JANUARY

SECTION 2
Assessment of Progress to Date
This section addresses each of the conditions for sustainability
identified in Section 1 and assesses progress that has been made
as well as challenges that remain to be addressed. Although the
ACA has dramatically reduced uninsured rates, enrollment in
the individual market has been lower than initially expected and
enrollees have been less healthy than expected. For the most part,
competing plans face the same rules. However, the uncertain and
changing regulatory environment—including legal challenges to
the ACA, allowing individuals to retain pre-ACA coverage, and
constraints on risk corridor payments—contributed to adverse
experience among insurers. As a result of these and other factors,
insurer participation and consumer plan choice declined in 2016
and declined further in 2017.
Individual enrollment at sufficient levels and a
balanced risk profile
Sufficient enrollment levels.
The number of individuals selecting marketplace plans during the annual open enrollment
periods increased from 8.0 million in 2014 to 11.6 million in 2015, and to 12.7 million in
2016. 2 Enrollment numbers decline during the year, as individuals shift to other coverage
sources (or to being uninsured) and insurers cancel coverage for consumers who don’t pay
their premiums. Offsetting part of this decline is enrollment during special enrollment
periods (SEPs) for individuals who experience a qualifying event, such as a loss of coverage
through a job. At the end of 2015, 8.8 million individuals had marketplace coverage, down
from 11.6 million during the open enrollment period. 3
AMERICAN ACADEMY OF ACTUARIES 7