Tuesday, February 18, 2014

160,000 NC residents enrolled thru health exchange--so far

There's good news to report about the new individual health insurance exchanges that are now operating under the Affordable Care Act.

Nationally, just under 3.3 million people enrolled in individual insurance plans through the state- and federally-run exchanges during their first four months of operation, according to figures from the U.S. Department of Health and Human Services. In North Carolina, just over 160,000 people had selected an individual plan.

Although NC is 10th among states in population, it was 5th among states in private, individual health insurance enrollments during the first four months of the insurance exchanges. An additional 48,000 people were assessed as being eligible public insurance for Medicaid or the State Children's Health Insurance Program.

To put the figures in context, approximately 1.7 million North Carolinians lacked health insurance prior to the exchanges opening.

The high levels of enrollments aren't the only good news.

The plans are enrolling young people. Among NC enrollees, 25 percent were 18-34 years old; 17 percent were 35-44 years old; 22 percent were 45-54 years old; and 30 percent were 55 years old or older. The age distribution of NC enrollees is similar to the national age distribution.

The enrollment of young people is important to the sustainability of the private plans. The Kaiser Family Foundation has estimated that the plans would remain profitable so long as the proportion of 18-34 year-olds was at least 25 percent. As younger people are more likely to purchase insurance near the end of the open enrollment period than the beginning, the profitability threshold is likely to be met.

Also, an extraordinarily large proportion of NC enrollees--72 percent--have elected for coverage under a "silver" plan.

The exchange plans very in cost and coverage from the lowest-cost and most minimal coverage "catastrophic" plans through progressively higher cost and better coverage "bronze," "silver," "gold," and "platinum" plans. Nationally, 62 percent of enrollees opted for "silver" plans. Only about one-sixth of NC enrollees chose "catastrophic" or "bronze" plans, compared to one-fifth of enrollees nationally.

The ACA mandated minimum standards for health insurance plans, including coverage for prescription drugs, coverage for maternity care, requirements to insure people with pre-existing conditions, and annual caps on out-of-pocket expenses. These mandates led to the cancellation of many bare-bones plans. The logical choice for people who truly prefer bare-bones plans would be one of the "catastrophic" or "bronze" plans. The fact that so few have chosen these plans suggests either that the number of cancelled plans was more modest than originally thought or that people preferred and are now able to obtain better coverage than they could under the old system or possibly both.

The high levels of enrollments also come despite constant disparagement from the state's elected officials, despite the lack of state cooperation in establishing or running the health insurance exchange, and despite exchange plans that offer fewer choices and higher costs than the national average (due in no small part to the lack of state cooperation).

All-in-all, the enrollments suggest that there was substantial pent-up and unmet demand for health insurance in the state prior to the implementation of the ACA. Politicians who would return North Carolinians to that regime would cause tremendous harm.


polifrog said...

"To put the figures in context, approximately 1.7 million North Carolinians lacked health insurance prior to the exchanges opening."

Is that context?

How many of the referenced 160k enrolled thus far had insurance prior to being kicked off their preferred individual plan by the ACA?

Although the data is scarce indications are that 90% of those enrolled in the ACA had insurance prior to being forced out.

How many have paid for this insurance? Enrollment is not the same as a paying customer. According to insurance Co. data 20% have not paid.

So we can lower your 160k by 20% leaving 128K truly enrolled. Of those 10% did not previously have insurance, about 13 thousand.

The number of North Carolinians who have lost their insurance due to the ACA? 473,000.

To sum up:
Since the ACA has kicked off:
== 473,000 have lost their insurance due to the ACA.
== 115,220 of those then bought insurance through the ACA exchange.
== And almost 13,000 once uninsured gained insurance.

That means 345000 more North Carolinians are without insurance since the ACA kicked off.

This does not even include the pain of those demoted to part time work or fired altogether due to the ACA.

The ACA is hurting North Carolinians.

Dave Ribar said...


You raise a good point that the 160,000 into the exchange policies and 48,000 into Medicaid are flows but that we don't know the exact sources into those flows.

However, your conclusion that "345,000 more NC residents are without insurance" seems far-fetched, especially in light of national Gallup polling data that indicate that insurance coverage has increased substantially over the last few months, not decreased.

Also, there's no evidence that any appreciable portion of the 473,000 NC residents who received notices over the summer ever went without insurance.

First, it's hard to find support for the 473,000 number (the number was used by NC Ins. Comm. Wayne Goodwin, but his office won't confirm the number). Second, nearly all the people who received those notices were offered other policies by their original insurers. Third, most of those people were also offered their original bare-bones policies in November.

In addition, the exchanges aren't the only way to purchase individual insurance. For example, insurance can be purchased directly through BCBS and through private exchanges. The 160,000 enrollees represent a portion of the flow but not the whole flow into individual coverage.

polifrog said...

"Also, there's no evidence that any appreciable portion of the 473,000 NC residents who received notices over the summer ever went without insurance."

Fair point, Dave. And one I had not considered.