Tax credits, rural customers increase in 2017-18 ACA enrollment

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) released its final report for the 2018 Open Enrollment Period for the Health Insurance Marketplace. Overall, national enrollment of approximately 11.8 million Americans was just three percent below last year’s total. Clearly, there is strong demand for quality and affordable health insurance and the Affordable Care Act’s (ACA) ability to decrease costs for consumers.

The continued demand also indicates that grassroots efforts and the outstanding work done by local organizations were successful in making up for the Trump administration’s decision to significantly cut advertising and outreach for the open enrollment period.

In Nebraska, 2018’s enrollment exceeded last year’s total by 6 percent, a new record of more than 88,000 customers. We ranked 6th in the country for increase year over year indicating that outreach by local enrollment assisters and Enroll Nebraska were successful in getting the word out in innovative ways despite challenging circumstances.


Coverage Year Plan selections
2014 (1st year) 42,957
2015 74,152
2016 87,835
2017 84,371
2018 88,213


Premiums for Nebraska insurance plans increased like much of the country; however, premium tax credits largely made up for that difference in cost for those who qualified. More Nebraskans than ever received tax credits (92 percent), which brought the price of the average monthly premium down from a year ago.


Coverage Year Average Premium Average APTC Average Premium after APTCs Percent Receiving APTCs
2016 $400 $295 $105 88.00%
2017 $595 $462 $133 91.03%
2018 $857 $805 $119 91.78%


The report’s state level data shows that enrollee demographics largely remained the same, but some trends deserve note. The proportion of rural enrollments were higher than they have been compared to last two years. This is possibly due to the saturation of news coverage describing the efforts to repeal the ACA and increased interest from low-income customers in rural areas.


Coverage Year Rural Non-Rural
2016 43,039 44,796
2017 43,354 41,017
2018 45,661 42,552


Additionally, enrollment among Nebraska’s African-American population was slightly down for this open enrollment period while enrollment among whites increased. This decline could be due to cuts to enrollment assister budgets and a lack of advertising to reach harder-to-reach populations.


Coverage Year African-American White
2017 1,628 56,162
2018 1,602 59,282


Overall, the 2018 Open Enrollment period for the Health Insurance Marketplace was a huge success! Continuing to monitor the trends in enrollment, costs and assistance, as well as efforts to sabotage or destabilize the Marketplace will be a priority as we go forward.

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