Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020 Donna - - PowerPoint PPT Presentation

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Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020 Donna - - PowerPoint PPT Presentation

Feb 08, 2023 220 likes •474 views

Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020 Donna Friedsam October 2019 ACA Plan Selections for Plan Year 2019 Plan Selections As of 12/15/ 2018 Total Consumers Selecting Plans 205,118 Consumers with APTC 176,908 (86%)

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Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020

Donna Friedsam October 2019

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SLIDE 2

ACA Plan Selections for Plan Year 2019

Plan Selections As of 12/15/ 2018 Total Consumers Selecting Plans 205,118 Consumers with APTC 176,908 (86%) Consumers with CSRs 86,060 (42%) Average Premium statewide (before APTCs) $700 Average Premium statewide (after APTCs) $161 Average APTC among consumers receiving APTCs $625 Average Premium for Consumers receiving APTC $97

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Plan Selections: Open Enrollment Trend 2016-19

Open Enrollment Plan Year (Enrollment Period Length) Number of Plan Selections OE 2017 (12 weeks) 242,863 OE 2018 (6 weeks) 225,435 OE 2019 (6 weeks) 205,118 2019 ACA Plans Effectuated Coverage Number

  • f Plan

Selections Percent of Plan Selections Effectuating Coverage through February 2019 193,303 94% Consumers with Premium Subsidies (APTCs) 171,386 89% Consumers with Cost-Sharing Reductions (CSRs) 82,745 43%

  • Effectuated enrollment refers to those consumers who pay select a plan and pay

their first month premium to activate their coverage.

  • In 2019, 94% of Wisconsin consumers who selected an ACA Marketplace plan went
  • n to effectuate their enrollment, resulting in 193,303 actual plan enrollments in

February 2019.

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ACA Marketplace Plan Selections during open enrollment have decreased statewide during the past two years, with the pull back of federal resources, reduction in weeks available, and other factors.

OE 2014-15 OE 2015-16 OE 2016-17 OE 2017-18 OE 2018-19 Wisconsin QHP Selections 207,340 239,034 242,863 225,435 205,118 207,340 239,034 242,863 225,435 205,118 180,000 190,000 200,000 210,000 220,000 230,000 240,000 250,000

Wisconsin QHP Selections

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63,439 69,320 62,773 53,554 46,353 52,805 59,759 52,553 47,659 43,161 31,405 38,245 35,519 34,305 32,581 19,697 26,294 23,568 22,860 21,933 23,069 33,465 33,052 38,121 38,783

  • 10,000

20,000 30,000 40,000 50,000 60,000 70,000 80,000 2015 2016 2017 2018 2019

Trend in Plan Selections by Income Group

≥100% -≤150% FPL >150% -≤200% FPL >200% - ≤250% FPL >250% - ≤300% FPL >300% - ≤400% FPL

The decreases have

  • ccurred predominantly

among the lowest income groups, while the number

  • f consumers with

incomes over 200% FPL has increased.

Net Change ≥100% - ≤150% FPL Net Change >150% - ≤200% FPL Net Change >200% - ≤250% FPL Net Change >250% - ≤300% FPL Net Change >300% - ≤400% FPL Net Change Other FPL Net Change Total 2015-19 (17,086) (9,644) 1,176 2,236 15,714 5,382 (2,222) % change

  • 27%
  • 18%

4% 11% 68% 32%

  • 1%
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SLIDE 6

30.6% 29.0% 25.8% 26.1% 22.6% 25.5% 25.0% 21.6% 23.2% 21.0% 15.1% 16.0% 14.6% 16.7% 15.9% 9.5% 11.0% 9.7% 11.1% 10.7% 11.1% 14.0% 13.6% 18.6% 18.9% 8.2% 5.0% 14.6% 4.2% 10.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2015 2016 2017 2018 2019

Plan Selections by Income Range, 2015-2019

Other FPL >300% - ≤400% FPL >250% - ≤300% FPL >200% - ≤250% FPL >150% -≤200% FPL ≥100% -≤150% FPL

  • Lowest income range consumers (100-150% FPL) account for a declining

proportion of Marketplace consumers.

  • Consumers with incomes >200% FPL account for an increasing share of

Marketplace plans, with consumers in the 300-400% FPL range increasing the most.

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226,060 131,446 19,172 148,007 101,709 112,444 50,000 100,000 150,000 200,000 250,000 Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

Adult BadgerCare and SSI-Medicaid Trend, 2013-2019

Parents/Caretakers Childless Adults SSI

  • Adult enrollment in BadgerCare and SSI-Medicaid has remained flat or declined

since 2017.

  • The decline in ACA Marketplace enrollment by lower income adults in 2017-2019

was not balanced out by any increases in BadgerCare or SSI-Medicaid enrollment.

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SLIDE 8
  • The proportion of re-enrollees has

increased steadily and substantially.

