Summary of Dr. Jonathan Gruber’s Health Insurance
Exchange Modeling
Jeff BontragerColorado Health Institute
Marketing, Enrollment and Outreach Workgroup (MEOW) Meeting
September 21, [email protected]
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 EnrollmentsInsurance Category 2011 % of population
Employer-Sponsored Insurance (ESI) 2,650,000 62.3%
Small Firm ESI (1-50 employees) 570,000 13.4%
Large Group ESI 2,080,000 49.0%
Individual Market Insurance 310,000 7.2%
Public Insurance 440,000 10.3%
Uninsured 850,000 20.1%
Table 2: Estimate of ACA Effect, 2016No Reform With ACA ACA Impact
ESI 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
Table 3: Summary of Previously Uninsured, 2016 Post-ACA
Adult females 19-44
Adult females 45-64
Adult males 19-44
Adult males 45-64
Children Ages 0-18
Medicaid/CHP+
39,000 21,000 41,000 11,000 19,000
Reformed or Unreformed Non-group
30,000 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
Table 4: Movements due to ACA: 2016Ex-ante
ESI Nongroup Public Uninsured Total
ESI 2,440,000 - - 160,000 2,600,000
Ex-Post 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
Total 2,630,000 330,000 550,000 860,000 4,390,000
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 individual reformed market
470,000 -
Employees (& dependents) of firms receiving tax credit
120,000 590,000
Non-tax credit recipients in individual reformed market
150,000 740,000
Employees (& dependents) of non-tax credit firms with <50 employees
420,000 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.
34%
11%
7%6%
18%
14%
5%
5% 0%
Figure 19: Nongroup Premium Changes (including tax credits) for those Remaining on Nongroup: 2016
<-50%-50% to -25%-25% to -10%-10% to 0%0%0% to 10%10% to 25%25% to 50%>50%
Table 7: Household Budget Effects: 2016Status Quo (in billions)
After ACA (in billions)
ACA Effect (in billions)
Per Household Effect
Wages $162.1 $162.4 $0.3 $130
Exchange Credits $0.0 $1.0 $1.0 $440
Public Insurance $0.0 $0.6 $0.6 $270
Additional Benefits
$1.9 $840
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*