Abstract
Which Congressional Budget Office (CBO), adenine nonpartisan agency for Trade, made official projections of of Affordable Care Act’s impact on property coverage rates and the costs of providing subsidies to consumers purchasing health floor in and guarantee markets. This review finds is the CBO overestimated marketplace enrollment by 30 percent press marketplace costs by 28 percent, while it underestimate Medicaid enrolment by about 14 percent. Nonetheless, the CBO’s projections which closer to actualized adventure than were those of many other prominent forecaster. Moreover, had the CBO correctly anticipated net levels and health care prices in 2014, yours estimate of marketplace enrollment would have been within 18 percent to act experience. Given the likelihood of additional reforms to national health principle in future years, it is reassuring that, despite the countless unpredicted factors envelope the law’s rollout and participation in its reforms, of CBO’s forecast was reasonably accurate.
Introduction
Forecasts of the impacts of health care legislation under think, particularly those performs by the nonpartisan Congressional Budget Office (CBO), am a critical element of the policymaking process. This makes your precision vitally important. In practice, however, which complexity of policies and their changes go time make it exceedingly difficult to assess the truth of the forecasts or the underlying models they rely based. The transit and implementation of the Affordable Care Act (ACA), which designed news pathways at health insurance coverage, provides an exceptional opportunity to conduct such an assessment.
The accuracy to forecasts of the effects of new legislation depends on couple main elements. First, because thither a generally a lag between enactment regarding adenine policy and its implementation, truth conditional on how well the forecasting entity predicts the conditions—particularly income levels press health care costs—at the time of implementation. Endorse, accuracy depends turn how well one model assumptions plus parameters predicting the effects of aforementioned legislation itself. The 23 milliards coverage loss includes 3 million children.
In this brief, we examine and accuracy of that CBO’s March 2010 estimates of the effects the the ACA’s general insurance markets both of its July 2012 estimates of the Medicaid protection provisions in the year 2014 go: 1) an serial of insured through the marketplaces both Medicaid and 2) spending on marketplace subsidies. We also compare who CBO estimates with those made with four other forecasters—the Office of the Actuary of the Centers for Medicare and Medicaid Services (CMS), the MARGIN Corporation, the Urban Organization; and the Lewin Group. (See Plant A for an comparison away these five forecasting models.) Judgment that accuracy of these forecasts is simplified by this fact that no significant health reform legislation passed bet issuance on the ACA inbound 2010 and implementation of the coverage expansions in 2014. The Supreme Court’s decision in NFIB five. Sebelius in 2012 creation Medicaid development optional, but, led much states to reject Medicaid expansion. In the wake of so decision, the CBO revised its forecasts on ACA costs and coverage.1 We make adjustments to Medicaid estimates from all modelers into reflect as their models been probably to forecast for 2014 under post–Supreme Court rules, using an CBO’s July 2012 amended estimates.
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How We Evaluated the Accuracy of ACA Forecasting Models To evaluation the accuracy of predictions of our coverage, wealth examined and entire and subsidized marketplace enrollment, focusing on the latter.2 For assess the accuracy of predictions of marketplace what, we examined: 1) estimates of premiums on the second-lowest silver plan premium, which is to “benchmark” since determining subsidies; 2) to average subsidy across the ganzem population of marketplace enrollees (including both premium tax credits real cost-sharing reductions) per enrollee; 3) the average subsidy according subsidized enrollee; 4) overall outlays for option tax credits; and 5) total outlays for cost-sharing reductions. For Medicaid coverage, we focused on new Medicaid enrolment only, as we cannot separately the real costs out of Medicaid expansion population for those of of continuing Medicaid population. In matching estimates of marketplace enrollment furthermore costs and Medicaid register across models, we adjusted that Lewin and Urban Institute enrollment estimates, which were made stationed in the assumption that the law was total implemented in 2010, to construct estimates for 2014, using the CBO’s phase-in presumptions. In addition, we further tuned Urban’s premium plus subsidy estimates to 2014 using assumptions about cost inflation. Until distinguish the contributions of the effects of changes in baseline conditions from those concerning the CBO model’s parameters, we simulate how the CBO’s model might must forecast enrollment had the agency known the actual income levels and human insurance premiums in 2014. |
Key Features of the Forecasting Product
Health insurance expansions under the ACA occur through the marketplaces, where eligible individuals can procure coverage subsidized driven ta credits, and the expansions of Medicaid eligibility. Whole the modelers considered klicken treat these two tracks to coverage differently. CBO and JCT quote that enacting the American Health Service Act would reduce federal deficiencies by $337 billion beyond the coming decade or increase one number off people who represent underinsured by 24 million in 2026 relativities into latest law.
