Aug 13, 2019

Wealthier people are ditching the ACA exchanges

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Data: Centers for Medicare & Medicaid Services; Chart: Axios Visuals

The universe of people covered by the Affordable Care Act keeps narrowing.

Between the lines: People who make too much money to qualify for help paying their premiums are fleeing the ACA’s insurance exchanges. But the exchanges are still pretty stable for people who receive premium subsidies, according to new federal data.

You can see two clear trends in these data.

  • First, unsubsidized enrollment has fallen as premiums continue to rise. That makes sense: If you’re on the hook for your entire premium, you’re more likely to bail when those premiums rise.
  • Overall enrollment tapered off under the Trump administration, which also makes sense: Trump’s policy decisions contributed to big premium spikes in 2018, and he has also expanded access to non-ACA options that may be more attractive to healthier, unsubsidized people.

My thought bubble: This is the continuation of a somewhat ironic trend. As the ACA’s coverage expansion has shrunk, the law has evolved to look more like a traditionally liberal health care program.

  • Part of the initial goal was to create a competitive marketplace that would benefit even the middle-class households too wealthy for a premium subsidy.
  • That’s the part that has fallen by the wayside as the ACA’s coverage expansion has narrowed down. Now it’s mainly direct government assistance — through Medicaid and premium subsidies — that’s concentrated among the poorest households.

Go deeper: The ACA is smaller, weaker and more liberal than Obama intended

Go deeper

Coronavirus dashboard

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  1. Global: Total confirmed cases as of 3 a.m. ET: 5,410,228 — Total deaths: 345,105 — Total recoveries — 2,169,005Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 1,643,499 — Total deaths: 97,722 — Total recoveries: 366,736 — Total tested: 14,163,915Map.
  3. World: White House announces travel restrictions on Brazil, coronavirus hotspot in Southern Hemisphere Over 100 coronavirus cases in Germany tied to single day of church services — Boris Johnson backs top aide amid reports that he broke U.K. lockdown while exhibiting symptoms.
  4. Public health: Officials are urging Americans to wear masks headed into Memorial Day weekend Report finds "little evidence" coronavirus under control in most statesHurricanes, wildfires, the flu could strain COVID-19 response
  5. Economy: White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Public employees brace for layoffs.
  6. Federal government: Trump attacks a Columbia University study that suggests earlier lockdown could have saved 36,000 American lives.
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Updated 2 hours ago - Politics & Policy

U.S. coronavirus updates

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

The CDC is warning of potentially "aggressive rodent behavior" amid a rise in reports of rat activity in several areas, as the animals search further for food while Americans stay home more during the coronavirus pandemic.

By the numbers: More than 97,700 people have died from COVID-19 and over 1.6 million have tested positive in the U.S. Over 366,700 Americans have recovered and more than 14.1 million tests have been conducted.

World coronavirus updates

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Japan's economy minister outlined plans on Monday to end the nationwide state of emergency as the number of new novel coronavirus cases continues to decline to fewer than 50 a day, per Bloomberg. Japan has reported 16,550 cases and 820 deaths.

By the numbers: Over 5.4 million people have tested positive for the virus as of Monday, and more than 2.1 million have recovered. The U.S. has reported the most cases in the world (over 1.6 million from 13.7 million tests). The U.K. is reporting over 36,800 deaths from the coronavirus — the most fatalities outside the U.S.