Health Reform WK-EDGE Enrollment figures not drastically different from 2017, many state-specific factors,
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Thursday, June 28, 2018

Enrollment figures not drastically different from 2017, many state-specific factors,

By Kelly J. Rooney, J.D., M.P.H.

Despite the drive during 2017 to repeal and replace the Affordable Care Act (ACA), enrollment in the ACA’s marketplace coverage did not change drastically overall between 2017 and 2018; there was a drop of only 3.8 percent. In fact, while most states experiences declines, 15 states saw an increase in enrollment. The Urban Institute, with support from the Robert Wood Johnson Foundation, has been tracking the implementation and effects of health reform since 2011. It looked to identify the reasons for the increased enrollment in 2018 in Rhode Island, Washington, and New York, as well as what attributed to the lowest enrollment figures coming out of West Virginia and Louisiana. Key factors influencing marketplace enrollment were found to be: 1) prices compared to non-marketplace plans; (2) size of premium tax credits; (3) advertising; (4) use of social media; (5) news coverage; and (6) length of enrollment period.

Interview findings. The Urban Institute interviewed some stakeholders in states that experienced high highest increases and the lowest drops in enrollment about the factors affecting their enrollment levels.

  1. Rhode Island had a 12 percent increase in marketplace enrollment for the 2018 plan year. The state’s stakeholders cited a longer enrollment period than the federal period, active social media efforts, improvements to the marketplace’s IT platform which eliminated glitches; and that navigators allowed consumers to schedule appointments for enrollment assistance as reasons for the higher figures. In addition, the state "silver-loaded" the cost-sharing reduction (CSR) payments, meaning that insurers added the costs of providing CSRs to enrollees into the premiums for silver-tier plans.
  2. Washington had an increase of 8 percent. Similar to Rhode Island, Washington stakeholders cited silver-loading, increased social media and outreach efforts, and the state’s insurance commissioner encouraging marketplace enrollment for that state’s success. The most cited explanation, however, was the elimination of many counties’ off-marketplace offerings, so that consumers in many cases had to choice but to enroll in marketplace plans.
  3. New York saw an increase of 4 percent from 2017 to 2018. New York stakeholders mentioned that the marketplace issued clear messaging to consumers noting affordability of the plans and clearing up confusion, as well as other strategies undertaken to drive up enrollment from the state level. Despite there being federal efforts to eliminate the ACA, the state had an outspoken governor touting support of the New York marketplace.
  4. West Virginia had a decrease in enrollment of 19.5 percent. Stakeholders explained that the cost of CSRs were added to all tiers so there were premium increases for most enrollees. There was a shorter enrollment period than in previous years and confusion and uncertainty around the ACA in the state. Consumers may have been misled by short-term and limited benefits plans that were aggressively marketed at the same time as marketplace plans.
  5. Louisiana had a drop of 23.5 percent. That state had minimal advertising, less assistance available to help enrollees, and, like in West Virginia, confusion and uncertainty around the ACA. Stakeholders also cited the mid-2016 Medicaid eligibility expansion, which was well-publicized, as a driver in lower marketplace enrollment.

Looking to 2019 plan year. The government’s proposal to permit less comprehensive, short-term plans to be offered is the biggest threat to premium amounts and marketplace offerings. Enrollment for 2019 could also be affected by the relief from the requirement for marketplaces to have at least two navigators and for the navigators to have a physical presence in the location; as well as the repeal of the individual mandate which takes effect in 2019.

Companies: Urban Institute; Robert Wood Johnson Foundation

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