HealthAndEconomy.org 

 

Health and Economy Baseline 
Estimates 

February 18, 2016 

 
In the third year of the Affordable Care Act’s implementation, focus continues to be on 
outreach efforts to the uninsured along with the enduring problems of American health 
care: increasing and unpredictable costs, large numbers of uninsured individuals, and 
adequate access to care. The Center for Health and Economy (H&E) is dedicated to 
assessing the impact of proposed reforms that attempt to address these issues. The 
following report details the most recent updates to the H&E baseline estimates of 
insurance coverage, federal budgetary impact, plan choice, and the premium landscape of 
health insurance for Americans under the age of 65.  

 
KEY FINDINGS: 

  In 2016, the change in average individual market premiums will vary by plan 

type, with projected premium increase ranging between 4 percent and 7 percent. 
In 2017, the increase in average premiums is projected to range between 4 and 8 
percent.  

  Average subsidized premiums are expected to increase ranging from 4 percent to 

17 percent in 2016. After 2017, average subsidized premiums are expected to 
increase by 5 to 12 percent annually, driven by rising health care costs and 
indexed subsidy adjustments.  

  The individual market includes an estimated average of 31 million members in 

2015, with 10 million lives covered through subsidized insurance offered in the 
Marketplace. Subsidized enrollment is projected to grow to 16 million in 2017, 
and the total size of the individual market is estimated to expand to 36 million by 
2017.  

  As premiums and health care costs rise, plans chosen in the individual market are 

expected to shift towards lower cost options. Highly subsidized enrollment in 
silver plans is projected to fade as a percentage of enrollment on the individual 
market, while enrollment in bronze plans grows among households between 200 
and 400 percent of the Federal Poverty Level (FPL) which are eligible for 
subsidies but not silver-plan cost-sharing.  

  The health insurance coverage provisions under current law for the non-elderly 

are estimated to increase Federal outlays by $4.269 trillion between 2017 and 
2026.  

 
 
 
 

 

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INSURANCE COVERAGE 

Table 1. Health Insurance Coverage (millions) 

 

 

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Individual Market 

31 

34 

36 

33 

32 

31 

29 

28 

28 

27 

27 

27 

  

Health Insurance Marketplace 

10 

13 

16 

17 

16 

15 

14 

13 

13 

12 

12 

12 

  

Other Non-group Insurance 

20 

22 

19 

16 

16 

15 

15 

15 

15 

15 

15 

15 

  

 

 

 

 

 

 

 

 

 

 

 

 

  

Employer Sponsored Insurance 

146 

145 

145 

145 

145 

145 

145 

145 

145 

145 

145 

144 

  

 

 

 

 

 

 

 

 

 

 

 

 

  

Medicaid 

49 

51 

51 

51 

51 

52 

52 

52 

52 

53 

53 

53 

  

 

 

 

 

 

 

 

 

 

 

 

 

  

Other Public Insurance

2

 

10 

10 

11 

12 

12 

13 

13 

14 

14 

15 

16 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Total Non-Elderly Population 

270 

271 

273 

274 

275 

277 

278 

280 

281 

282 

284 

285 

Total Insured

1

 

234 

239 

241 

240 

240 

239 

239 

239 

239 

239 

239 

240 

Uninsured

1

 

36 

32 

32 

34 

36 

37 

39 

41 

42 

43 

45 

46 

Percent Uninsured

13% 

12% 

12% 

12% 

13% 

13% 

14% 

15% 

15% 

15% 

16% 

16% 

1

 All insurance coverage estimates refer only to the under-65 population. 

 

 

2

 Other Public Insurance includes under-65 Medicare enrollment.  