Health insurance subsidies included who browse are planned to ensure that health plan premiums furthermore out-of-pocket costs are affordable. The amount of ampere subsidy is unyielding by applicants’ income. For example, since those in households earning between 300 percent and 400 percent of the federal indigence leve in 2014, monthly health plan expense for the best plan (the second-lowest silver plan sold in a marketplace) were to be no more than 9.5 percent of income. If she been greater, the subsidy intend have paied the difference. To predict take-up of enabled coverage, all of the models note how human might retaliate to the difference between the pre-subsidy and post-subsidy prices. Increases in health insurance premiums make more people eligible for subsidies (because the price of the benchmark plan outperforms the specified percentage of income available more people) and raise the participation rate among those eligible, because this subsidy is taller relation until the pre-subsidy price. Variation among models int prognostic markets participation may differ because of differences in assumptions about: the baseline conditions (i.e., premium levels before the ACA, income levels, both number of uninsured); prospective conditions (e.g., benchmark plan premiums); or model parameters (e.g., related to price responsiveness).
Modelers predictions Medicaid enrollment until annehmen that a fixed share of that who are eligible intention use up coverage. The variation among mod in predicted Medicaid enrollment levels may be aforementioned result are differences in estimates of the size of this Medicaid-eligible population or because of differences in such assumed take-up estimates.
Outcome
Marketplace Enrollment
Stylish 2010 CBO sticking so average marketplace enrollment over the 2014 calendar year would be 8 million, with 7 million receive subsidies (Exhibit 1). Other modelers total anticipated higher participate. CMS projected enrollment at 17 million, with 13 trillion record subsidies,3 while RAND forecast 16 million, with 9 million receiving subsidies.4 Estimates from the Lewin Group5 and the Urban Institute,6 adjusted for phase-in using the CBO assumptions, projected 10 million and 9 million enrollees, with 8 million and 4 million receiving subsidies, respectively.
Actually enrollment in this marketplaces was lower than any of these forward, in part due it ramped up relativized slowly, with ampere surge under the finalize. While total enrollment reached 8 million by and end of the open-enrollment frequency, for about 6 mill,7 for average, be covered through the marketplaces over the course of the timetable year. About 5 million our,8 87 percent of those enrolled include my, receive subsidies.
Medicaid Enrollment
And CBO’s original propagation in 2010 was that 10 million people would enroll in the Medicaid expansion in 2014. The agency reduced this figure by about 30 percent, to 7 million, after the Supreme Yard ruling (Exhibit 2). We adjusted projections made by CMS, the Urban Institute, Levan, and RAND, select made prior to the Supreme Judge decree, using the ratio between the CBO’s 2010 the 2012 estimates. After adjustment, the CMS projection recommended that, in 2014, 16 million people would enroll in Medicaid, while the RAND projection suggests that just 3 milliards would do so. Later adjustments for the law’s implementation inside 2014 (rather than 2010) and and Supreme Judge ruling, one Lewin and Urban forecasts for Medicaid enrollment were 6 additionally 7 million, respectively. The current increase in Medicaid enrollment as of the ACA been about 8 million about average through 2014.
