Unin­sured rate dips 2.7 points

Modern Healthcare - - NEWS - By Paul Demko —with Har­ris Meyer

Roughly 5.4 mil­lion Amer­i­cans who pre­vi­ously lacked health in­sur­ance have ac­quired cov­er­age since the state and federal ex­changes opened on Oct. 1, ac­cord­ing to a new study con­ducted by the Ur­ban In­sti­tute’s Health Pol­icy Re­search Cen­ter. The unin­sured rate for nonelderly adults dropped to 15.2% in March, down 2.7 per­cent­age points from Septem­ber, ac­cord­ing to the cen­ter’s sur­vey re­sults.

The re­searchers found a large gap in the unin­sured rate be­tween states that have opted to ex­pand Med­i­caid to adults with in­comes up to 138% of the federal poverty level and those that have not im­ple­mented that piece of the Pa­tient Pro­tec­tion and Af­ford­able Care Act. In Med­i­caid ex­pan­sion states, 12.4% of adults lacked cov­er­age, com­pared with 18.1% in non-ex­pan­sion states. Roughly half the states have opted to pur­sue the Med­i­caid ex­pan­sion.

The Ur­ban In­sti­tute study likely un­der­es­ti­mates the num­ber of pre­vi­ously unin­sured in­di­vid­u­als who have ob­tained cov­er­age since Oct. 1. That’s be­cause 80% of the sur­vey was con­ducted prior to the first week of March and there­fore may not fully re­flect the surge of en­roll­ments that oc­curred leading up to the March 31 dead­line.

“I think you can view this as a lit­tle bit of a low­ball,” said Kather­ine Hempstead, a se­nior pro­gram of­fi­cer at the Robert Wood John­son Foun­da­tion, which paid for the study. “If we had been in the field at the end of March we would have seen a larger de­cline.”

ACA sup­port­ers are cel­e­brat­ing af­ter last week’s an­nounce­ment by the Obama ad­min­is­tra­tion that en­roll­ment had reached the 7.1 mil­lion en­roll­ment tar­get, and the num­ber is likely to rise through April 15. But it’s cer­tain that some of those people who signed up ul­ti­mately will not be en­rolled for a va­ri­ety of rea­sons. In­sur­ers are say­ing 10% to 20% of the people who have signed up haven’t paid their first pre­mium.

In ad­di­tion, there will con­tinue to be so-called churn. Re­searchers at the UC Berke­ley La­bor Cen­ter re­cently es­ti­mated that only about 55% of in­di­vid­u­als ob­tain­ing cov­er­age through Cov­ered Cal­i­for­nia would re­main in an ex­change plan for at least a year. Some people will leave their ex­change plan be­cause they gained em­ployer-pro­vided cov­er­age or their in­come dropped and they qual­i­fied for Med­i­caid.

The Ur­ban In­sti­tute study is seen as the first cred­i­ble as­sess­ment of how many pre­vi­ously unin­sured in­di­vid­u­als have gained cov­er­age dur­ing the Oba­macare open en­roll­ment pe­riod for 2014. The Obama ad­min­is­tra­tion has not re­leased data on how many of the ex­change cus­tomers who signed up for pri­vate plans were pre­vi­ously unin­sured or how many have paid their pre­mi­ums.

En­roll­ment will not fully stop with the March 31 open en­roll­ment dead­line. That’s in part be­cause the federal and state ex­changes will al­low in­di­vid­u­als who started the en­roll­ment process prior to the end of the month an op­por­tu­nity to com­plete the process. In ad­di­tion, in­di­vid­u­als who have un­der­gone a “qual­i­fy­ing life event” will still be el­i­gi­ble to sign up for cov­er­age through­out the year. That could in­clude di­vorce, los­ing a job, hav­ing a child, grad­u­at­ing from col­lege, or hav­ing to shift out of Med­i­caid due to higher in­come.

Out­side of the Oba­macare ex­changes, eHealth, an on­line in­sur­ance bro­ker, has iden­ti­fied 20 car­ri­ers in 14 states that are con­tin­u­ing to sell in­di­vid­ual-mar­ket plans at least through April 15. Be­yond that, in­sur­ance ex­perts say it would be risky for any one in­surer to con­tinue sell­ing in­di­vid­ual plans through­out the year be­cause it could at­tract people with health prob­lems—while in­sur­ers are pro­hib­ited by the ACA from check­ing ap­pli­cants’ health sta­tus, lim­it­ing ben­e­fits, or charg­ing a higher pre­mium. In con­trast, dur­ing open en­roll­ment, all in­sur­ers are equally at risk of sign­ing up sicker en­rollees.

“I would cer­tainly urge in­sur­ance clients to weigh the risk care­fully be­fore choos­ing to ac­cept people out­side open en­roll­ment,” said Hans Leida, an ac­tu­ary at con­sul­tancy Mil­li­man.

There have been other pre­lim­i­nary signs that the unin­sured rate has been drop­ping. A Gallup poll re­leased in Fe­bru­ary found that the rate had fallen to 16%, down from 17.1 % in the fourth quar­ter of 2013.

Jonathan Gru­ber, an econ­o­mist at Mas­sachusetts In­sti­tute of Tech­nol­ogy who con­sulted in craft­ing the Mas­sachusetts and federal health­care re­form laws, cau­tions that any as­sess­ment of the im­pact on the unin­sured rate at this point is in­her­ently flawed be­cause there are just not enough data avail­able to judge how the health­care re­form law has changed the in­sur­ance land­scape.

“It’s go­ing to take three years for the law re­ally to phase in,” Gru­ber said. “People need to just calm the heck down.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.