State-based Health Insurance Marketplace Performance September - - PowerPoint PPT Presentation

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State-based Health Insurance Marketplace Performance September - - PowerPoint PPT Presentation

Oct 15, 2023 474 likes •605 views

State-based Health Insurance Marketplace Performance September 2019 Current Marketplace Models WA M MT ND E OR VT NH MN ID MA NY WI SD MI WY CT RI PA IA NE NJ NV OH IL IN DE UT CO MD CA WV VA KS KY MO DC TN

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SLIDE 1

State-based Health Insurance Marketplace Performance

September 2019

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SLIDE 2

Current Marketplace Models

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State-based marketplaces (SBM) (13) State SBMs using the federal platform (SBM-FP) (1) FFM transitioning to SBM (1) FFM with a State SHOP (2) States using the federally facilitated marketplace (FFM) (29) SBM-FP transitioning to SBM (3) SBM-FP, exploring transitioning to SBM (1) SBM-FP with a state SHOP (1)

NH MA NJ CT RI DE VT DC MD PA FL GA SC KY IN OH MI TN MS AL MO IL IA LA AR OK NE ND SD HI MT WY UT AK AZ NM ID CA NV WV M E VA NC NY TX CO KS MN WI WA OR

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SLIDE 3

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Authority over key marketplace functions, by model

Marketplace Function SBM SBM-FP FFM Plan Management Set/collect assessments State Both Federal Qualified health plan review and certification State State Both Outreach and Marketing Navigator program State State Federal Advertising State State Federal Agents/brokers State State Federal IT/Operations Integrated eligibility system State Federal Federal Application State Federal Federal Online tools (e.g., calculators) State Federal Federal Call center State Federal Federal Set special enrollment periods Both Federal Federal

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SLIDE 4

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State-based marketplace (SBM) enrollment holds steady

CMS Marketplace Open Enrollment Period Public Use Files, 2016-2019, available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/Marketplace-Products/index.html; ASPE Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report https://aspe.hhs.gov/pdf-report/health- insurance-marketplace-2015-open-enrollment-period-march-enrollment-report; Health Insurance Marketplace Summary Enrollment Report for the Initial Annual Open Enrollment Period https://aspe.hhs.gov/pdf-report/health-insurance-marketplace-summary-enrollment-report-initial-annual-open-enrollment-period

Since 2016, enrollment has remained steady in SBM states.

  • SBM enrollment grew marginally

from 2018 to 2019

  • Enrollment in the FFM dropped by

3.7% in 2019.

2 4 6 8 10 12 14 2014 2015 2016 2017 2018 2019 Millions

Health Insurance Marketplace Enrollment (Plan Selections) 2014-19

All states (51) SBM (17) FFM (34)

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SLIDE 5

SBM states have had greater success in reducing the number of uninsured

10.6% 7.1% 6.4% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 2013 2014 2015 2016 2017 2018

Average Uninsured Rate 2013-2018

FFM (no Medicaid expansion) FFM (Medicaid expansion) SBM

  • SBM states have seen a 50.5%

reduction in their total number of uninsured since 2013—compared with a 30.4% reduction in FFM states.

  • Since 2016, the number of

uninsured has risen by 6.1% in FFM

  • states. SBM states have held steady

with an increase of only 0.5%

Data from United State Census Bureau. Reports available at: https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf; https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf

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SLIDE 6

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SBMs target younger enrollees

  • SBMs have tailored efforts, including

marketing and outreach strategies, to engage younger enrollees.

  • Younger enrollees, considered healthy and

lower-cost, are essential to maintain a good risk mix and lower overall premiums.

  • Total enrollment among young enrollees

has risen by 11.5% in SBM states, while dropping by 11.3% in FFM states.

Enrollment Is measured by plan selections. State-by-state data by age is unavailable for 2014; calculations for 2015 based on plan selections with available data on enrollment type. CMS Marketplace Open Enrollment Period Public Use Files, 2016-2019, available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/Marketplace-Products/index.html; ASPE Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report https://aspe.hhs.gov/pdf-report/health- insurance-marketplace-2015-open-enrollment-period-march-enrollment-report

  • 4.7%
  • 11.3%

11.5%

  • 15.0%
  • 10.0%
  • 5.0%

0.0% 5.0% 10.0% 15.0% All States FFM SBM

% Change in Total Enrollment Among Individuals Ages 0-34, 2015-19

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SLIDE 7

SBMs curb premium growth

Average benchmark premiums as analyzed by the Kaiser Family Foundation and weighted based on total marketplace enrollment. Data adapted from: https://www.kff.org/health- reform/state-indicator/marketplace-average-benchmark-premiums/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

