Insurance Market Trends and State Marketplaces · Insurance Market Trends and State Marketplaces...
Transcript of Insurance Market Trends and State Marketplaces · Insurance Market Trends and State Marketplaces...
Insurance Market Trends and State MarketplacesWashington Health Benefit Exchange
June 23, 2016
Larry Levitt
Senior Vice President
Kaiser Family Foundation
@larry_levitt
8.0
11.7 12.7
16.3
End of OpenEnrollment, 2014
End of OpenEnrollment, 2015
End of OpenEnrollment, 2016
If All States PerformedLike the Top 10
Source: HHS data and Kaiser Family Foundation estimate.
Marketplace QHP plan selections (millions)
22%
25%
26%
26%
28%
35%
46%
61%
61%
65%
66%
74%
Iowa
Minnesota
South Dakota
New York
North Dakota
Washington
United States
North Carolina
Massachusetts
Maine
Florida
District of Columbia
Source: http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/
Marketplace QHP signups as a share of the potential market in 2016
19%
28%
43%
44%
45%
46%
71%
91%
96%
100%
102%
110%
District of Columbia
New York
Colorado
South Dakota
West Virginia
Washington
United States
North Carolina
Montana
Oregon
Florida
Massachusetts
Source: Kaiser analysis, ASPE
Subsidized marketplace QHP signups as a share of estimated eligibles, 2016
Source: Kaiser Family Foundation analysis of the Current Population Survey.
Eligibility For coverage among the remaining uninsured as of early 2015
171,000 5,160,000
67,000 1,672,000
116,000 2,911,000
99,000 2,654,000
168,000 4,436,000
Washington (621,000) All States ExpandingMedicaid (16.8 million)
Income Too High/EmployerOffer
Unauthorized Immigrant
Tax Credit Eligible
Medicaid-Eligible Kids
Medicaid-Eligible Adults
11.7
8.8 7.8
4.9
Plan selections, end of openenrollment, 2015
Effectuated enrollment, end of2015
Plan selections, end of openenrollment, 2016
New
Renewing
Source: HHS data
Churn in marketplace enrollment (millions)
SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Most marketplace QHP enrollees satisfied with plans
37%
38%
32%
30%
26%
23%
18%
38%
36%
34%
34%
33%
35%
33%
8%
11%
14%
14%
8%
18%
19%
7%
9%
16%
14%
11%
22%
26%
10%
6%
4%
8%
22%
2%
4%
Choice of hospitals
Choice of primary care doctors
Doctor visit copay
Prescription copay
Choice of specialists
Monthly premium
Annual deductible
Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied Don't know/Refused
AMONG NON-GROUP ENROLLEES WITH MARKETPLACE PLANS: Thinking about your current health insurance plan, how satisfied are you with each of the following?
Note: “Too soon to tell” (Vol.) responses included in Don’t know/Refused category.SOURCE: Kaiser Family Foundation Surveys of Non-Group Health Insurance Enrollees
Among marketplace QHP enrollees, satisfaction with premiums and deductibles has declined since 2014
51%
60%
59%
46%
37%
32%
4%
3%
8%
2016
2015
2014
AMONG NON-GROUP ENROLLEES WITH MARKETPLACE PLANS: Percent who say they are satisfied/dissatisfied with their plan’s…
…annual deductible
59%
64%
68%
40%
32%
27%
1%
4%
5%
2016
2015
2014
Satisfied Dissatisfied Don't know/Refused
…monthly premium
75%
61%
58%
54%
51%
46%
41%
29%
19%
30%
34%
35%
36%
43%
40%
57%
Who says they benefited or were negatively affected by ACA?
AMONG NON-GROUP ENROLLEES WITH MARKETPLACE QHP PLANS: Percent who say they have benefited or been negatively affected by the ACA…
Republicans
Benefited Negatively affected
NOTE: The share who say they neither benefited nor were negatively affected is not shown.SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Lower-deductible plans
Receiving tax credit
TOTAL MARKETPLACE ENROLLEES
Independents
NOT receiving tax credit
Democrats
High-deductible plans
Average medical deductible, in plans with combined medical and prescription drug deductibles, 2016
$5,765
$3,064
$1,247
$21$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
Bronze Silver Gold Platinum
Average medical deductible in plans with combined medical and prescription drug deductible, 2016
$3,064
$2,491
$709
$221
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
Silver CSR73 (200-250% ofpoverty)
CSR87 (150-200% ofpoverty)
CSR94 (100-150% ofpoverty)
NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively.SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2016. Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/
$9,751
$1,454
$4,176
$20,379
$7,922
$808
$2,590
$18,148
$0
$5,000
$10,000
$15,000
$20,000
$25,000
All Non-ElderlyHouseholds WithPrivate Insurance
and Income >100%of Poverty
100% to 250% FPL 250% to 400% FPL Over 400% FPL
Liquid Assets
Net Financial Assets
Median liquid and net financial assetsAmong all non-elderly, non-poor households with only private coverage
NOTES: FPL refers to the 2013 Federal Poverty Level.SOURCE: Kaiser Family Foundation analysis of 2013 Survey of Consumer Finance (SCF) data.
Peterson-Kaiser Health System Tracker
256%
32%
-50%
0%
50%
100%
150%
200%
250%
300%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total Covered Costs
Paid by Insurance
Spending on Deductibles
Spending on Copayments
Spending on Coinsurance
Workers' Wages
Changing nature of employer health insurance, 2004-2014
Source: Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).
Cumulative increases in health costs, amounts paid by insurance, amounts paid for cost sharing and workers’ wages, 2004-2014
26%
37%
26%
14%
53%
20%
26%
15%
47%
22%
Total adults ages 18-64
Less than $50,000
$50,000 to $99,999
$100,000 or more
Uninsured
Insured
Private insurance, high…
Private insurance, low…
Have a disability
No disability
Shares reporting problems paying medical bills in past year
Percent who say they or someone in their household had problems paying medical bills in the past 12 months:
*High deductibles defined as $1,500 and above for an individual or $3,000 and above for a family.SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
By household income
By insurance status
By plan deductible
By disability status
75%
32%
26%
Copays, deductibles, or coinsurancewere more than they could afford
Received care from an out-of-network provider, and insurance
would not cover or would only covera portion
Submitted a claim to insurancecompany but the claim was denied
Most who had problems paying medical bills while insured say cost-sharing was more than they could afford
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS WHO WERE INSURED WHEN TREATMENT BEGAN: Percent who say each of the following was a reason they had problems paying medical bills:
NOTE: Question wording abbreviated. See topline for full question wording.SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
• Increasing enrollment is key to improving the risk pool and keeping the market attractive to insurers.
• Outreach! Now is not the time to take the foot off the accelerator.
• We are in for bigger premium increases in 2017 in most markets.
– Akin to a market correction to compensate for under-pricing.
– Continued plan switching could keep consumer premium increases down, though there are tradeoffs to this degree of disruption.
• Most counties nationwide have 3 or more insurers participating in the marketplace, but the number of counties with just 1 insurer is growing.
• Many reasons to believe the market is sustainable.
– Substantial and still growing enrollment.
– End of transitional plans (in many states).
– Cushioning effect of premium subsidies.
– Have not yet seen the full effect of the individual mandate.
• Significant changes may be coming federally, depending on the outcome of the election.
Looking ahead