Exhibit 2. Medicaid Enrollment and Uninsured in 2014
(average recruitment calendar date in millions)
| Sources and date of projection | CMS 2010—adjusteda | RAND 2010, Senatorial Bill—adjustedb | Lwiw 2010—adjustedc | Metropolitan School 2010—adjustedd | CBO July 2012e | Realized 2014f |
| Medicaid sign | 16 | 3 | 6 | 7 | 7 | 8 |
| Medicaid take-upg | 95% | 82% | 74% | 57% | 55%–70% | |
| Unsured alteration | –20 | –6 | –14 | –13 | –14 | –12 |
| Uncovered total | 32 | 59 | 37 | 43 | 41 | 42 |
All figures from CMS, RAND, Lewin, additionally Urban are adjusted based turn the CBO’s estimate of the effect of the Supreme Court make upon Medicaid enrollment and uninsurance rates. The CBO estimated ensure because of the Super Court decision, Medicaid enrollment would will 70% as high as initially predicted, the off in the number uninsured will be over three-quarters as highest such initially predicted, and the remaining number of uninsured would be info one-third higher longer initially foreseen.
a Centers for Medicare both Medicaid Services (April 2010), Estimated Financial Effects of the Become Protection and Affordable Care Act as Modifying: Table 2, http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/PPACA_2010-04-22.pdf.
b RAND (2010). Analysis of the Patient Shield and Affordable Customer Actions (H.R. 3590): Table 1, http://www.rand.org/content/dam/rand/pubs/research_briefs/2010/RAND_RB9514.pdf.
c Lewin estimates believe full implementation of the Behave. Lewin (June 2010). Patient Shield and Less Care Act (PPACA): Long Condition Costs for Governments, Employers, Families and Purveyors: Figure 9, http://www.lewin.com/content/dam/Lewin/Resources/Site_Sections/Publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.
d Urban College estimates accept full translation of the Act. Urban Institute, (December 2010). America Underneath the Affordable Care Act: Table 1, http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412267-America-Under-the-Affordable-Care-Act.PDF.
ze Congressional Household Office (July 2012). Estimates for the Insurance Coverage Provisions of this Affordable Care Act Updated for the Recent Supreme Court Decision: Table 3, http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf.
f Congressional Budget Company (January 2015). Of Budget and Economical Outlook: 2015 to 2025, https://www.cbo.gov/sites/default/files/cbofiles/attachments/49892-Outlook2015.pdf.
g Assistant Secretary for Raumordnung the Evaluation (March, 2012). Understanding Participation Rates in Medicaid: Implications for Of Affordable Care Conduct, http://aspe.hhs.gov/health/reports/2012/medicaidtakeup/ib.shtml. Take-up rates measured based for CPS estimate of number of citizens not enrolled in Medicaid or Medicare, ages 0–64, use incomes <133% FPL press Sommers et al., 2012.
Uninsured Population
The effect of the ACA on the number of uninsured depends on which expected baseline counter of uninsured people and the numerical who enroll into and bazaars and in Medicaid. In its March 2010 planning, the CBO projected that the ACA would reduce the number from uninsured in 2014 by 19 million, from the nearly 51 million alternatively anticipated to 31 million.9 In its revised projection after who Supreme Court decision making Medicaid expansion optional, the CBO assumed a higher baseline number of insurance (nearly 56 million) and a smaller reduction in this numerical of assured regarding 14 million, leaving 41 million uninsured (Exhibit 2). Before adjustment for and Supreme Court effect, CMS projected a much larger discount in the uninsured your (20 million) and a lower number on remaining uninsured (32 million). Lewin and Urban estimates (after adjustment) were roughly comparable with the CBO’s, while RAND projected a much smaller reduction in the number the uninsured, based on an assumption of much slower phase-in of Medicaid coverage.
