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By Sara Hansard
June 21 — Millions of people who paid fines for being uninsured under the ACA will be the target of outreach efforts this fall to help them enroll in health plans.
That was one of several steps announced June 21 by the Department of Health and Human Services to sign up more young adults for coverage in 2017 through the Affordable Care Act health insurance marketplaces. Getting more young adults to sign up, which would lower costs and help keep premiums down, is a major goal of the Obama administration and health insurers offering marketplace plans.
Young adults are more likely to pay the tax penalty for failing to have coverage, the HHS said in a fact sheet.
Only about 28 percent of enrollees in the marketplaces are ages 18 to 34. Enrollment runs from Nov. 1 through Jan. 31, 2017.
About 27 percent of individuals who still don't have health-care coverage after three years of ACA plan availability are younger than 30, and 68 percent of eligible, uninsured individuals have few health risks, according to data from McKinsey and Co. cited in the HHS fact sheet. About 12.7 million people enrolled for ACA marketplace coverage in 2016.
The outreach effort is the first time the HHS has worked in partnership with the Internal Revenue Service to identify people who are potential marketplace enrollees. The outreach will target people who paid a fee for not having qualified coverage in 2015 or who claimed an exemption from the fee.
In 2014, 7.9 million income tax filers paid the fee for not having health insurance and millions more claimed an exemption, including some who could be eligible for substantial financial assistance through the marketplace, the HHS said in the fact sheet.
About 45 percent of taxpayers who paid a penalty or claimed an exemption in 2014 were under the age of 35, while only about 30 percent of all taxpayers were under 35, it said.
Data show that educating people about the penalty could raise enrollment by 13 percent, Christen Linke Young, principal deputy director for the Center for Consumer Information and Insurance Oversight, said during a press call June 21.
“This is not an unprecedented approach,” she said, citing a partnership formed between health and tax agencies in Massachusetts, which enjoys a stable risk pool for its state-run marketplace.
Getting cooperation from the IRS “is at least a start” to reaching the remaining uninsured who are the most likely to sign up, Linda Blumberg, a senior fellow with the Urban Institute Health Policy Center, told Bloomberg BNA June 21.
“The IRS can't give confidential information without permission but if there's a way for the IRS to act as a conduit to allow individuals who are interested to have someone contact them to help them, that would be a good step forward,” she said.
Guidance was also released June 21 by the HHS's Centers for Medicare & Medicaid Services, the Department of Labor's Employee Benefits Security Administration (EBSA) and the Department of the Treasury to remove obstacles that may have made it difficult for health insurers to reach 26-year-olds who are no longer eligible to stay on parents' plans under the ACA.
Since 2010 when the ACA was enacted, the percentage of uninsured people ages 19 to 25 has been cut in half, to 15.8 percent, the HHS said. Much of that drop is due to a provision in the law allowing young adults to stay on parents' health insurance plans until the age of 26, Young said.
But 2014 Census data show an almost 4 percentage point increase in uninsured rates at age 26, as well as an almost 7 percentage point increase in uninsured rates at age 19, when many lose coverage under Medicaid and the Children's Health Insurance Program, the fact sheet said. About 86,000 26-year-olds signed up for 2016 coverage through HealthCare.gov, 60 percent more than 25-year-olds who signed up, it said.
Employer plans are required to send 26-year-olds notices about opportunities to enroll under the Consolidated Omnibus Budget Reconciliation Act, or COBRA, as well as marketplace coverage, Young said.
“But plans may have believed that they were not allowed to do more, like help consumers through the enrollment process or give young adults information about specific marketplace products,” she said.
The guidance makes clear that the sponsors of employer plans can and are encouraged to provide additional information that will help people understand their options and enroll in marketplace coverage, including information about how to enroll as well as “general information about specific products offered in the marketplace,” Young said.
The HHS also announced a new 2017 open enrollment partnership with Lyft, which will develop user discount codes for people using its ride-sharing service to attend open enrollment events where they can receive assistance signing up for coverage, the HHS fact sheet said. Lyft will also publicize enrollment deadlines and the importance of getting health insurance through the ACA to its drivers in 190 cities, the HHS said.
In addition, the American Hospital Association will develop a social media toolkit that hospitals can use to reach young adults in their communities to provide information about how to enroll through the exchanges and information about the subsidies, the HHS said.
Going into the fourth enrollment the HHS is developing new functions to e-mail consumers “in near-real-time” about completing the next step in the enrollment process, Joshua Peck, chief marketing officer at the CMS, said on the press call. Young adults are twice as likely to enroll in response to e-mail outreach than older people, he said.
Young adults are “far more deadline-driven than the general population,” Peck said. The HHS will time its e-mail, television ads and other forms of outreach around Dec. 15, Jan. 15 and Jan. 31, which are the last days that people can enroll for coverage beginning on Jan. 1, 2017, or for 2017 coverage in general, respectively.
While getting more young adults to sign up for coverage would likely help keep premiums lower, it isn't a panacea for reducing costs, Kaiser Family Foundation Associate Director Cynthia Cox told Bloomberg BNA. KFF estimates that 40 percent of people who could sign up for marketplace coverage are between the ages of 18 and 34, including those who are on parents' plans, she said.
But getting more young people in the marketplaces would only reduce premiums by a modest amount, Cox said.
“It's also about getting healthy people to sign up of any age group,” she said.
Robert Laszewski, president of policy and marketplace consulting firm Health Policy and Strategy Associates Inc., told Bloomberg BNA in an e-mail June 21 that the HHS's steps to attract more young people to the marketplaces “are all good incremental steps but they don't constitute a game changer. What the administration needs to do is to make these plans more attractive to the healthy with premiums and deductibles that are more attractive—especially for those who earn more than 200 percent of the federal poverty level.”
Subsidies are available to ACA enrollees with incomes between 100 percent and 400 percent of the federal poverty level, but subsidies decline substantially for people earning more than 200 percent of the poverty level.
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