 

 

 
H&E estimates there were 234 million non-elderly US residents with health insurance in 
2015—86 percent of the total non-elderly population. Estimates of health insurance 
coverage encompass four primary categories: the individual market, employer sponsored 
insurance, Medicaid, and other public insurance. The individual market is divided into 
two subsets: subsidized and unsubsidized coverage. Subsidized coverage is purchased 
through the Health Insurance Marketplace, and unsubsidized coverage is comprised of 
similar insurance plans purchased either directly from the insurer or through the 
Marketplace without financial assistance. H&E makes no distinction between 
unsubsidized enrollees through the Marketplace and households that purchase individual 
market insurance directly from an insurer. Estimates concerning Medicaid also include 
beneficiaries of the Children’s Health Insurance Program. Other public insurance is 
primarily comprised of Medicare coverage for disabled persons, but also includes 
Tricare, the Indian Health Services, and other federal health care programs for specific 
populations.  
The rollout of the Marketplace is based on a four-year implementation period and initial 
estimates of the uninsured population are benchmarked using the Congressional Budget 
Office (CBO) estimates for 2015 and 2016. By 2017, the number of insured, non-elderly 
Americans is projected to increase to 241 million—89 percent of the total non-elderly 
population. The increase in insured Americans is primarily the result of three factors: the 
expansion of Medicaid, the continuing implementation of the subsidized Marketplace, 

 

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and an increasingly costly tax penalty for remaining uninsured. The average population 
of non-elderly Medicaid beneficiaries is estimated to be 49 million in 2015 and will rise 
to 53 million by the end of the analysis period. These estimates are subject to the 
uncertainty of each state’s decision regarding Medicaid expansion.  
The individual market is estimated to expand from 31 million covered lives in 2015 to 36 
million in 2017, driven largely by expansion in the Marketplace. The increase in 
coverage through Medicaid and the individual market is in part offset by a decrease in 
those insured through employer sponsored coverage.  
As seen in Table 1, the number of individuals with unsubsidized, individual market 
insurance is expected to decrease after 2016. In 2017, the discontinuation of non-
qualified health plans currently available in the market are expected to lead to 3 million 
fewer individuals with unsubsidized, non-group plans. Rising costs and higher income 
contributions for subsidized enrollees are estimated to lead to higher uninsured numbers 
later in the analysis period. 

PREMIUMS 

Table 2. Average Premiums in the Individual Market 

 

 

2014 

2015 

2016 

2017 

2018 

2019 

2020 

2021 

2022 

2023 

2024 

2025 

Single 
Coverage  Platinum 

4,800 

4,900 

5,200 

5,500 

5,800 

6,100 

6,500 

6,900 

7,300 

7,700 

8,200 

8,600 

Gold 

3,800 

3,900 

4,100 

4,300 

4,600 

4,900 

5,200 

5,500 

5,800 

6,100 

6,500 

6,900 

Silver

2

 

4,400 

4,500 

4,800 

5,000 

5,300 

5,600 

5,900 

6,300 

6,600 

7,000 

7,400 

7,800 

Silver 

3,200 

3,200 

3,400 

3,600 

3,800 

4,100 

4,300 

4,600 

4,800 

5,100 

5,400 

5,700 

Bronze 

2,600 

2,400 

2,500 

2,700 

2,800 

2,900 

3,000 

3,100 

3,200 

3,300 

3,300 

3,400 

Catastrophic 

1,700 

1,700 

1,800 

1,900 

2,000 

2,100 

2,100 

2,200 

2,300 

2,300 

2,400 

2,500 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Family 
Coverage

1

  Platinum 

19,400  19,400  20,500  21,700  23,000  24,400  25,800  27,400  29,000  30,700  32,600  34,500 

Gold 

15,600  15,700  16,600  17,600  18,700  19,800  21,000  22,200  23,600  25,000  26,500  28,000 

Silver

2

 

16,500  16,800  17,800  18,900  20,100  21,400  22,700  24,100  25,500  26,900  28,200  29,500 

Silver 

13,100  13,200  14,100  14,900  15,800  16,800  17,800  18,800  20,000  21,200  22,400  23,800 

Bronze 

10,800  10,500  10,900  11,500  11,800  12,100  12,500  12,900  13,300  13,700  14,100  14,500 

Catastrophic 

6,300 

6,500 

6,700 

6,600 

6,800 

7,000 

7,200 

7,400 

7,600 

7,900 

8,100 

8,400 

1

 Family coverage estimates are based on a family size of four persons. 

2

 Silver plans offered to low income households receive cost-sharing benefits that alter the effective 

premium relative to un-assisted silver plans.  