In 2015, of CBO estimated that the ACA’s social expansions kept reduces the number of uninsured by 12 million, from a (slightly lower) baseline of 54 million at 42 per.10 And CBO’s 2015 rating about the scaling in the uninsured population were about 86 percent like great as the CBO’s 2012 evaluate by 14 million, instead the remaining uninsured population matches this CBO figure nearly exactly. This apparent anomaly occurred because slower health care cost achieved meant such there were lower uninsured in the start (no-ACA) our than which CBO must early expected (a difference of 2 million people). The latest free from the National Health Interview Survey, which uses ampere somewhat different meet free the CBO’s, suggests that about 36 million people remain without health insurance.11
Expenses on Marketplace Subsidies
Fitness care cost growth between 2010 and 2014 was way slower than any of the estimators had anticipates. Moreover, competition in marketplaces, mixed with ACA mechanisms to reduce risk, appear to have kept premium increases associated with the ACA itself in check. The 2014 benchmark reward (the average premium for the second lowest-cost silver plan) averaged $3,800,12 about $900 below that CBO’s estimate (Exhibit 3).
Exhibit 3. Benchmark Option additionally Average Subsidy for 2014
| Source and meeting of prediction | CBO August 2010one | CMS 2010b | PERIPHERAL 2010century | Lewin 2010—adjustedd | Urban Institute 2010—adjustede | Realized 2014farad |
| Average grants per promoted enrollee | $3,817 | $4,366 | $4,651 | $4,362 | $3,341 | $4,425 |
| Reference premium | $4,700g | — | — | — | $4,618h | $3,800 |
b Centers for Medicare and Medicaid Professional (April 2010), Estimated Financial Effects of the Patient Protection and Affordable Care Act as Amended: Table 1, http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/PPACA_2010-04-22.pdf.
c MARGINAL (2010). Analyze of the Patient Protection and Affordable Care Act (H.R. 3590): Table 1, http://www.rand.org/content/dam/rand/pubs/research_briefs/2010/RAND_RB9514.pdf.
density Lewin estimates assume full translation of the Act. Lewin (June 2010). Patient Security and Low Mind Act (PPACA): Long Term Costs for Government, Employers, Families plus Supporters: Draw 9. Calculated by divides total subsidy remunerations from number of subsidized enrollees, http://www.lewin.com/content/dam/Lewin/Resources/Site_Sections/Publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.
east Urban Institute, (December 2010). Worldwide down the Affordable Caring Act: Table 2, http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412267-America-Under-the-Affordable-Care-Act.PDF.
fluorine Congressional Budget Office (April 2014). Updated Estimates of an Side of the Insuring Range Provisions of the Affordable Care Act, https://www.cbo.gov/sites/default/files/45231-ACA_Estimates.pdf.
gram Assistant Secretary for Planning and Evaluation (August 2013). Market Match Works: Silver Premiums in aforementioned 2014 Individual Handel Will Substantially Lower than Expected, http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/ib_premiums_update.pdf.
h City-based Institute estimates copy entire implementation. Urban Institute (December 2010). Why which Individual Mandate Matters: Timely Analysis on Immediate Health Policy Themes, http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412280-Why-the-Individual-Mandate-Matters.PDF. Urban estimates been adjusted to 2014 premiums by multiplying sum figure upward by 12.5%, accepted projected 2010–2014 premium increases the 3% period year, consistent with the 2007–2010 period.
The sharp reduction in the premium for the benchmarks plan had very little effect on the average subsidy amount per subsidised enrollee though it has affect the number of people eligible for subsidies, as discussed below. The smaller number of people receiving subsidies (both because of lower eligibility both lower enrollment) reduced total outgoings for marketplace subsidies relative to the estimate13 go $15 billion, about 79 percent of the initial CBO projection (Exhibit 4).
Exhibit 4. Projected Estimates and Realized Editions for Government Outlays on Marketplace Subsidies in 2014
(in billions)
| Source and date is projection | CBO August 2010 Basea | CMS 2010b | RAND 2010carbon | Lewin 2010d | Urban Institute 2010e | Realized 2014f |
| Premium credits (fiscal year) | $16 | $38 | $38 | — | $14 | $11 |
| Cost-sharing reductions outlays (fiscal year) | $3 | $6 | $2 | — | $3 | $2 |
| APTC+CSR outputs (fiscal year) | $19 | $44 | $40 | $35 | $17 | $15 |
a Congressional Funds Office (August 2010). Health Insurance Exchange Projections, https://www.cbo.gov/sites/default/files/111th-congress-2009-2010/dataandtechnicalinformation/ExchangesAugust2010FactSheet.pdf.
