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%
2,080,000
49.0%
Individual Market Insurance
310,000
7.2%
Public Insurance
440,000
10.3%
Uninsured
850,000
20.1%
Large Group ESI
Table 2: Estimate of ACA Effect, 2016
No Reform
With ACA
ACA Impact
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
ESI
Table 3: Summary of Previously
Uninsured, 2016 Post-ACA
Adult
females 1944
Adult
females 4564
Adult males
19-44
Adult males
45-64
Children
Ages 0-18
39,000
21,000
41,000
11,000
19,000
Reformed or 30,000
Unreformed
Non-group
41,000
72,000
40,000
29,000
Employer
Sponsored
Insurance
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
Medicaid/C
HP+
Table 4: Movements due to ACA: 2016
Ex-ante
ESI
ESI
Ex-Post
Nongroup
Public
Uninsured
Total
2,440,000
-
-
160,000
2,600,000
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
2,630,000
330,000
550,000
860,000
4,390,000
Total
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
470,000
individual reformed market
-
Employees (& dependents) 120,000
of firms receiving tax credit
590,000
Non-tax credit recipients in 150,000
individual reformed market
740,000
Employees (& dependents) 420,000
of non-tax credit firms with
<50 employees
1,160,000
Table 6: Premiums and Actuarial
Values for those Remaining on
Nongroup: 2016
Ex-Ante
Ex-Post
(No Subsidies)
Ex-Post
(With Subsidies)
Average Nongroup
Premium
$5,580
$6,610
$4,060
Average Nongroup
Actuarial 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.
Figure 19: Nongroup Premium Changes (including tax
credits) for those Remaining on Nongroup: 2016
5%
0%
5%
<-50%
34%
14%
-50% to -25%
-25% to -10%
-10% to 0%
0%
0% to 10%
10% to 25%
18%
25% to 50%
11%
6%
7%
>50%
Table 7: Household Budget Effects:
2016
Status Quo (in
billions)
After ACA (in
billions)
ACA Effect (in
billions)
Per Household
Effect
$162.1
$162.4
$0.3
$130
Exchange Credits $0.0
$1.0
$1.0
$440
Public Insurance
$0.6
$0.6
$270
$1.9
$840
Wages
$0.0
Additional
Benefits
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*