Estimates of the subsidy eligible premiums available in the Marketplace are calculated 
using publicly available data on plans offered in the 36 Federally Facilitated 
Marketplaces. Premium estimates for unsubsidized health insurance are calculated from a 
sample of plans available on ehealthinsurance.com. In both cases, H&E uses the default 
age rating curve put forth by the Department of Health and Human Services to impute the 

 

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applicable premium for a particular household. For simplification and comparability, 
H&E uses a standard family size of four (two adults and two children) when estimating 
family premiums. Subsidy payments and tax revenue are adjusted for the appropriate 
average family size in budget impact estimates.  
 
Subsidized insurance plans offered in the Marketplace are divided into four categories—
Platinum, Gold, Silver, and Bronze—that correspond to four approximate actuarial 
values—90 percent, 80 percent, 70 percent, and 60 percent. The actuarial value refers to 
the expected percentage of annual medical expenses covered by the insurance plan.  

Table 3. Average Marketplace Premiums After Credits 

 

 

2014 

2015 

2016 

2017 

2018 

2019 

2020 

2021 

2022 

2023 

2024 

2025 

Single 
Coverage  Platinum 

4,200 

4,100 

4,400 

4,600 

4,900 

5,200 

5,600 

5,900 

6,300 

6,600 

7,100 

7,500 

Gold 

3,300 

3,200 

3,400 

3,600 

3,900 

4,100 

4,300 

4,600 

4,900 

5,200 

5,500 

5,900 

Silver

2

 

1,100 

1,200 

1,400 

1,600 

1,700 

1,900 

2,100 

2,300 

2,500 

2,700 

3,000 

3,200 

Silver 

2,800 

2,700 

2,800 

3,000 

3,200 

3,400 

3,600 

3,800 

4,100 

4,300 

4,600 

4,900 

Bronze 

2,000 

2,000 

2,000 

2,100 

2,100 

2,200 

2,200 

2,300 

2,300 

2,400 

2,500 

2,500 

  

  

 

 

 

 

 

 

 

 

 

 

 

  

Family 
Coverage

1

  Platinum  15,300  15,400  16,400  17,400  18,600  19,800  21,000  22,400  23,800  25,300  27,000  28,700 

Gold 

11,700  11,800  12,600  13,400  14,200  15,200  16,200  17,200  18,400  19,600  20,900  22,200 

Silver

2

 

4,700 

5,500 

6,000 

6,500 

6,900 

7,400 

8,000 

8,500 

9,000 

9,600  10,300  11,200 

Silver 

9,800 

9,900  10,600  11,200  12,000  12,700  13,600  14,500  15,400  16,400  17,500  18,600 

Bronze 

6,800 

6,900 

7,100 

7,200 

7,400 

7,600 

7,800 

8,000 

8,200 

8,400 

8,600 

8,800 

1

 Family coverage estimates are based on a family size of four persons. 

2

 Silver plans that receive cost-sharing assistance have exceptionally low, after-credit premiums, 

primarily because they are only offered to households that receive generous premium subsidies.  

Eligible households may purchase subsidized coverage for a specified percentage of 
household income that ranges from 2.03 to 9.66 percent in 2016, depending on income. A 
federal subsidy pays the remaining portion of the premium that is not covered by the 
household’s specified income contribution. This specified income contribution is also 
subject to annual increases if the annual increase in health insurance costs exceeds a 
measure of household income growth. H&E also projects an additional cost control 
measure, which prescribes further increases in the income contribution if total subsidy 
spending exceeds .504 percent of GDP, will be triggered after 2018, the first year in 
which it is eligible to take effect. 
It is important to note that, because of additional cost-sharing assistance, the plan designs 
categorized as Silver vary significantly in actuarial value across different income 
categories. For enrollees in the marketplace that earn between 100 and 150 percent of the 
FPL, Silver plans have an actuarial value of 94 percent, the highest of any plan offered in 
the Marketplace. For enrollees earning between 150 and 200 percent of FPL, Silver plans 
have an actuarial value of 87 percent, and for enrollees earning between 200 and 250 

 

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percent of FPL, Silver plans have a 73 percent actuarial value. H&E estimates the 
unsubsidized premiums for these high-value silver plans using the true actuarial value of 
the plan, rather than the Silver plan price.  
Unsubsidized insurance plans, purchased in the Marketplace or directly from an insurer, 
are similar in design and price to those eligible for subsidies. The ACA requires that all 
health insurance plans meet certain requirements in order to certify as qualified coverage. 
However, some non-qualified health plans already in existence are available to 
consumers until 2017. Before the qualified health plan regulations are enforced, lower 
cost plan options are available to consumers who seek unsubsidized health insurance 
coverage outside of the Marketplace. 
 

