Easiest way for Republicans to hurt ACA exchange enrollment? Expand Medicaid!

As I noted earlier today, the Centers for Medicare & Medicaid Services have released an updated 2023 ACA Open Enrollment Period data report, which runs through 12/03/22 for the 33 states hosted by the federal exchange and 11/26/22 for the 18 states which operate their own exchanges.

There were several major takeaways, including an overall 18% year over year enrollment increase so far, with new enrollments up 28%, active renewals for current enrollees up 17% and so forth.

However, there's another important factor to look at when comparing 2023 ACA enrollment to date vs. the same point in 2022 (actually one day less): Medicaid expansion.

The table below breaks out every state's 2023 enrollment vs. the same point in 2022, including which type of exchange they use as well as their ACA Medicaid Expansion status as of this writing:

As you can see, there's a stark contract between federal exchange and state-based exchanges states: The former is up 23% y/y while the latter is down almost 13% so far.

Now some of this may be due to different reporting methodology. However, there's also a stark difference between how states which have expanded Medicaid are performing compared to last year as opposed to states which haven't done so: the former are only up 2.7% y/y while the latter are up a whopping 26.6%.

The reason for this is pretty obvious: In expansion states, anyone earning less than 138% of the Federal Poverty Level gets redirected towards Medicaid, while in non-expansion states there's a huge population of low-income Americans who qualify for $0-premium, high-value private ACA exchange policies instead.

It's also worth noting that all 12 non-expansion states (South Dakota voters expanded the program last month but it doesn't go into effect until 2023) are hosted via the federal ACA exchange, HealthCare.Gov. This helps explain the huge discrepancy in enrollment between the federal and state-based exchanges.

In other words, if Republican lawmakers really want to "stick it to Obamacare!" the most effective way to do so would be to expand Medicaid in Texas, Florida, Georgia and the other remaining holdout states! ACA exchange enrollment would drop by perhaps a million or more people earning between 100 - 138% FPL, since they'd be shifted over to Medicaid enrollment instead!