Half of Uninsured Have Shopped in ACA Marketplaces

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By Sara Hansard

Jan. 13 — About half of the approximately 10.5 million uninsured people who are eligible to get health coverage under the Affordable Care Act have shopped in the ACA marketplaces and are probably easier to enroll, a researcher said Jan. 13.

These remaining uninsured people are “split sort of down the middle between those who went to the marketplace, looked for coverage, looked other places as well for coverage, and then those who have not gone to the marketplace,” Mike Perry, a partner in PerryUndem Research, said during a teleconference sponsored by health-care advocacy organization Families USA. People who haven't shopped have “big gaps in knowledge” and don't understand the tax credits available for financial help, he said.

After the first two years of ACA enrollment, cost remains the top barrier to enrolling the remaining uninsured, and there needs to be more education about tax credit subsidies that are available to help pay for coverage, Perry said. The third year's enrollment period ends Jan. 31.

While the desire to be protected from high medical bills has been the top reason for people enrolling in ACA plans, the second reason is rising fines for not having coverage, Perry said. In 2016 the fines rise to at least $695 per year for individuals or $2,085 for families, and Perry said that informing people about the fine “is a motivator to enrollment.”

Since open enrollment began Nov. 1 nearly 8.7 million consumers signed up for health coverage through the federal HealthCare.gov marketplace or had their coverage automatically renewed, the Centers for Medicare & Medicaid Services said in a fact sheet Jan. 13.

Dropping Special Enrollment Periods

Andy Slavitt, acting administrator of the CMS, said Jan. 11 that some special enrollment periods will be eliminated to push people into signing up during the normal annual open enrollment periods (08 HCDR, 1/13/16). Insurers have complained that many people are signing up outside of the normal open enrollment period and then dropping coverage once they have received treatments.

But Peter Lee, executive director of state-run ACA marketplace Covered California, said during the teleconference that surveys in his state found that more than 85 percent of people who have dropped plans in the marketplace left for other coverage, such as employer-sponsored health insurance or Medicare. “The fallacy that people are leaving to go bare or uninsured is not the case,” he said.

However, “there is churn,” Lee said. About a third of people who sign up during open enrollment will not be covered in the marketplace at the end of the year, he said. To maintain a healthy risk pool in the marketplaces new members need to be added as people drop out, he said.

“You will see over time the increasing importance of special enrollment, of people throughout the year who lose job-based coverage, who are determined ineligible for state Medicaid programs because their income goes up, coming to exchanges,” Lee said.

Large Growth Won't Continue

“The reality for exchanges across the nation is going to be the large growth we saw in the first few years is not going to continue,” Lee said. “There's going to be continued new enrollment, but net growth will be relatively small because you're going to be constantly refreshing people to move in and out of coverage.”

Lee said he attended a meeting with Slavitt Jan. 12, and the CMS appears to be narrowing some of the current 33 special enrollment periods “that are infrequently used and maybe inappropriately used.”

ACA Choices

Separately, the Blue Cross Blue Shield Association (BCBSA) released a study Jan. 13 finding that the share of health maintenance organization and exclusive provider organization (EPO) products offered on the ACA marketplaces increased from 41 percent in 2015 to 52 percent in 2016. In addition, the lowest-cost silver plans in 46 percent of all counties were HMO products in 2015 compared to 57 percent of counties in 2016, the study said. EPOs don't require participants to have a primary care provider, but they must choose providers from a predetermined network. 

In 2016 consumers in most regions still have multiple options from which to select, the report said. Price differences for the same types of health plans are narrowing, with only 1 percent of counties having a price difference of more than 10 percent between the two most affordable silver plans.

BCBS companies offer products in marketplaces in 89 percent of counties, and BCBS companies sell individual and group health insurance products throughout the country in addition to the ACA marketplaces.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com