PLAN CHOICE 

Table 4. Plan Choice Distribution in the Individual Market

1

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Platinum 

7% 

7% 

6% 

6% 

5% 

5% 

4% 

4% 

3% 

3% 

3% 

2% 

Gold 

16% 

17% 

14% 

15% 

13% 

11% 

10% 

8% 

6% 

5% 

5% 

4% 

Silver

2

 

44% 

41% 

43% 

47% 

44% 

40% 

35% 

30% 

25% 

20% 

16% 

14% 

Bronze 

14% 

19% 

22% 

30% 

35% 

40% 

46% 

52% 

58% 

64% 

69% 

72% 

Catastrophic 

19% 

17% 

15% 

2% 

3% 

4% 

5% 

6% 

7% 

7% 

7% 

7% 

  

 

 

 

 

 

 

 

 

 

 

 

  

Total Enrollment (millions) 

31 

34 

36 

33 

32 

31 

29 

28 

27 

27 

27 

27 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 5. Plan Choice Distribution in the Health Insurance 
Marketplace 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Platinum 

2% 

4% 

5% 

4% 

4% 

4% 

3% 

3% 

3% 

3% 

2% 

2% 

Gold 

5% 

10% 

9% 

8% 

7% 

6% 

5% 

4% 

3% 

3% 

3% 

2% 

Silver

2

 

74% 

66% 

62% 

58% 

54% 

48% 

42% 

35% 

29% 

23% 

18% 

14% 

Bronze 

19% 

20% 

24% 

30% 

36% 

42% 

50% 

57% 

65% 

72% 

77% 

81% 

  

 

 

 

 

 

 

 

 

 

 

 

  

Total Enrollment (millions) 

10 

13 

16 

17 

16 

15 

14 

13 

13 

12 

12 

12 

1

 The Individual Market refers to the commercial, non-group market and includes sales of 

insurance within the Marketplace and direct sales by insurers.  

2

 Silver plans include plans that receive cost-sharing assistance. 

H&E assumes an underlying health insurance cost growth of 6 percent throughout the 
ten-year window as premiums increases were above 6 percent in 2014 and 2015 and are 
projected to increase at similar levels moving forward.

i

 Actual year on year premium 

growth estimates vary as a result of changes in the enrollment mix and other factors. For 
example, the growing size of the individual market between 2015 and 2016—associated 

 

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in part with increased participation of the young and healthy—leads to lower estimated 
increases in average premiums for many plan design categories. After 2017, premiums in 
the individual market are projected to grow annually at rates closer to the underlying 
growth rate of 6 percent. Due to growing applicable income contribution rates, subsidized 
premium growth for some plan designs is expected to exceed the underlying health 
insurance growth rate.  
 
H&E uses the subsidized and unsubsidized Marketplace enrollment in each metal level 
after the first year to calibrate plan preferences in the individual market and estimate plan 
choices throughout the ten-year analysis window.   
 
H&E estimates that the large enrollment in Silver plans in 2015 among subsidized 
insurance plans will give way to higher enrollment in Platinum, Gold, and Bronze plans 
in 2015 and 2016. The large majority of Silver plan enrollment is estimated to be largely 
comprised of households eligible for extra cost-sharing benefits. As the market grows to 
include more households that are eligible for premium credits but not cost sharing 
assistance (earning between 250 and 400 percent of FPL), the distribution of subsidized 
enrollment among the four metal levels is expected to become more evenly distributed in 
2017.  
 
Beyond 2017, lower cost insurance plans are estimated to gain market share, shifting 
away from more generous plans in response to the steadily rising cost of health insurance. 
Bronze plans are expected to dominate the individual insurance market by 2021. Under 
the ACA, catastrophic coverage is not certified as qualified health insurance coverage for 
adults over the age of 30. However, that provision is not enforced for adults over the age 
of 30 that are already enrolled in catastrophic coverage until 2017.  
 

