A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere.
Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income.
In addition to the 40 percent of enrollees who move to Medi-Cal or job-based insurance, between 2 and 8 percent of those who sign up for Covered California are estimated to become uninsured, the analysis noted.
This process — “churn” to those who study health insurance — is well-known in the Medi-Cal and individual insurance market.
The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall.
In a statement in the Rose Garden, President Barack Obama, said, “The debate over repealing this law is over. The Affordable Care Act is here to stay.”
But he alluded to continuing political pressure from Republicans and other opponents of the law and acknowledged challenges still remain. Although the law is bringing coverage to millions of Americans, “that doesn’t mean that all the problems in health care are solved forever.”
White House Press Secretary Jay Carney broke the news of the enrollment tally at his daily press briefing, telling reporters that the last-minute surge of traffic to the website and the call center pushed enrollment to 7,041,000, a figure that does not include sign-ups in the past few days through state-based exchanges. Healthcare.gov is managing enrollment in 36 states, while 14 states and District of Columbia are running their own exchanges.
“What was predicted to be a failure has been a success … despite the fact that we basically lost two months because of the troubles with the website,” Carney said, adding later that “we crossed one milestone here but there are many more to cross in the future.”
Carney said it is still too early to know how many enrollees did not previously have health care coverage or how many have paid their first premium, although the “overwhelming majority” of people pay premiums on time, he said. Department of Health and Human Services Secretary Kathleen Sebelius said Monday in a television interview that insurance companies estimate that between 80 and 90 percent of enrollees have paid their premiums.
The Congressional Budget Office originally projected that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million. Rightly or wrongly, the ability of the law to hit that target had become a bellwether of the law’s success. But there are practical implications as well. The more enrollees there are, the more likely the risk pool will be balanced between sick and healthy individuals. That calculus will be based on enrollments at the state and local levels where premiums are set, say experts.
“Each state is its own insurance market, whether it uses the federal exchange system or not. These state differences could mean that the Obamacare exchanges are viable in some states and regions of the country, while in other states and regions the numbers remain too low to sustain a stable insurance pool,” James C. Capretta, a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute, wrote in a column published Tuesday in National Review Online.
Democrats hailed the 7 million tally. “Americans have spoken by the millions in their desire for more affordable, comprehensive health insurance,” said Rep. Sander Levin, D-Mich, the ranking member of the House Ways and Means Committee. “Insurance that can’t kick them off when they get sick. Insurance that can’t limit lifetime coverage. Insurance that doesn’t threaten to bankrupt their families when an illness strikes. The amount of interest in the insurance exchanges demonstrates that the reality experienced in health care reform refutes the Republican rhetoric to destroy it.”
House Speaker John Boehner, R-Ohio, said House Republicans would continue with their efforts to repeal the law. “The president’s health care law continues to wreak havoc on American families, small businesses and our economy, and as I’ve said many times, the problem was never just about the website – it’s the whole law,” Boehner said in a statement. “Millions of Americans are seeing their premiums rise, not the lower prices the president promised. Many small businesses are afraid to hire new workers, instead cutting hours and dropping health coverage for existing employees. Many Americans can no longer see their family doctor, despite the pledge no one would lose access to their physician.”
Capretta’s column expressed similar concerns. “The end result will be a reduction in the uninsured of some magnitude, that’s for sure,” he wrote. “But it was never going to be hard to reduce the uninsured if that was all that concerned policymakers. Massive public subsidies and expansion of free public-insurance programs can expand insurance enrollment, so long as others were willing to pay for it.”
Obama acknowledged the health law’s bumpy rollout and warned there may be more days ahead where the website isn’t working and said some parts of the law must be improved. A handful of Senate Democrats – including some facing tough re-election campaigns – have introduced legislation to change some elements of the law, including adding a less generous level of coverage that would be cheaper than those currently on the exchanges and making coverage optional for employers with up to 100 workers.
