As premiums spiked in 2017, the market where people buy their own health insurance saw a significant decline in enrollment among those who don't qualify for federal subsidies.
That is the conclusion of a new federal report that finds the number of unsubsidized individual-market enrollees in the U.S. dropped last year by about 1.27 million people, or roughly 20 percent.
Enrollment among those who received tax credits, meanwhile, dropped by just 3 percent, according to the report from the federal Centers for Medicare and Medicaid Services (CMS).
The federal agency pinned the blame on premium increases that averaged 21 percent across the country. In Minnesota, where the premium jumps were even higher, enrollment in the unsubsidized market was cut in half while the number buying with tax credits grew by 45 percent.
"Nationally, the decrease in enrollment among unsubsidized enrollees was driven by large premium increases, but also likely by cutbacks in outreach and general confusion surrounding the [federal Affordable Care Act] as the Trump administration took office," said Larry Levitt of the Kaiser Family Foundation via e-mail.
The individual market primarily serves people under age 65 who are either self-employed or don't get coverage from their employer. The ACA brought sweeping changes to the individual market, where insurers before the federal health law could deny coverage to people based on pre-existing health conditions.
The new report underscores trends that were previously noted in Minnesota, where insurers reported a large decline in individual market enrollment even as more Minnesotans are purchasing coverage through the MNsure health exchange. People at certain income levels who buy through MNsure receive tax credits that substantially discount out-of-pocket premium costs.
The number of Minnesotans buying individual coverage without tax-credit subsidies declined by 53 percent between 2016 and 2017, with the tally falling to 92,539, according to the new report. The number buying with tax credits via MNsure increased by about 45 percent to 61,932.