BUDGET 

H&E estimates the impact on the federal budget of the major health insurance coverage 
provisions of current law with regards to the non-elderly population. Budget impact 
estimates do not include estimates for non-ACA tax expenditures encoded in current law, 
such as the employer sponsored health insurance tax expenditure.

ii

 H&E does, however, 

estimate the additional revenue gained by removing the tax exclusion for high-cost 
employer sponsored insurance plans implemented by the ACA, known as the Cadillac 
tax. 
 
Medicaid coverage and expenditure estimates are calculated based on the number of 
states that had chosen to implement Medicaid expansion by January 1, 2016. These 
predictions are sensitive to future state-level decisions on expansion as well as new 
program waivers that alter the design of a state’s Medicaid program.  
 
 
 
 
 
 

 

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Table 7. Cost of Current Law Coverage Provisions (billions)

1

 

2017 

2026 

   

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Sources of Funds

2

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Tax on Employer Sponsored Health 
Insurance 

19 

20 

20 

20 

19 

18 

16 

132 

  

Individual and Employer Mandate 
Taxes 

10 

11 

13 

15 

17 

19 

22 

25 

28 

32 

37 

219 

   Subtotal  

10 

11 

13 

15 

35 

38 

42 

45 

47 

50 

53 

352 

     

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Uses of Funds

3

 

  

  

  

  

  

  

  

  

  

  

  

  

  

   Health Insurance Marketplace 

 

 

 

 

 

 

 

 

 

 

 

 

  

    

Cost Sharing Benefits 

12 

13 

15 

14 

14 

13 

12 

10 

105 

    

Premium Tax Credits 

58 

64 

77 

79 

81 

81 

82 

83 

84 

86 

89 

93 

835 

   Medicaid 

188 

199 

202 

208 

214 

219 

226 

233 

241 

249 

259 

269  2,320 

   Medicare 

65 

76 

76 

89 

93 

97 

100 

104 

107 

111 

114 

117  1,008 

   Subtotal  

324 

352 

370 

391 

401 

410 

420 

430 

441 

454 

468 

484  4,269 

     

  

  

  

  

  

  

  

  

  

  

  

  

  

  

Net Budgetary Impact

4

 

-317  -343  -360  -377  -386  -376  -382  -388  -396  -407  -418  -431 

-

3,920 

1

 Cost estimates refer only for the under-65 population. 

 

 

2

 Positive values denote increases in revenue; negative values denote decreases in revenue. 

 

 

3

 Positive values denote increases in spending; negative values denote decreases in spending. 

 

 

4

 Positive values denote surplus; negative values denote deficit. 

 

 

 

 

 
 
Over the decade spanning between 2017 and 2026, H&E estimates that non-elderly 
coverage provisions under current law will cost $4.269 trillion. The cost is partially off-
set by $352 billion in increased revenue through the tax on high-cost employer sponsored 
insurance, the individual shared responsibility tax, and the employer shared responsibility 
tax. The ACA introduced a number of taxes that are not directly related to the health 
insurance coverage of the non-elderly population. In 2012, CBO estimated non-coverage 
provisions of the ACA to reduce the deficit by $1.28 trillion over 10 years.

iii

 

 
 

PRODUCTIVITY AND ACCESS 

In an effort to shed light on how health care policy and consumer choices affect health 
care quality, H&E estimates two measures: the Medical Productivity Index (MPI) and the 
Provider Access Index (PAI). Health insurance plan designs are associated with varying 
degrees of access to desired physicians and facilities as well as incentives that promote or 

 

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discourage efficient use of resources. H&E estimates each index by attributing 
productivity and access scores to the range of plan designs available and exploits 
changing plan choices to project the evolution of health care quality.   
 
The Medical Productivity Index is designed to reflect the expected gains in health status 
in return for medical expenditures. Plan designs that encourage patients to consider the 
price of treatment when making health care decisions, such as high deductible plans, are 
ascribed high MPI scores, while plans with low cost-sharing requirements or first dollar 
coverage are ascribed low scores. The index ranges from a low of 1.0 to a high of 4.0.  
 