  • Many re-enrollees continue to rely on

active reenrollment, rather than relying

  • n automatic processes.
  • This reflects the need to re-assess

available plans, premiums, and available subsidies every year.

44.2% 38.0% 26.3% 21.4% 19.1% 55.8% 54.1% 73.7% 62.2% 80.9% 0% 20% 40% 60% 80% 100% 2015 2016 2017 2018 2019

New Consumers and Re-enrollees: Trend 2015-2019

New Consumers Re-enrollees 74.2% 73.7% 71.6% 67.5% 54.0% 25.8% 26.3% 28.4% 32.5% 46.0% 0% 20% 40% 60% 80% 100% 2015 2016 2017 2018 2019

Re-enrollees: Active and Automatic, 2015-2019

Active Re-enrollees Automatic Re-enrollees

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SLIDE 9

New Consumers 19% Active Re-enrollees 74% Automatic Re- enrollees 26% Re-enrollees 81%

Plan Selections, New and Re-enrollments, Plan Year 2019

Active Re-enrollees who Switched Plans Active Re-enrollees who Remained in the Same Plan or a Crosswalked Plan PlanYear 2018 81.7% 18.3% Plan Year 2019 41.0% 59.0%

  • Over 80% of Re-enrollees for Plan Year 2018 switched plans, while for 2019 plan

switching declined to about 41%.

  • This likely reflects the 2017 federal change in CSR policy and the initiation of

silver-loading for Plan Year 2018, along with the departure of some QHPs from the market for Plan Year 2018.

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Catastrophic 0.9% Bronze 35.8% Silver 49.3% Gold 13.8% Platinum 0.2%

Plan Selections by Metal Level, Plan Year 2019

≥100% -≤150% FPL 22% >150% -≤200% FPL 21% >200% - ≤250% FPL 16% >250% - ≤300% FPL 11% >300% - ≤400% FPL 19% Other FPL 11%

Plan Selections by Income Level, Plan Year 2019

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58.5% 54.0% 51.1% 43.5% 42.0% 0.0% 20.0% 40.0% 60.0% 80.0% 2015 2016 2017 2018 2019

Consumers with CSR

Consistent with the changing income composition

  • f Marketplace consumers, a declining proportion

qualify for Cost-Sharing Reductions (CSRs), which require income <250% FPL.

  • With the decline in CSR-

linked consumers, an increasing proportion of consumers select bronze and gold plans, while a decreasing proportion select silver plans.

  • This trend also likely reflects

the effect of silver loading in premiums after 2017, and the ability of consumers to apply their APTCs to other metal levels.

22.7% 23.5% 27.0% 33.4% 35.8% 70.5% 70.6% 68.3% 54.1% 49.3% 4.3% 4.6% 0.0% 11.4% 13.8% 0% 20% 40% 60% 80% 100% 2015 2016 2017 2018 2019

Plan Selections by Metal Level, 2015-2019

Bronze Silver Gold

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Age < 18 6% Age 18-25 8% Age 26-34 15% Age 35-44 15% Age 45-54 18% Age 55-64 38%

Plan Selections by Age, Plan Year 2019

For the 2019 plan year, 23% of consumers selecting plans statewide are in the 18- 34 year age range.

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SLIDE 13

3.6% 7.0% 6.8% 6.3% 6.1% 8.8% 9.0% 8.7% 8.2% 7.7% 17.0% 17.0% 16.3% 15.9% 15.5% 15.2% 14.0% 14.2% 14.3% 14.5% 21.1% 20.0% 19.3% 18.6% 17.9% 31.8% 33.0% 34.4% 36.2% 38.1% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% 2015 2016 2017 2018 2019

Plan Selections by Age Group, 2015-2019

Age < 18 Age 18-25 Age 26-34 Age 35-44 Age 45-54 Age 55-64

Consumers in the 55-64 age range account for an increasing share of ACA Marketplace plan selections.

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Uninsured in 2013 and 2017: Before and After the ACA Took Effect

  • About 5.4% of residents were uninsured in 2017, down from 9.1% in 2013.
  • Persons without insurance decreased by about 207,877 people, a reduction of

about 40%.

  • Decreases in the number of uninsured people occurred across all income levels.

207,125 97,420 93,195 59,086 213,232 149,169

100000 200000 300000 400000 500000 600000

Wisconsin Uninsured 2013 and 2017, Residents for Whom Poverty Status is Determined ≥200% FPL 138-199% FPL <138% FPL

2013 2017

Total 513,552 Total 305,675

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SLIDE 15

<100% FPL, 19.6% 100-199% FPL, 31.6% 200-299% FPL, 23.1% ≥ 300% FPL, 25.7%

Who is Still Uninsured?: Wisconsin Residents who Remained Uninsured, ACS 2017

Children under the age of 19 make up about 17% of the remaining uninsured, with an estimated 52,599 in that age range remaining uninsured inWisconsin as of 2016.