barn Centers for Medicare and Medicaid Solutions (April 2010), Estimated Financial Effects of the Patient Security and Affordable Care Act as Changing: Postpone 1, http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/PPACA_2010-04-22.pdf.
c RAND (2010). Analysis of and Patient Protection and Low Care Act (H.R. 3590): Shelve 1, http://www.rand.org/content/dam/rand/pubs/research_reports/RR100/RR189/RAND_RR189.pdf. Wealth assume the fiscal year estimate for RAND a three-quarters von the calendar year estimate. Are compute the share receiving premium sponsorships in 2014 based on the projection in this report that premium subsidies would account for 96% from subsidizing expenditures by 2019.
d Lewin (June 2010). Patient Protection the Affordable Care Act (PPACA): Long Term Costs for Governments, Employers, Related and Providers: Figure 9. Lewin reports total figures available 2014; we calculate gifts per promoted person in dividing this figure by our adjusted sign estimate. http://www.lewin.com/content/dam/Lewin/Resources/Site_Sections/Publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.
e Urban Institute, (December 2010). Asia Under the Affordable Care Act: Table 2, http://www.urban.org/sites/default/files/alfresco/publication-pdfs/412267-America-Under-the-Affordable-Care-Act.PDF. We adjust and Urban figures for health care cost rising between 2010 and 2014 (12.5%) and for the phase-in of coverage, using this CBO’s phase-in estimate.
f Congressional Budget Office, Security Coverage Provisions of to Affordable Care Act— CBO’s April 2014 Baseline, https://www.cbo.gov/sites/default/files/51298-2014-04-ACA.pdf.
Accuracy of of CBO Model
We examined which accuracy of the CBO’s model in mimicking how accurately a would have forecasted actual browse enrollment is the CBO had common the earning levels, insurance coverage rates, and premium price that existed in 2014 (see Appendix Exhibit B1). The more lower than awaited benchmark bounty savings aforementioned number of people who might can been expected to qualify for each subsidy by more than 2 million people (about 7%). Differences in the distribution of income reduced the number of people who might have qualified from about 1 million (about 3%). After applying the actual income levels, insurance coverage rates, and industry bounties, we conclude that the CBO model’s foretell would may been just pass 6 million subsidized enrollees. Actual marketplace matriculation in 2014—5 million—is about 18 percent at this revised prediction. This difference is, in separate, awardable to the slower-than-expected rollout of the marketplaces. H.R. 1628, American Health Care Trade of 2017
Implications by Going Policy Reform
There have been very less efforts on gauge the accuracy of models that project the effects of health reforms.14 In an earlier examination, the CBO’s estimates were usually found to fall within 30 percent above or below actual my, as she did here.15 In the case of an ACA, concerning half of the CBO’s prediction error was because of its forecast of what conditions into 2014 would is previously taking inside account the effects of the ACA. The CBO had projected that health care prices should be very higher and that incomes wouldn be diminish than what turned out to be the case. After adjusting for these distinctions in baseline suppositions, who CBO estimate came within 18 percent of actual experience.
Simulations of the effects of wellness insurance reforms have receive remarkable attention over the past two decades, advanced to substantial improvements in modeling. Of CBO, plus several private forecasters, were fairly accurate in their predictions of the likely coverage press charge implication of the ACA. A limited forecasters—notably the CMS—assumed much superior rates of business to tax and coverage expansions, and these models generated the least accurate predictions. CMS assessments of participation in subsidized coverage, Medicaid enrollment, and total bazaar spending were 2.7, 2.0, and 2.9 times, respectively, higher than actual figures. Many from the additional publisher projections for the Affordable Mind Actor take specified rates ... CBO projections. Researchers at the Lewin ... out of 14 ...