 

Table 8. Medical Productivity Index 

 

 

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Individual Market 

2.5 

2.4 

2.4 

2.2 

2.2 

2.3 

2.3 

2.3 

2.3 

2.4 

2.4 

2.4 

  

Marketplace 

2.0 

2.1 

2.1 

2.1 

2.1 

2.1 

2.1 

2.2 

2.2 

2.2 

2.2 

2.2 

  

Other Non-Group Insurance 

2.8 

2.8 

2.8 

2.4 

2.4 

2.5 

2.6 

2.7 

2.8 

2.9 

2.9 

3.0 

  

  

 

 

 

 

 

 

 

 

 

 

 

  

Employer Sponsored Insurance 

2.3 

2.3 

2.3 

2.3 

2.4 

2.4 

2.4 

2.5 

2.5 

2.5 

2.6 

2.6 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Private Insurance 

2.3 

2.3 

2.3 

2.3 

2.3 

2.4 

2.4 

2.4 

2.4 

2.4 

2.5 

2.5 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Medicaid 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

1.5 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Total Insured

1

 

2.1 

2.1 

2.1 

2.1 

2.1 

2.2 

2.2 

2.2 

2.2 

2.2 

2.2 

2.3 

   

 

 

 

 

 

 

 

 

 

 

 

 

Table 9. Provider Access Index 

 

 

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025  2026 

Individual Market 

3.2 

3.1 

3.0 

2.7 

2.6 

2.6 

2.5 

2.5 

2.4 

2.3 

2.2 

2.1 

   Marketplace 

3.0 

2.9 

2.8 

2.7 

2.6 

2.6 

2.5 

2.4 

2.3 

2.2 

2.1 

2.0 

   Other Non-Group Insurance 

3.4 

3.2 

3.3 

2.6 

2.6 

2.6 

2.6 

2.6 

2.6 

2.6 

2.5 

2.5 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Employer Sponsored Insurance 

3.8 

3.8 

3.8 

3.8 

3.8 

3.7 

3.7 

3.7 

3.7 

3.7 

3.6 

3.6 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Private Insurance 

3.7 

3.7 

3.7 

3.6 

3.6 

3.6 

3.6 

3.6 

3.5 

3.5 

3.5 

3.5 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Medicaid 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

1.0 

  

 

 

 

 

 

 

 

 

 

 

 

  

  

Total Insured

1

 

3.1 

3.1 

3.0 

3.0 

3.0 

2.9 

2.9 

2.9 

2.9 

2.9 

2.8 

2.8 

1

 Productivity and access estimates refer only to the under-65, non-disabled population 

 

 

 
The Provider Access Index is designed to reflect the availability of primary and specialty 
physicians and facilities. Plans with large networks, such as Platinum plans offered in the 
individual market, are ascribed high scores for providing exceptional access. Bronze and 

 

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other low cost plans that afford access only to limited networks are ascribed low PAI 
scores. The index ranges from a low of 1.0 to a high of 5.0.  
 

CHANGES FROM PREVIOUS BASELINE ESTIMATES 

As a new and improving organization, H&E is constantly reevaluating the assumptions 
and technical methods that are used to create baseline and proposed estimates of health 
insurance coverage provisions under current law. This publication is the fifth 
comprehensive baseline report, and the fourth to include detailed estimates on the net 
budgetary impact of the ACA and Medicaid for individuals under 65. H&E currently 
projects that the under-65 coverage provisions of current law will increase the deficit by 
$343 billion in 2016, a decrease of $28 billion from the May 2015 baseline estimate. 
H&E also projects that, on average, 239 million individuals under the age of 65 will be 
insured during the year of 2016, which is 5 million less than the May 2015 baseline 
estimate due to a lower projected enrollment in the individual market. The updates to 
baseline predictions are a result of growing information concerning the rollout of the 
ACA that inform many of the underlying assumptions in our modelling. However, some 
notable differences are a result of a few key technical changes.  
 

