RWJF reports on ACA performance variances among states

A Robert Wood Johnson Foundation (RWJF) report provides a comparative review of market performance variations among the states that offer the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The report highlights state winners and losers under the ACA by examining the 2017 and 2018 statistical data related to enrollment numbers, affordability and carrier participation.

Affordability. According to the RWJF report, states in the West had the most expensive average bronze plans at an average of $353. Montana, however, stood out as a bright spot due to its ACA plan costs being below the regional average in 2018 at $281. Alaska was honorably mentioned for managing to reduce the cost of its cheapest bronze plan between 2017 and 2018 by 25 percent.

In 2018, the South had the second most expensive average bronze plan at $338. In the Midwest region, the cheapest bronze plan was $309. Iowa and Nebraska were among the states with dramatic premium increases. The Northeast had the lowest-cost bronze plan, averaging $286. New Jersey is a particular bright point with the cheapest bronze plan cost in the nation at $264.

Carrier participation. The worst ACA carrier participation was in the South. Many counties have only one carrier offering the ACA option. Alabama, however, was a bright spot because its cheapest bronze plan was more than $50 less than the regional average. The increased competition that results from a more diverse carrier participation pool within a region contributes to managing affordability.

As an example, Montana’s ability to maintain statewide participation from three carriers appears to be a significant factor in it being an affordability bright spot in the otherwise more expensive western region. In New Jersey, carrier participation increased in 2018 due to a carrier’s reentry into its marketplace. The state now has the cheapest bronze plan costs in the nation. In contrast, the majority of counties in the South have only one carrier. The average costs for their bronze plans in 2018 were above the national average.

Enrollment. According to the RWJF report, four states had notably low enrollment in grandfathered and transition plans: Alabama, Kansas, Montana and New Jersey. Alabama, however, was deemed a bright spot in the South due its enrollment decline being below the regional average. The Midwest region was noted as having the smallest enrollment decline between 2017 and 2018.

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