Addressing an audience that included key congressional Democrats and administration officials, Obama chided Republicans and other critics who have pushed for the law’s repeal without offering alternatives and urged them to work with him and Democrats to make changes. “Why are folks working so hard for people not to have health insurance?” Obama asked, adding later, “there are still no death panels. Armageddon has not arrived. Instead this law is helping millions of Americans and in the coming years it will help millions more.”
Last minute health insurance shoppers nationwide turned up in record numbers online Monday, and they also showed up in person at clinics, county health departments and libraries to sign up for Obamacare on the last official day of open enrollment. Here are dispatches from public radio reporters in Ohio, Pennsylvania and Houston — three of the 36 states that are using healthcare.gov — and Minnesota, which has one of the most troubled state-run marketplaces.
OBSTACLES IN CLEVELAND: A steady stream of people filed through the doors of the Neighborhood Family Practice, a free clinic on Cleveland’s near west side Monday, but Leah Pallant, an outreach and enrollment coordinator at the clinic expected many of them to leave without actually selecting a plan before the midnight deadline.
“The website is already in and out,” Pallant said. “The number of people on the website really made it difficult to keep working, because it basically just shuts you out entirely when they have too many visitors.”
Care coordinators constructed an inspirational billboard for folks signing up at the Neighborhood Family Practice (Photo by Sarah Jane Tribble/WCPN).
Federal officials said more than 1.2 million people from around the country had visited by noon Monday, and the site was handling as many as 125,000 people at a time. The site was down from about 3:20 a.m. until 9 a.m. for maintenance and then again later midday; at other points during the day it shunted people into a “virtual waiting room.”
Coordinators in Ohio and across the country encountered many of the same problems as people trying to sign up at home.
Pallant’s colleague, coordinator Jackie Mostow, was working with Cleveland resident Callie Williams. “We can try,” Mostow told Williams, “but what we might end up doing is trying to create an account and we’ll schedule you an appointment to come back.”
Williams, who hasn’t had insurance since the 1990s, said she is willing to wait a bit longer. “Just schedule me an appointment to come back,” she said.
Uninsured Californians flocked to shopping malls, beauty salons, clinics and libraries Monday to meet the deadline for enrolling in health coverage.
The website of the state-run insurance exchange, coveredca.com, was so inundated that officials directed some consumers who began online applications to return later to complete them.
The state was seeing a “huge surge” in last-minute applications, with more than 150,000 people signing up in the last week, Peter Lee, executive director of the exchange said Monday. More applications were started on Sunday than any other day since Oct. 1, when open enrollment began on the nation’s insurance exchanges.
By 5 p.m., the website had seen 420,000 unique visitors, slowing it down. “That volume of response is unprecedented,” Lee said.
Altogether, more than 1.2 million Californians have enrolled in health insurance through Covered California, according to Lee.
LAKEPORT, Calif.—When we last left Brad Stevens, he was living in Lakeport, Calif., a struggling massage therapist in a struggling town on the southern tip of Clear Lake. Brad has been uninsured his entire adult life and believed firmly that clean living and exercise could stave off any need for medical care. After a bike accident which injured his shoulder and a battle with advanced thyroid cancer, Brad was anxious to enroll in some form of insurance – any kind of insurance – under the Affordable Care Act.
“I talked to an insurance guy who is selling Obamcare and found out I don’t qualify,” Brad said last November. “What I’m going to get is Medi-Cal,” California’s Medicaid program.
Health insurance for Brad Stevens meant taking tons of vitamins and spending three hours at the gym every day. But after hurting his shoulder and a battle with thyroid cancer, the 59-year-old realized he’s not invincible (Photo by Heidi de Marco/KHN).
The insurance broker had warned Brad about long wait times, but when he called the toll-free line for Covered California, the state’s insurance marketplace, Brad said, “I waited four minutes. It was a piece of cake.” The operator didn’t offer to help him apply for Medi-Cal,but instead told Brad to call the social services office in Lake County. “It wasn’t a one-stop shop.”