 

Table 10. Change in Coverage Estimates (millions) 

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025 

Individual Market 

-1 

-5 

-4 

-6 

-6 

-6 

-6 

-6 

-6 

-6 

-6 

   Health Insurance Marketplace 

-2 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

   Other Non-group Insurance 

-2 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

-3 

    

 

 

 

 

 

 

 

 

 

 

  

Employer Sponsored Insurance 

    

 

 

 

 

 

 

 

 

 

 

  

Medicaid 

    

 

 

 

 

 

 

 

 

 

 

  

Other Public Insurance 

     

  

  

  

  

  

  

  

  

  

 

  

May 2015 Total Insured

1

 

236 

244 

245 

245 

245 

245 

245 

245 

245 

245 

245 

Feb 2016 Total Insured

1

 

234 

239 

241 

240 

240 

239 

239 

239 

239 

239 

239 

 

1

 All insurance coverage estimates refer only to the under-65 population. 

  * Difference between baseline estimates is between 0 and 1 billion.  

 
A combination of many things have led to reduced projections in spending and coverage 
relative to the May 2015 baseline. Less people have purchased insurance in the individual 
marketplace than previously expected—opting to either go uninsured or to obtain 
insurance in another way. H&E expects 13 million people to purchase insurance through 
the Health Insurance Marketplace in 2016 which is 2 million less than was estimated in 
the May 2015 baseline. By 2018, H&E estimates the number of people insured through 
the individual market to be 6 million less than previously projected. This less-than-
expected take up of insurance in the individual market is partially offset by Medicaid 
expansion, as three states expanded their Medicaid programs in 2015.  

 

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10 

 

Table 11. Change in Budgetary Impact Estimates 

(billions)

1

 

 

 

 

 

2015  2016  2017  2018  2019  2020  2021  2022  2023  2024  2025 

2016 

2025 

Change in Sources of 
Funds Baseline 
Estimates

2

 

  

  

  

  

  

  

  

  

  

  

    

  

Tax on Employer 
Sponsored Health 
Insurance 

-21 

-21 

-2 

-1 

-1 

-45 

  

Individual and 
Employer Mandate 
Taxes 

  

Subtotal  

-20 

-20 

-1 

3 

-36 

  

  

  

  

  

  

  

  

  

  

  

  

    

Change in Uses of Funds 
Baseline Estimates

3

 

  

  

  

  

  

  

  

  

  

  

 

  

  

Cost Sharing 
Benefits 

-4 

-6 

-5 

-4 

-3 

-2 

-1 

-22 

  

Premium Tax Credits 

-21 

-31 

-30 

-29 

-30 

-30 

-30 

-31 

-32 

-32 

-296 

  

Medicaid 

-2 

-1 

-1 

-3 

13 

 

Medicare 

-6 

-6 

-1 

-2 

-3 

-4 

-4 

-16 

  

Subtotal  

-3 

-21 

-38 

-29 

-29 

-31 

-32 

-33 

-34 

-36 

-38 

-321 

  

  

  

  

  

  

  

  

  

  

  

  

    

May 2015 Net Budgetary 
Impact

4

 

-324  -371  -404  -394  -403  -411  -420  -429  -440  -453  -467 

-

4,192 

Feb 2016 Net Budgetary 
Impact without Medicare 
Estimate

4

 

-256  -273  -289  -295  -300  -284  -288  -292  -297  -303  -312 

-

2,932 

Feb 2016 Net Budgetary 
Impact with Medicare 
Estimate

4

 

-317  -343  -360  -377  -386  -376  -382  -388  -396  -407  -418 

-

3,833 

1

 Cost estimates refer only for the under-65 population. 

 

 

2

 Positive values denote increases in revenue; negative values denote 

decreases in revenue. 

 

 

3

 Positive values denote increases in spending; negative values denote 

decreases in spending. 

 

 

4

 Positive values denote surplus; negative values denote deficit. 

 

 

* Difference between baseline estimates is between 0 and 1 billion.  

 

 

 
Expectations regarding enrollment in the subsidized Health Insurance Marketplace have 
changed. In particular, the changes have led H&E to estimate fewer low-income enrollees 
in subsidized Marketplace plans, which in turn leads to lower estimates of income-based 
subsidies and cost-sharing. As a result, H&E expects a substantial decrease in the amount 
of funds used relative to the May 2015 baseline. H&E projects $21 billion less in