ACA Open Enrollment #1 in the Books

by Spilman Thomas & Battle, PLLC
Contact

With the first annual Affordable Care Act open enrollment in the books (although the end of open enrollment is still something of a moving target – more on that later), everyone is examining, discussing, applauding and challenging the numbers. And there are a lot of numbers to consider: How many people signed up for health insurance coverage during open enrollment? How many of them went into Medicaid? How many of them are young, healthy people vs. older, less healthy people? How many of them either have paid, or will pay, the premium needed to actually obtain the coverage? How many of those who signed up were previously uninsured? And the list goes on and on.
 
Issues and opinions abound about what the numbers really mean, but the announcement from the White House on April 1 is that at least 7.1 million people have signed up for health insurance through the exchanges, meeting the goal set months ago by the administration. As we all recall, the open enrollment road started out particularly bumpy on October 1, 2013, with the HealthCare.gov website unable to fulfill its promise of a smoothly operating insurance marketplace. The technical problems caused a significant delay and required many repairs and changes to the website. It was not until December 2013 that substantial numbers of users could shop for and buy insurance on the federal website without lengthy wait times and other problems. And even after the consumer experience began to improve, insurers expressed concern that the information they were receiving about enrollees was inaccurate or duplicative as a result of the federal system’s administrative deficiencies. The fact that the enrollment goal might have been reached is, therefore, noteworthy.
 
But what do the numbers mean? First, most agree that it will take some time before we really know how effective the many provisions of the ACA have been when it comes to insuring the previously uninsured and what the cost to the country is for that coverage. The numbers show many people who have gained coverage for health care services in the past few months are in state Medicaid programs. Twenty-eight jurisdictions have or are planning to expand their Medicaid programs in some fashion under the ACA. In addition, the efforts to reach out to that “expansion population” have resulted, to a degree, in more people coming into the traditional Medicaid program (the so-called “woodwork effect”). In West Virginia, well over 90,000 people have been enrolled in the expanded Medicaid program. The long-term implications of adding more people to the Medicaid rolls is a concern at the state level when it comes to budgets and trust in the federal government to meet its significant matching obligations to fund those programs under the ACA. In addition, while the law is called the “Affordable” Care Act, many would point out that the care itself is no more affordable than it ever was; the difference is that we now subsidize premiums for lower-income people with taxes and penalties collected under the new law. Data analysis through mid-March for West Virginia shows that 86 percent of people who enrolled through the exchange did so with the help of subsidies. While there are initiatives imbedded in the ACA to reduce the cost of medical services over time, the results are not immediately ascertainable.
 
There is much debate right now about how many of the 7.1 million people were previously uninsured, or whether they were just moved from one form of coverage to another. In West Virginia, Highmark (the only carrier offering products on the exchange in the state) announced that a total of 20,131 people have purchased ACA-compliant plans, with 14,839 through the exchange and 5,292 buying directly from Highmark. The company also said 63 percent of the total number were new members, meaning they were either previously uninsured or were insured with a different carrier. There is also a great deal of debate about how many of the 7.1 million have paid premiums, and whether this calls into question the accuracy of that number. After all, if premiums are not paid the coverage will not be issued. Highmark’s announcement acknowledges that not every enrollee has paid the first month’s premium. To be fair, those who signed up towards the end of open enrollment will not have a payment due yet so it is difficult to say how dramatically premium payment will ultimately affect the numbers.
 
As mentioned above, the open enrollment “deadline” is a loose term. The Obama administration has stated that consumers who tried to enroll before March 31 without completing the process will have additional time to do so. Some of the state-based exchanges have extended their open enrollment deadlines as well. These extensions could change the final open enrollment number and delay for weeks or months the most meaningful analysis of the demographics. However, setting politics aside, it does appear that more people are obtaining coverage for health care services under the law, which is a good thing.
 
As we continue forward with implementation, it is also critical to understand how administratively challenging it has been for the insurance industry to put the ACA changes into effect, often with little guidance from the administration. Affordability remains hugely important, and insurers stress that we cannot lose our focus on this point. Insurers cannot design products that meet consumer needs and remain affordable if state legislatures create an increasingly restrictive statutory environment. High value provider networks will reduce cost and improve quality of care. Innovative benefit design that provides consumer choice will help keep coverage affordable. Legislation imposing restrictions on provider contracting and limiting product design will not lead to affordable products that meet the needs of today’s consumers. While we await further analysis of the successes and failures of the ACA, we should keep in mind that, at the end of the day, the goal is more high-quality, affordable coverage. -

 

With the first annual Affordable Care Act open enrollment in the books (although the end of open enrollment is still something of a moving target – more on that later), everyone is examining, discussing, applauding and challenging the numbers. And there are a lot of numbers to consider: How many people signed up for health insurance coverage during open enrollment? How many of them went into Medicaid? How many of them are young, healthy people vs. older, less healthy people? How many of them either have paid, or will pay, the premium needed to actually obtain the coverage? How many of those who signed up were previously uninsured? And the list goes on and on.
 