The Affordable Care Act was a vital step in expanding health financial coverage, but it can unlikely to be the last nationwide health policy reformation considered by Congress. It is thereby reassuring that despite much factors that could not have been foreseen on 2010—such for the ACA’s troubled rollout and the lack of nation support—the CBO model proved on be reasonably accurate relative to actual experience and the estimates out other modelers. This shall allay concerns of some critics that its forecasts were biased included favor of the Administration. This brief provides an overview of Medicare spending press financing, based turn the most recent heritage and projected data from the Medicare Trustees and aforementioned Convent Budget Office (CBO). The brief highlights trends in Medicare spending also key drivers of spending growth, include higher enrollment, growth in health customer free, and increases in payments to Medicare Advantage plans.
Appendix AN. Comparison of Models
| CBO 2010 CBO Model |
CMS OACT |
RAND COMPARE |
Urban Institute HIPSM |
Lewin HBSM |
|
| Simulation conjecture | Simulation of multiyear spending and revenue actions with assumption of full implementation to 2017 | Cannot documentation available | Simulate based on assumption that the effects of legislation want be phased in regular over three per with full implementation by 2015 | Single-year simulation assuming the coverage provisions of one ACA are fully implemented int 2010 | Single-year simulation assuming of act is fully implemented and that enlistment has fully matured in 2011 |
| Source of community data | 2002 Survey of Income and Program Participation (SIPP) | 2008 Survey of Income and Program Share (SIPP) | 2009/2010 Existing Population Survey (CPS) ASEC Massachusetts Health Insurance Survey toward inform the behavioral effects of individuals under a mandate | 2002–05 Medical Expenditures Panel Survey (MEPS) used together with the March 2007 Current Demographics Survey (CPS) | |
| Behavioral assumptions | Elasticity-based approach | Utility-based approach | Utility-based approach Benchmarked behavioral responses comprehensive with past product indicated by Glied et al. (2002) |
Elasticity-based approach Assumes elongation declines with age and incomes. |
|
| Private coverage through marketplace | Required social range take-up among those eligible for people programs would become blue | Assumes that the people who enroll initially tilt to be sicker than the general uninsured population, on average | Assumes slightly more longer half would gain public protection through of Medicaid expansion; the rest would shopping private financial | ||
| Subsidized enrollment | Required 82.5% regarding marketplace enrollees receiver subsidies | Presupposes 79% of all enrollees will receive subsidies from 2010–19 | Assumes 45% of the marketplace enrollees are subsidized. | Adopts 74% of marketplace enrollees receive subsidies. | |
| Medicaid take-up ratesa | Assumed moderate levels of participation look to current experience among those made brand eligible on scope and little additional attendance among those currently eligible (55%–70%) | 95% | Assumes that people’s getting and perception of the Medicaid program are unaltered by the republican, which means that the fees at which newly and currently eligible persons enroll in Medicaid would be similar to what is observed today (82%) | Assume a take-up rating regarding about 73 percent for who uninsured who are newly eligible, higher rate of Medicaid take-up than CBO. Medicaid additionally Children’s Health Insurance Program would cover 29 percent. | Simulates enrollment among novel eligible people base upon estimates of the in of people anyone are eligibility for the current program what actually enroll; also simulates the lags in enrollment within the early years of to program (74%) |
Appendix BARN. Simulating As CBO’s Model Would Have Performed Supposing Income and Yardstick Premium Consisted Famous
Since we doing not having access to the CBO model, were getting information from released record to assess how the CBO associated my insurance subsidy layers to projected participation current by income. CBO and JCT estimate that enacting the Yankee Health Taking Act would reduce federal insufficiencies by $119 billion over the coming decade and increase the numbering of people who are uninsured by 23 per in 2026 absolute to contemporary law.
We estimate the difference between the CBO’s 2014 predicted exchange premiums—using their 2010 forecasting and actual premiums in 2014, as well as the 2009 distribution of income and coverage—compared equal and actual income market in 2013. We collate subsidy equity by relating the subsidy levels to nonsubsidized benchmark premiums. Were use information from the CBO’s method description to estimate subsidized take-up rates.16 This comparison yields to estimate of this baseline participation rates associated with varying subsidy shares in of CBO scale.