When Brad finally called the county social services office on January 6, he was worried his two aging cars and the modest home he had bought long ago from his mother would count against him— a common concern. Sure enough, the forms that arrived in the mail asked for details about Brad’s bank account and any cars he owned. “So I called them back up and said, ‘You don’t need half of this stuff that you’re requesting.’ They said, ‘Yes, you’re right. That’s an old form. We haven’t switched over.’”
On January 23, Brad collected his records and made the half hour drive down to the county office. “They were really efficient at the office,” Brad said, sounding surprised. Of the county worker, “She was like, Boom! Boom! Boom! She’s been doing this ten years. I was just signing stuff.” The county worker told him to expect the Medi-Cal enrollment to take 45 days.
When we next talked on February 7, he was anxious to get his insurance card. He needed to refill his thyroid medication—Brad has no thyroid and relies on medication to keep his body functioning. His pharmacist told him that the company that makes his pills had raised the price from $12.99 to $68. “I’m down to 24 pills right now, so I’m counting them daily. If I haven’t gotten my [Medi-Cal] number before I’m out of pills, I’m going to call Walmart to find out what their price is.”
More than 6 million people have signed up for health insurance through the health law’s state and federal online marketplaces, or exchanges, since Oct. 1, the administration announced Thursday.
President Barack Obama, who is traveling in Europe, announced the number in a conference call with groups that are helping consumers sign up for coverage.
In a blog post, Centers for Medicare & Medicaid Administrator Marilyn Tavenner said the health law’s web site, healthcare.gov, and 800 number, had near record traffic Wednesday, with 1.5 million visitors and more than 430,000 phone calls.
“With 4 days left for consumers to sign up for coverage, we are working hard to ensure that our systems can handle the unprecedented demand as people enroll before the March 31 deadline,” Tavenner wrote.
The Congressional Budget Office originally estimated that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million. Federal officials have said they do not yet know how many people who have enrolled have paid their first month’s premium. Insurance industry officials have reported that about 70 to 80 percent of enrollees have paid.
Reaching 6 million has both practical and political significance. The more enrollees there are, the more likely the risk pool will be balanced between sick and healthy individuals. That calculus will be based on enrollments at the state and local levels where premiums are set, say experts. Republicans have expressed skepticism that the law would provide affordable coverage for millions of Americans and called for its repeal.
Americans have already qualified for about $10 billion in tax credits to help them purchase private health insurance this year through the Affordable Care Act, according to a study from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
That’s an average of $2,890 for each of the 3.5 million people who qualified for a subsidy as of March 1 — about 83 percent of those who enrolled in an exchange plan.
But four of five Americans who could qualify for a subsidy hadn’t applied for coverage by that date. And sign-up rates varied greatly by state. More than half of the subsidy money allotted so far will go to consumers in California, Florida, North Carolina, Texas and New York.
“States that are lagging in enrollment are leaving billions of dollars on the table that their residents qualify for,” said Larry Levitt, one of the study authors. In Hawaii, South Dakota, Iowa, New Mexico, North Dakota, Washington, D.C., and Oklahoma, for example, 10 percent or fewer of those eligible for tax credits signed up.
If all states had been able to enroll people at the rates of the five most successful states (Washington, Connecticut, California, Rhode Island and Vermont), where an average of 39 percent of those eligible signed up, another 3.1 million people would have qualified for an additional $8.6 billion in premium subsidies.
That money could provide a valuable infusion of cash that “not only has a benefit to individuals, but also to state economies as well,” Levitt said.
With less than a week left for customers to apply for insurance through the health care marketplaces, a poll released Wednesday finds that half of the people still without health coverage intend to remain uninsured.
Five million people have signed up for insurance since the marketplaces created by the federal health law opened in October. The official deadline to sign up without facing a financial penalty is March 31, although federal officials told news organizations Tuesday that consumers who begin the process before then and have had trouble with the technology will an extension of several weeks to finish the process. The Congressional Budget Office estimates by the year’s end, 6 million people will have obtained insurance on the marketplaces.
