in the SHOP, there has been an 80 percent increase in enrollment in ACA-compliant plans and a 31 percent reduction in the enrollment in pre-ACA plans. Approximately 55 percent of covered individuals in the small group market remain in pre-ACA plans, primarily in “transitional plans,” which groups were allowed to temporarily renew under CMS guidance. (Under the 3/5/2014 CMS Memorandum, carriers can allow individuals and small employer groups to choose to renew these plans for policy years beginning on or before October 1, 2016).


Background on Milliman Survey on Texas ACA Enrollment

Milliman was asked by the Texas Association of Health Plans to compile the results of an enrollment survey of its members. This is the second year this survey has been conducted, soliciting information on the number of enrollees in the Texas commercial health insurance market segments (individual, small group, and large group). The first survey compiled enrollment as of 12/31/2013 and 7/31/2014, while this year’s study covers enrollment as of 12/31/2014 and 7/31/2015. This report contains the summarized results and describes the underlying methodology and assumptions.

This is an updated enrollment survey for the traditional fully-insured commercial insurance market in 2013, 2014, and 2015.

This survey only represents enrollment in the fully-insured market, and does not include self-funded groups.

Over 95% of the 2014 Texas fully-insured commercial market is represented in the survey (96.0% of the individual segment, 97.6% of the small group segment, and 98.3% of the large group segment).

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