Summary of Dr. Jonathan Gruber’s Health Insurance

Exchange Modeling

Jeff Bontrager

Colorado Health Institute

Marketing, Enrollment and Outreach Workgroup (MEOW) Meeting

September 21, 2011

bontragerj@coloradohealthinstitute.org

Background and caveats

• This presentation was given by Dr. Jonathan Gruber from MIT to the Colorado Health Benefit Exchange Board on Sept 16, 2011

• Data source is the 2008-09 Colorado Household Survey and the Gruber Microsimulation Model

• All numbers are estimates, limited to ages 0-64

• The final report, including narrative, methods and assumptions, is planned for release within the next month

Table 1: Colorado Enrollments

Insurance Category 2011 % of population

Employer-Sponsored Insurance (ESI) 2,650,000 62.3%

Small Firm ESI (1-50 employees) 570,000 13.4%

Large Group ESI 2,080,000 49.0%

Individual Market Insurance 310,000 7.2%

Public Insurance 440,000 10.3%

Uninsured 850,000 20.1%

Table 2: Estimate of ACA Effect, 2016

No Reform With ACA ACA Impact

ESI 2,630,000 2,600,000 -30,000

Small Firm ESI (1-50 employees) 560,000 540,000 -20,000

Other ESI 2,070,000 2,060,000 -10,000

Unreformed Non-group 340,000 60,000 -280,000

Reformed Non-group 0 620,000 620,000

Tax Credit Recipients 0 470,000 470,000

Non-Recipients 0 150,000 150,000

Public Insurance 550,000 710,000 160,000

Uninsured 860,000 400,000 -460,000

Total 4,390,000 4,390,000

Table 3: Summary of Previously Uninsured, 2016 Post-ACAAdult females 19-44

Adultfemales 45-64

Adult males 19-44

Adult males 45-64

Children Ages 0-18

Medicaid/CHP+

39,000 21,000 41,000 11,000 19,000

Reformed or Unreformed Non-group

30,000 41,000 72,000 40,000 29,000

Employer SponsoredInsurance

38,000 12,000 53,000 17,000 36,000

Total Newly Insured

111,000 74,000 170,000 68,000 85,000

Remaining Uninsured

90,000 43,000 88,000 49,000 84,000

Baseline Uninsured

202,000 117,000 259,000 116,000 170,000

Table 4: Movements due to ACA: 2016

Ex-ante

ESI Nongroup Public Uninsured Total

ESI 2,440,000 - - 160,000 2,600,000

Ex-Post Reformed or Unreformed Nongroup

130,000 330,000 0 220,000 680,000

Public 30,000 - 550,000 130,000 710,000

Uninsured 40,000 - 0 350,000 400,000

Total 2,630,000 330,000 550,000 860,000 4,390,000

Note: “-” indicates a movement that is less than 10,000 but greater than 0.

Table 5: Reformed Market Participation and Tax Credit Uptake:

2016# of individuals Cumulative # of individuals

Tax credit recipients in individual reformed market

470,000 -

Employees (& dependents) of firms receiving tax credit

120,000 590,000

Non-tax credit recipients in individual reformed market

150,000 740,000

Employees (& dependents) of non-tax credit firms with <50 employees

420,000 1,160,000

Table 6: Premiums and Actuarial Values for those Remaining on

Nongroup: 2016Ex-Ante Ex-Post

(No Subsidies)Ex-Post (With Subsidies)

Average NongroupPremium

$5,580 $6,610 $4,060

Average NongroupActuarial Value

.608 .676 .675

Note: The changes in this table do not reflect removal of pre-existing

conclusions restrictions, reuse of any funds that fund the high risk pool (which is

now folded into the reformed market), or reinsurance/risk adjustment/risk

corridor mechanisms.

34%

11%

7%6%

18%

14%

5%

5% 0%

Figure 19: Nongroup Premium Changes (including tax credits) for those Remaining on Nongroup: 2016

<-50%

-50% to -25%

-25% to -10%

-10% to 0%

0%

0% to 10%

10% to 25%

25% to 50%

>50%

Table 7: Household Budget Effects: 2016

Status Quo (in billions)

After ACA (in billions)

ACA Effect (in billions)

Per Household Effect

Wages $162.1 $162.4 $0.3 $130

Exchange Credits $0.0 $1.0 $1.0 $440

Public Insurance $0.0 $0.6 $0.6 $270

Additional Benefits

$1.9 $840

ESI Contribution $4.0 $3.8 -$0.2 -$90

Non-group Premium

$1.8 $1.8 $0.0 $0

OOP Spending $2.6 $2.4 -$0.2 -$90

Taxes $37.0 $37.4 $0.4 $180

Additional Costs $0.0 $0

Net Effects $1.9 $840

$1,500*

$1,150*