July | August 2017






Health Care Enrollees Spread across all States

By Debra Miller, CSG Director of Health Policy
When the open enrollment period for new health insurance under the Affordable Care Act ended April 19, 8 million Americans had signed up for private insurance plans. The final number exceeded by 1 million the original projections of the Congressional Budget Office.
“The 8 million number was important politically and publicly because the CBO’s 7 million estimate was the target,” said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. “Eight million, in spite of the near-disastrous rollout in October, reflects the need for health insurance. When you offer more affordable and available coverage, people will sign up.”
State-by-state numbers bear this out.
According to U.S. Department of Health and Human Services data released last week, state tallies ranged from 1.4 million in California, a state that ran its own health insurance exchange, to 11,970 in Wyoming, where residents used the federally run exchange.
The District of Columbia and the 14 states that opted to operate their own exchanges accounted for 32 percent of those who selected a plan through the health insurance exchanges.
A separate report from DHHS released May 1 announced 4.8 million new Medicaid enrollees during the open enrollment period. This includes states that have expanded Medicaid eligibility to 138 percent of the federal poverty levels and states that have not.
“Even in states without expansion, people previously eligible didn’t always know that. There were also barriers to enrollment. The ACA requires all states to streamline and simplify the application process,” Tolbert said.
Matt Salo, executive director of the National Association of Medicaid Directors, told CSG signups for Medicaid will continue throughout the year. “We don’t have an open enrollment period,” he said.
Salo said Medicaid programs can handle the new enrollees.
“It’s really only a 10 percent or so increase,” he said. “It won’t necessarily be easy, but it can be done. One of the challenges includes ensuring access for primary care and specialty care. Some of this can be dealt with by increasing payment rates, but in many cases, states will have to look at scope of practice laws, minute clinics (like those in retail stores) and other approaches.”
In most of the 27 states plus the District of Columbia that are expanding their Medicaid programs, Salo said, “the expansion will be met by managed care, (and) the real issue is, are managed care plans ready for the influx and have they appropriately prepared for the changing case mix?”
Tolbert acknowledged the concern of whether the newly insured, whether through private plans or through Medicaid, will be able to get care. But, she said, “We won’t know the answer until people try to access care. We do know that capacity is uneven.”
Looking to the future, Salo predicted more states will expand Medicaid.
“Arkansas, Michigan and Iowa all expanded (Medicaid) this year. New Hampshire is next. Pennsylvania is likely soon. Others are getting closer,” Salo said. “Most states, however, will have to wait until after the November elections to even debate the issue, so we’re looking at mid to late 2015 at the earliest.”
Tolbert said Kaiser’s analysis indicates there would not be a death spiral in premium prices during the next open enrollment period as many have predicted. While 28 percent of the newly insured are what she called coveted young adults, the health status of those in the new pool is more important than age.
She also said the growing number of people with health insurance will help improve the state of America’s health in the long run.
“We know that health insurance matters. It matters to whether and when people access care. They are more likely to go to a provider, to be diagnosed earlier and to be appropriately treated,” Tolbert said.



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