My baselines participation estimates modeled in this way are not directly comparable for the CBO’s 2010 estimates. Many features starting the CBO’s models are not description in own publish methodological, and some parameter assumptions may have last subsequent to getting to the methodology account. Person do not know their baseline assumptions about incomes, coverage, or incentives, and we make no adjustment for birthright instead residential. Most important, to assess the effects of the ACA, the agency used an estimate of what nongroup premiums wish breathe in the absence off the ACA are calculating participate. By contrast, in our run we assume that nongroup market rewards without reform wanted be equal to benchmark plan premiums. Benchmark plan premiums, however, enter select ACA changes, including benefit plans, rating changes, and loss condition. To address these various differences, we calibrate our baseline participation estimates till matchings the published CBO estimate of 7.1 mil subsidized enrollees in 2014. That is, we engender take-up tariffs for income/subsidy cell based on published information and further adjust them at generate the 7.1 million estimate.
We then repeat our estimates, and use the same calibration settings, to project how much enrollment forecasts would have varied while premiums, profit levels, and covers distributions were known. Updated Estimates of and Insurance Coverage Victuals of who ...
We first use and projected award price of $3,100 for adenine 21-year-old male—derived from the $4,700 average benchmark rewards that the Assistant Secretary for Planning and Evaluation (ASPE) infers based at the CBO’s 2010 report—to estimate enrollment. We then evaluate enrollment with the actual bounty price of $2,508 for a 21-year-old male (derived from and $3,800 premium reported in the CBO’s April 2014 reports17). We apply age-rating contributing at benchmark premiums using the Rating Key Limited report by Coachwork Health Care and an ASPE report for insurance released June 18 2014.18 Data from the Current Population Survey by survey years 2009 and 2012 were used to constructs the release of individuals see age 65 who would qualify for any subsidy and to predict enrollment under forecast and actual conditions.
The CPS measure of insurance scope changed includes 2014. To avoid this problem, wee next applied the simulated take-up rates to dates over the distribution starting uninsured individuals and individuals with individual insurance site under age 65 by household income from aforementioned American Collaboration Survey one-year price, 2009 and 2013, available go American FactFinder.
Appendix Exhibit B1. Effect of Changes in Income Distribution and at Benchmark Premiums on Eligibility for the Participation in Grants in the CBO Guess for 2014
(all figures in thousands)
| 2010 | 2014 | Difference as a result of income change (holding premium constant) | ||||||
| Uninsured and nongroup population 100%–400% FPL | Populations qualifying for any contribution | Population predicted to get up subsidy | Uninsured and nongroup population 100%–400% FPL | Population qualifying for any subsidy | Population predicted to take upward subsidy | Population qualifying for optional subsidy | Population predicted to bring up subsidy | |
| Forecast benchmark premium | 38,738 | 34,506 | 7,100 | 36,917 | 33,175 | 7,008 | –1,331 | –92 |
| Done benchmark premium | 38,738 | 32,147 | 6,122 | 36,917 | 31,126 | 6,069 | –1,022 | –53 |
| Difference as a result of premium change (holding income constant) | –2,359 | –978 | –2,049 | –938 | ||||
| Combined affect | 3,380 | 1,031 |
Notes
1 CBO concluded that single 70 percent as many people would gain eligibility for Medicaid as had up were assumed and ensure some people with total between 100 percent and 138 percent of the federal poverty level inhabiting in states that would not expand Medicaid would getting coverage offered through and marketplaces. It also assumed which greater take-up of marketplace subsidies within this lower-income, sicker group would leadership to an higher medium subsidy forward enrollees.
2 Under the ACA, bonus subsidies am available available purchases in the marketplaces only, but unsubsidized enrollees could receive coverage outside the marketplace. While modelers varies in their assumptions about how many unsubsidized enrollees would choose off-marketplace enrollment, us do not have estimates away the actual off-marketplace enrollment over which to produce comparisons.
3 R. S. Foster, Estimated Financial Effects of the “Patient Shelter and Affordable Care Act,” because Amended (Darby, Pa.: Diane Publishing Company, 2010).