The Kaiser Family Foundation’s latest poll, conducted in mid-March, found that 50 percent of adults under age 65 who still lack coverage plan to remain without insurance, while 40 percent aim to sign up by the deadline at month’s end. (KHN is an editorially independent program of the foundation.) The other 10 percent said they did not know what they would do or refused to talk about it.
Of the uninsured, two out of three said they have not tried to get coverage yet. The rest said they attempted to get it through an online marketplace such as healthcare.gov, the state-federal Medicaid program, their employer or a private insurance company.
While Latino enrollment has lagged in California’s insurance marketplace, Asians have signed up in numbers outstripping their representation in the pool of eligible people. According to new Covered California data, the overwhelming majority of Chinese, Korean and Vietnamese enrollees are buying plans through certified insurance agents, as opposed to community groups or the Covered California website.
A Covered California brochure in Chinese.
There is no charge to consumers who work with agents, whose commissions are paid by insurance companies.
Since January, Asians have been enrolling in strong numbers. People of Asian descent make up about 14 percent of California’s eligible pool, according to estimates compiled by the UCLA Center for Health Policy Research and the UC Berkeley Labor Center. Asians reached that target straight out of the gate, making up 13.5 percent of all enrollees by January. They have surged from there. In the most recent data from Covered California, which comprised enrollment from Oct. 1 to Feb. 28, Asians made up 22.9 percent of all enrollees.
Licensed insurance brokers can sell customers plans on the Covered California marketplace, but they must first be specially certified to do so. Covered California says 40 percent of its total Covered California enrollments are coming via these certified insurance agents. But within certain Asian sub-populations, the percentage is much higher, Covered California says:
57 percent of Chinese enrollments are through certified insurance agents (CIAs)
65 percent of Vietnamese enrollments are through CIAs
70 percent of Korean enrollments are through CIAs
These numbers “suggest that the Asian agents are a driving force in helping Covered CA exceed our enrollment goal in Asian communities,” Wendy McAnelly, a public information officer for Covered California, said in an email.
This information was not a big surprise to Simon Chew. He runs Ehealth-Plans, an insurance business with four offices in San Francisco. All his agents are trilingual — in English, Mandarin and Cantonese. Chew estimates he’s signed up 2,000 people since the Covered California marketplace opened last October, and half of them were uninsured. He sees a difference between how Caucasians shop and how his clients — overwhelmingly Chinese Americans and Chinese immigrants — shop. While what he calls the “mainstream market” is comfortable purchasing insurance online, those of Chinese descent want to do business face-to-face, with someone of a similar background.
A new tier of coverage should be added to the health law’s online marketplaces, or exchanges, that would be less comprehensive than what plans are now required to offer, the head of the health insurance industry’s trade group said Sunday.
“I would create a lower tier, so that people could gradually get into the program, so they could be part of the risk pool, so we don’t hold the healthier people outside,” Karen Ignagni, president and CEO of American’s Health Insurance Plans, said in an interview on C-SPAN’s Newsmakers. “What I would do is give people more choices.”
Plans on and off the health law’s exchanges are required to cover a package of essential health benefits, including hospitalization, maternity and newborn care, pediatric care and prescription drugs. Ignagni said that some people who had not purchased that coverage before don’t want to do so now and want other choices. Requiring such comprehensive coverage may be “a bridge too far” for some people, she said.
The health law features four tiers of coverage – platinum, gold, silver and bronze – plus a catastrophic option open to people under 30, people who qualify for hardship exemptions and some people in the individual market whose plans were cancelled because they did not comply with the health law.
In the interview, Ignagni also said while the health law’s website, healthcare.gov, is working far better now for consumers than at its technologically troubled Oct. 1 launch, “much work remains” on the “back end” functions that insurers depend on to get information about enrollees and payment information.
“The whole finance package is left to be built. How do the plans receive their premium subsidies [from the federal government] for the individuals who are eligible for them and ultimately how do we reconcile with the exchange in terms of the people they think we have and the people we really have,” she said.