ACA’s hid­den statistic: 7.8 mil­lion en­rolled out­side ex­changes

Modern Healthcare - - NEWS - By Paul Demko

HHS an­nounced last week that 7.5 mil­lion Amer­i­cans had signed up for health cov­er­age through the Oba­macare ex­changes, ex­ceed­ing the Con­gres­sional Budget Of­fice’s orig­i­nal es­ti­mate of 7.1 mil­lion. What’s got­ten less at­ten­tion is the large num­ber of people who have signed up for cov­er­age out­side the ex­changes, ei­ther di­rectly with health plans or through bro­kers.

While the federal govern­ment hasn’t re­leased any to­tals, a new study by the RAND Corp. es­ti­mates that 7.8 mil­lion people en­rolled out­side the ex­changes be­tween Novem­ber and mid-March and that 94% pre­vi­ously had cov­er­age.

Amer­ica’s Health In­sur­ance Plans com­plained in a let­ter to the CMS that the op­tion of sign­ing up di­rectly with in­sur­ers hasn’t been more promi­nently fea­tured on the Health­ web­site.

The ex­changes’ tech­no­log­i­cal prob­lems likely con­trib­uted to the siz­able of­fex­change en­roll­ment. Quincy, Mass.based Har­vard Pil­grim Health Care said it added 11,000 mem­bers in Maine and New Hamp­shire for cov­er­age that kicked in at the start of 2014, even though it did not par­tic­i­pate in the ex­changes. “We were get­ting inun­dated with tele­phone calls from frus­trated in­di­vid­u­als who be­lieved they were el­i­gi­ble for sub­si­dies but didn’t have any rea­son­able method for get­ting en­rolled,” said Eric Schultz, the plan’s pres­i­dent and CEO.

Some state reg­u­la­tors and in­di­vid­ual health plans have re­leased their data on signups out­side the ex­changes:

■ Blue Cross and Blue Shield plans signed up 1.7 mil­lion people out­side of the ex­changes through Fe­bru­ary.

■ Wash­ing­ton state re­ported roughly 184,000 off-ex­change en­roll­ments through the end of Fe­bru­ary.

■ CoOp­por­tu­nity Health, a new, con­sumer-gov­erned in­surer in Iowa and Ne­braska, signed up 11,000 of its 70,000 en­rollees out­side of the federal ex­change.

■ In Rhode Is­land, the two health plans sell­ing prod­ucts on the ex­change en­rolled 29% of their cus­tomers out­side of the on­line mar­ket­place.

■ Pre­ferredOne, owned by Minneapolis-based Fairview Health Ser­vices, said more than 70% of its 68,000 en­roll­ments since Oct. 1 have come via its web­site.

Con­sumers en­rolling out­side the ex­changes are thought to be health­ier and wealth­ier than those sign­ing up on the ex­changes, par­tic­u­larly since federal pre­mium sub­si­dies are avail­able only through ex­changes. Nearly half the cus­tomers who en­rolled through eHealth, an on­line bro­ker, be­tween Jan. 1 and March 23 were ages 18 to 34, a much higher per­cent­age than those en­rolling through the ex­changes.

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