$0.00 $100.00 $200.00 $300.00 $400.00 $500.00 2014 2015 2016 2017 2018 2019

Average Benchmark Premiums 2014-2019

FFM SBM

87 % growth 47 % growth

  • Premiums spiked from 2016 to 2018

driven in part by market uncertainty caused by:

  • Elimination of cost-sharing

reduction payments;

  • Conclusion of the federal

reinsurance program;

  • Uncertainty over the future of

the individual mandate;

  • Reduction in federal outreach

and marketing dollars; and

  • Instability driven by anticipated

expansion of short-term and association health plans.

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SLIDE 8

Rising premiums reduce unsubsidized enrollment

$200 $250 $300 $350 $400 $450 $500 $550 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000 2014 2015 2016 2017 2018 Average Premiums Unsubsidized enrollments

Unsubsidized Individual Market Enrollment and Change in Average Premiums

Enrollment Average 1st Quarter Premiums

  • Unsubsidized populations

include individuals earning 400%+ of FPL who do not qualify for financial assistance.

  • High premiums and out-of-

pocket costs pose a significant barrier to retaining unsubsidized populations.

Enrollment data does not include Massachusetts and Vermont; small group and individual insurance markets are merged in these states. Center for Medicare and Medicaid Services Enrollment Data available at: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Trends-Subsidized-Unsubsidized-Enrollment-BY17-18.pdf; Average premiums data from the Kaiser Family Foundation: https://www.kff.org/private-insurance/issue-brief/individual-insurance-market-performance-in-early-2019/

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SLIDE 9

SBM states enroll a greater proportion of unsubsidized individuals in coverage

Center for Medicare and Medicaid Services Data available at: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Trends-Subsidized- Unsubsidized-Enrollment-BY17-18.pdf Data not available from Massachusetts and Vermont; small group and individual insurance markets are merged in these states. Massachusetts officials report that enrollment for unsubsidized individuals has grown every year since 2014.

Subsidized and Unsubsidized Individual Market Enrollment, 2014-2018

  • SBM states actively engage

consumers to find the most affordable options—even if sold

  • utside of the marketplace.
  • State decisions to “silver-load” as a

result of termination of CSR payments has led to the availability

  • f more affordable options off-

exchange for some unsubsidized populations.

1 2 3 4 5 6 7 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 Subsidized Unsubsidized Millions

FFM States

1 2 3 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 Subsidized Unsubsidized Millions

SBM States

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SLIDE 10

$0.00 $50.00 $100.00 $150.00 $200.00 $250.00 $300.00 $350.00 $400.00 $450.00 $500.00 States that have not enacted a reinsurance program States that have enacted reinsurance programs

Benchmark Premium Growth in States Since Elimination of the Federal Reinsurance Program

2016 2019

Withdrawal of federal reinsurance in 2016 impacted premiums

Average benchmark premiums as analyzed by the Kaiser Family Foundation and weighted based on total marketplace enrollment. Data adapted from: https://www.kff.org/health- reform/state-indicator/marketplace-average-benchmark-premiums/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

  • 2016 marked the last year of the

federal reinsurance program, since then premiums have jumped significantly, especially those without a reinsurance program.

  • States that have passed reinsurance

programs have significantly mitigated premium growth, but reinsurance is financially challenging for most states

  • Six states implemented

reinsurance programs in 2019 (AK, MN, ME, NJ, MD, WI)

  • Five states will implement

reinsurance programs in the 2020 plan year (CO, DE, MT, ND, RI)

63 % growth 36 % growth

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SLIDE 11

State actions to improve qualified health plan affordability and choice

  • Reinsurance programs (AK, CO, DE, MD, ME, MN, MT, ND, NJ, OR, RI,

WI)

  • Additional state subsidies (CA, MA, VT)
  • State individual mandate (CA, DC, MA, NJ, RI, VT)
  • Regulation of short-term plans (CA, CO, CT, DC, DE, HI, IL, MA, MD,

MI, MN, ND, NH, MN, NM, NV, NJ, NY, OR, SC, SD, VA, VT, WA, WY)

  • Limitation or prohibition of association health plans (AK, CA, CT, DC,

IA, IN, KS, MA, MD, MI, NY, OR, PA, RI, VA, VT, WA)

  • Extended open enrollment period (CA, CO, CT, DC, MA, MN, NY, RI)
  • Public option (WA)