Issues and opinions abound about what the numbers really mean, but the announcement from the White House on April 1 is that at least 7.1 million people have signed up for health insurance through the exchanges, meeting the goal set months ago by the administration. As we all recall, the open enrollment road started out particularly bumpy on October 1, 2013, with the HealthCare.gov website unable to fulfill its promise of a smoothly operating insurance marketplace. The technical problems caused a significant delay and required many repairs and changes to the website. It was not until December 2013 that substantial numbers of users could shop for and buy insurance on the federal website without lengthy wait times and other problems. And even after the consumer experience began to improve, insurers expressed concern that the information they were receiving about enrollees was inaccurate or duplicative as a result of the federal system’s administrative deficiencies. The fact that the enrollment goal might have been reached is, therefore, noteworthy.
 
But what do the numbers mean? First, most agree that it will take some time before we really know how effective the many provisions of the ACA have been when it comes to insuring the previously uninsured and what the cost to the country is for that coverage. The numbers show many people who have gained coverage for health care services in the past few months are in state Medicaid programs. Twenty-eight jurisdictions have or are planning to expand their Medicaid programs in some fashion under the ACA. In addition, the efforts to reach out to that “expansion population” have resulted, to a degree, in more people coming into the traditional Medicaid program (the so-called “woodwork effect”). In West Virginia, well over 90,000 people have been enrolled in the expanded Medicaid program. The long-term implications of adding more people to the Medicaid rolls is a concern at the state level when it comes to budgets and trust in the federal government to meet its significant matching obligations to fund those programs under the ACA. In addition, while the law is called the “Affordable” Care Act, many would point out that the care itself is no more affordable than it ever was; the difference is that we now subsidize premiums for lower-income people with taxes and penalties collected under the new law. Data analysis through mid-March for West Virginia shows that 86 percent of people who enrolled through the exchange did so with the help of subsidies. While there are initiatives imbedded in the ACA to reduce the cost of medical services over time, the results are not immediately ascertainable.
 
There is much debate right now about how many of the 7.1 million people were previously uninsured, or whether they were just moved from one form of coverage to another. In West Virginia, Highmark (the only carrier offering products on the exchange in the state) announced that a total of 20,131 people have purchased ACA-compliant plans, with 14,839 through the exchange and 5,292 buying directly from Highmark. The company also said 63 percent of the total number were new members, meaning they were either previously uninsured or were insured with a different carrier. There is also a great deal of debate about how many of the 7.1 million have paid premiums, and whether this calls into question the accuracy of that number. After all, if premiums are not paid the coverage will not be issued. Highmark’s announcement acknowledges that not every enrollee has paid the first month’s premium. To be fair, those who signed up towards the end of open enrollment will not have a payment due yet so it is difficult to say how dramatically premium payment will ultimately affect the numbers.
 
As mentioned above, the open enrollment “deadline” is a loose term. The Obama administration has stated that consumers who tried to enroll before March 31 without completing the process will have additional time to do so. Some of the state-based exchanges have extended their open enrollment deadlines as well. These extensions could change the final open enrollment number and delay for weeks or months the most meaningful analysis of the demographics. However, setting politics aside, it does appear that more people are obtaining coverage for health care services under the law, which is a good thing.
 
As we continue forward with implementation, it is also critical to understand how administratively challenging it has been for the insurance industry to put the ACA changes into effect, often with little guidance from the administration. Affordability remains hugely important, and insurers stress that we cannot lose our focus on this point. Insurers cannot design products that meet consumer needs and remain affordable if state legislatures create an increasingly restrictive statutory environment. High value provider networks will reduce cost and improve quality of care. Innovative benefit design that provides consumer choice will help keep coverage affordable. Legislation imposing restrictions on provider contracting and limiting product design will not lead to affordable products that meet the needs of today’s consumers. While we await further analysis of the successes and failures of the ACA, we should keep in mind that, at the end of the day, the goal is more high-quality, affordable coverage. - See more at: http://www.spilmanlaw.com/Resources/Attorney-Authored-Articles/Insurance/ACA-Open-Enrollment-1-in-the-Books#sthash.Xx24n50i.dpuf

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Spilman Thomas & Battle, PLLC | Attorney Advertising

Written by:

Spilman Thomas & Battle, PLLC
Contact
more
less

Spilman Thomas & Battle, PLLC on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
Feedback? Tell us what you think of the new jdsupra.com!