Total Number of Uninsured Individuals, By Age

Persons 100-199% FPL most likely to be uninsured: 21.1% compared to 2.5% for persons >300% FPL, and account for 32% of all uninsured Wisconsin residents.

Under 19 years, 52,599 19-64, 253,092 65 years and

  • lder, 3,713

But persons above 200% FPL account for nearly half (49%) of all uninsured persons in Wisconsin.

18.9% 21.1% 7.6% 2.5% 5.4%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

<100% FPL 100-199% FPL200-299% FPL ≥ 300% FPL Total Uninsured

Total Number of Uninsured Individuals, By Income

59,912 70,611 305,675 96,593 78.558

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Where are the remaining uninsured?

https://medicaidpolicy.wiscweb.wisc.edu/data- resources/

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Number of insurance carriers

  • ffering plans in

Wisconsin, by county, for 2020 through the ACA Marketplace

1 2 3 4 5 6

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Insurers Offering Plans, 2020 Aspirus Arise Children’s Community Health Common Ground Dean Health Plan Group Health Coop of SCW Health Partners Medica MercyCare Molina Network Health Security Health Quartz WPS

Number of Counties by Number of Insurers

  • ffering Plans through the ACA Marketplace
  • 45 Wisconsin counties have at least three insurance carriers offering ACA plans.
  • 24 Wisconsin counties have two carriers offering ACA plans
  • 3 counties have only one insurance carrier offering ACA plans
  • These counties also have off-Marketplace carrier options.

11 34 20 4 3 3 24 19 19 5 2

5 10 15 20 25 30 35 40

1 insurer 2 insurers 3 insurers 4 insurers 5 insurers 6 insurers Number of Counties

Number of Counties by Number of Insurers Offering Plans through the ACA Marketplace, Plans Years 2019 and 2020

Number of counties 2019 Number of counties 2020

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$261 $302 $464 $440 $240 $301 $412 $406 $- $50 $100 $150 $200 $250 $300 $350 $400 $450 $500

2016 2017 2018 2019 Premium Trend, Benchmark Plan, 2016-2019 Wisconsin U.S.

15.7% 53.6%

  • 5.2%

25.4% 36.9%

  • 1.5%
  • 10.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

2016-17 2017-18 2018-19

Annual Premium Rate Changes, Benchmark Plan, 2016-2019 Wisconsin U.S.

Wisconsin’s average ACA Marketplace health plan rates have been slightly higher than the national average, and have followed the national trend over time. For the 2019 plan year, the premium rate changes declined substantially in Wisconsin and

  • nationally. Wisconsin’s rates

increased more than the national average in 2017-18, and are now decreasing slightly more than the national rate of decrease for 2019. Benchmark Plan = Second- Lowest Cost Silver Plan

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Rate Filings, Exchange Plan Filings, Plan Year 2020, Wisconsin Company Name Requested Rate Change Current Range of Rate Change Aspirus Arise Health Plan of Wisconsin, Inc. 0.44%

  • 1.58% to 3.65%

Children's Community Health Plan

  • 16.78%
  • 19.02% to -12.49%

Common Ground Healthcare Cooperative

  • 9.35%
  • 10.47% to -3.87%

Dean Health Plan 7.59%

  • 5.87% to 17.09%

Group Health Cooperative of South Central Wisconsin

  • 4.41%
  • 8.27% to -2.07%

HealthPartners Insurance Company

  • 9.56%
  • 11.08% to -7.97%

Medica Health Plans of Wisconsin

  • 12.22%
  • 18.46% to -1.59%

MercyCare HMO, Inc. 5.97%

  • 22.99% to 21.31%

Molina Healthcare of Wisconsin, Inc.

  • 9.86%
  • 16.32% to -9.54%

Network Health Plan

  • 7.45%
  • 9.59% to -0.85%

Quartz Health Benefit Plans Corporation

  • 1.32%
  • 9.35% to 9.03%

Security Health Plan of Wisconsin, Inc. 4.69%

  • 2.62% to 12.80%

WPS Health Plan, Inc.

  • 1.41%
  • 2.30% to -0.81%
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https://oci.wi.gov/Pages/Consumers/FindHealthInsurer.aspx

https://oci.wi.gov/Pages/Consumers/FindHealthInsurer.aspx

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What happening at the federal level?

  • Texas v U.S.; other litigation (AHP, STLD plans, risk

corridors)

  • Waivers and court challenges:

– work requirements – blocked in Arkansas, Kentucky, and New Hampshire, moving forward elsewhere – block grants –Tennessee newest proposal – partial expansion – turned down for Utah

  • Public charge rule
  • Debates related to the 2020 Presidential campaign

– Public option – M4A

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Contact me

Donna Friedsam Distinguished Researcher | Health Policy Programs Director Institute for Research on Poverty (IRP) University of Wisconsin - Madison dafriedsam@wisc.edu | v. 608.265.9377 Twitter @DonnaFriedsam