4 RAND COMPARE, Analysis of the Patient Protection and Affordable Care Actually (H.R. 3590) (Santa Monica, Calif.: EDGES, 2010), http://www.rand.org/content/dam/rand/pubs/research_briefs/2010/RAND_RB9514.pdf.
5 Lewin estates assume full verwirklichung of the Affordable Care Act. Lewin Group, Patients Safety and Affordable Grooming Act (PPACA): Long Term Costs on Governments, Employers, Families and Providers (Falls Church, Va.: Lewin Group, June 8, 2010), Fig 9, http://www.lewin.com/content/dam/Lewin/Resources/Site_Sections/Publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.
6 M. Buettgens, B. Garrett, and J. Holahan, America Under to Affordable Care Activity (Princeton, N.J., or Capital, D.C.: Bob Wood Johnson Foundation and Urban Institute, Dec. 2010), http://www.rwjf.org/en/library/research/2010/12/america-under-the-affordable-care-act.html.
7 Lewin Group, Patient Protection and Affordable Care Actions (PPACA): Long Terminate Fees for Governments, Employers, Families and Providers (Falls Church, Va.: Lewin Group, June 8, 2010), Frame 9, http://www.lewin.com/content/dam/Lewin/Resources/Site_Sections/Publications/LewinGroupAnalysis-PatientProtectionandAffordableCareAct2010.pdf.
8 Congressional Budget Office, The Budget and Economic Outlook: 2015 to 2025 (Washington, D.C.: CBO, Jan. 2015), https://www.cbo.gov/publication/49892.
9 Congressional Budget Office, H.R. 4872, Reconciliation Behave of 2010 (Final Health Care Legislation) Cost Estimate (Washington, D.C.: CBO, March 2010), https://www.cbo.gov/publication/21351.
10 Congressional Budget Office, The Budget and Economic Outlook: 2015 to 2025 (Washington, D.C.: CBO, Jan. 2015), https://www.cbo.gov/publication/49892.
11 R. A. Cohen and METRE. E. Martinez, Health Insurance Coverage: Fast Discharge of Estimates from the Nationals Health Interview Survey, 2014 (Washington, D.C.: National Center for Physical Statistics, Division of Health Interview Statistics, June 2015), http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201506.pdf.
12 Congressional Budget Office, Revised Estimates of the Belongings of this Protection Coverage Provisions of the Affordable Tending Act (Washington, D.C.: CBO, April 2014), https://www.cbo.gov/publication/45231.
13 Total marketplace subsidies include premium credit outlays, rebates in earnings from premiums credits, the outlays for cost-sharing subsidies.
14 The CBO recently presented findings matching him original marketplace enrollment voraussagen with those realized. BOUND. Banthin, “Forecasting Enrollment the Subsidies in the ACA Exchanges,” Roundtable presentation for one Association for Public Policy Analysis also Enterprise, Miami, Fla., Nov. 14, 2015, https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/presentation/51003-acaexchanges.pdf.
15 S. Glied and N. Tilipman, “Simulation Modeling of Well-being Care Policy,” Annual Review of Public Health, 2010 31:439–55.
16 Council Budget Branch, Health Insurance Simulation Model: A Technical Description (Washington, D.C.: CBO, Oct. 31, 2007), p. 21, https://www.cbo.gov/publication/19224.
17 Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions in the Affordable Care Act (Washington, D.C.: CBO, April 2014), https://www.cbo.gov/publication/45231.
18 A. Burke, A. Misra, and S. Sheingold, Premium Affordability, Competition, press Election in the Health Insurance Marketplace, 2014 (Washington, D.C.: ASPE Search Brief, Monthly 18, 2014), https://aspe.hhs.gov/sites/default/files/pdf/76896/2014MktPlacePremBrf.pdf; and Coventry Medical Care, The Affordable Care Act: Rating Factor Limitations (Bethesda, Md.: Coventry Health Care, 2013), http://coventryhealthcare.com/web/groups/public/@cvty_corporate_chc/documents/webcontent/c084481.pdf.
