Believe it or not, Friday's historic Supreme Court ruling allowing marriage equality for same-sex couples actually has an interesting connection with Thursday's ruling on ACA federal tax credits.
How? Well, the HHS Dept. recently posted this on Twitter:
Love is Love. Remember that getting married means a new opportunity to #GetCovered → http://t.co/... pic.twitter.com/TfoNPOOR32
— HHS.gov (@HHSGov) June 26, 2015
...with this graphic:
At around the same time, HHS Dept. spokesman Aaron Albright posted this:
FYI--Same-sex MARRIED couples and Marketplace coverage. https://t.co/...
— Aaron Albright (@AaronKAlbright) June 26, 2015
Same-sex married couples
Health coverage for same-sex married couples
For coverage starting in 2015, an insurance company that offers health coverage to opposite-sex spouses must do the same for same-sex spouses.
Protections against discrimination
As long as a couple is married in a jurisdiction with legal authority to authorize the marriage, an insurance company can’t discriminate against them when offering coverage. This means that it must offer to same-sex spouses the same coverage it offers to opposite-sex spouses.
This is true regardless of the state where:
--The couple lives
--The insurance company is located
--The plan is sold, issued, renewed, or in effect
Married same-sex couples and lower costs
The Marketplace also treats married same-sex couples the same as married opposite-sex couples when they apply for premium tax credits and lower out-of-pocket costs on private insurance plans. This is true in all states.
A couple may be eligible for premium tax credits on Marketplace plans as long as the taxpayer and spouse file a joint federal tax return for the year they’re getting Marketplace coverage. Married couples must file jointly in order to be eligible for tax credits, regardless of gender.
When you apply for help paying for coverage in the Marketplace, you’ll be asked if you’re married. If you and your spouse plan to file a joint federal tax return for 2014, select “yes.”
So. What impact, if any, will this have on off-season enrollments?
Well, prior to today, my estimate of off-season QHP selections this year has been roughly 7,500 per day.
Now, I don't know exactly how many people in the U.S. are homosexual; I've heard estimates from as low as around 2% to as high as 10%. Obviously some people don't like to discuss their sexuality, others may be confused about it, others yet are bisexual, transgender and so forth and don't easily fit into one category or the other, but let's say that around 5% of the total U.S. population could reasonably be included, or around 16 million people.
Of those, let's assume the age demographics are roughly the same among this subset of the population as the country as a whole. The eligible pool of those who could potentially enroll in private ACA policies is estimated by the Kaiser Family Foundation at around 29 million or so, or around 9% of the country. Let's again assume that these demographics are similar; that's around 1.45 million out of 16 million total.
Finally, nationally, around 10.3 million of those 29 million are already currently enrolled, or 35.5%. Once again, I have no idea whether a similar proportion of the homosexual community is among those, but assuming they are, that's around 500,000 out of 1.45 million who are already enrolled, leaving around 950,000 homosexual American citizens (or legal residents) who are not currently covered by an ACA-compliant healthcare policy, but are eligible to do so.
Now, this is further complicated by the fact that a bunch of states already had/have legally-recognized same-sex marraiges (plus, there are some number of people who are homosexual but are married to someone of the opposite gender anyway, etc). And, of course, legalizing same-sex marriage doesn't automatically mean that every gay person is going to rush out and do so; some are single, not ready for marriage, whatever. Plus, of course, about 23% of them are likely children under 18, who would only be enrolled if their parents/guardians did so and brought them along for the ride (plus some number of 19-26 year olds).
What's all of that cut it down to? Hard to say...perhaps 1/4 of this group is composed of adult gay/lesbian folks who intend on getting married, or around 250,000 nationally? Perhaps this would be lower...but then again, some of those folks would also have children who'd be added to the total as well, so it sounds about right to me.
Next: Not all of these people are planning on getting married immediately (ie, this year), but judging by the massive activity going on at the moment and the fact that some of these people have been waiting years or even decades to get hitched, I'd say we're probably looking at least half of them getting officially married over the next few months...call it 150,000?
Finally, the other question is, how many of that group will use their newfound status to actually enroll in a Qualified Health Plan via the ACA exchanges? Not a clue, but I'm comfortable with perhaps an even 100,000 or so.
In short, there's no way of knowing what impact today's ruling will have, and many of my estimates above are completely pulled out of thin air, I admit, but I wouldn't be surprised to see a minor bump in effectuated exchange enrollments of perhaps 100,000 people nationally over the summer and early fall, bringing The Graph from a steady average of 10.3 million up to around 10.4 million.
NOTE: I originally posted the above over at ACA Signups on Friday afternoon. The next morning I posted the following update:
Well whaddya know? It looks like I might prove to be more on-point here than I thought:
--Gay Marriage Ruling Means More May Get Hitched Or Lose Partner Benefits
Now that the Supreme Court has ruled that the Constitution guarantees a right to same-sex marriage, U.S. employers may shed same-sex domestic partner coverage to cut costs, say benefits consultants already working with employers on such moves.
The idea behind same-sex domestic partner benefits arose in the 1990s during an economic boom and period of full employment with employer after employer adding same-sex domestic partner workplace benefits as a way to “equalize the treatment of same sex couples and opposite sex couples,” J.D. Piro, senior vice president in the Aon Hewitt (AON) health law group said in an interview.
Offering same-sex domestic partner benefits was a key recruitment and retention tool for employers to attract gay and lesbian workers, but it also brought an added layer of administrative and legal bureaucracy that was a new expense to employers. The high court’s 5-4 ruling may now lead companies to cut costs and bring an end to the separate domestic partner benefit apparatus created two decades ago in their human resources departments.
In other words, there may be several hundred thousand (perhaps a few million?) homosexuals nationally who have, until now, been covered by employer sponsored insurance policies via their domestic partners employed by the companies. Over the next few months (or perhaps not until 2016? I'm not sure when this would take effect), they'll presumably be kicked off of those policies until they're
officially married to those partners. This is good news for the ACA exchanges in two ways:
--In cases where they lose their ESI coverage between now and November, they qualify for off-season enrollment due to their qualifying life change status
--In cases where they lose their ESI coverage starting in January, they'll be added to the pool of potential Open Enrollment enrollees
Either way, this should pad the enrollment numbers even more than I had figured last night.