Tuesday, March 15, 2016

Fun with Kaiser!

The Kaiser Family Foundation today published its updated state-by-state estimate of "Percent of Potential Marketplace Population Who Have Selected a Marketplace Plan."   Kaiser's Larry Levitt tweeted thusly about Florida, the state with the highest marketplace enrollment:
Two thirds is very high indeed, since Kaiser's "potential population" includes those who earn too much to qualify for subsidies, and most of them buy their coverage off-exchange. So I went back to Kaiser's last estimate of each state's potential subsidy-eligible marketplace population and compared the estimate for Florida to the number of 2016 Florida enrollees (as of the end of open enrollment) who obtained premium subsidies. Lo, the results:

Potentially subsidy-eligible:                          1,556,000 (Kaiser, Sept. 30, 2015)
Enrolled with premium subsidy for 2016*:   1,585,965   (HHS final enrollment report, 2016)
Percent of potentially subsidy-eligible pop:  102%

Yup -- more Floridians are enrolled with subsidies, or were as of the end of open enrollment on Feb. 1, than Kaiser estimated to be eligible for subsidies last fall. That's amusing. Let's keep in mind:
  • The estimate of the subsidy-eligible population is based on the 2015 Current Population Survey. which, detailed as it is, is based on respondents' self-reporting and can't be precise.

  • In 2015, HHS reported 13% attrition in marketplace enrollment by March 31 and 15% attrition by June 31. The first drop captures those who never paid their first premium. This year, the initial drop-off should be less steep, as HHS subtracted dropped plans from their running totals as open season progressed, which it had not done in prior years.

  •  In Florida, enrollment dropped from 1.6 million as of mid-February 2015 to 1,3 million as of June 30, or about 18%.  

  • ACA outreach and brokerage really took off in Florida in 2015, and I presume continued in 2016. There were lots of storefront brokerages in poor-to-working class areas in the Miami region.

  • Florida has not expanded Medicaid, and a huge number of its private plan enrollees would be Medicaid eligible if the state accepted the ACA expansion. 55% of 2016 Florida enrollees who reported household income have incomes in the 100-150% FPL range. Probably at least 2/3 of them, or over 35% of total enrollment, have incomes under 139% FPL, the cutoff for Medicaid eligibility in states that embrace the ACA expansion. 
The next shoe to drop, probably quite soon, will be Kaiser's updated estimate of the percent of subsidy-eligible population enrolled in marketplace plans, state-by-state. That is the more significant measure, since most of those who are not subsidy eligible and do buy plans in the individual market do so off-exchange, and we don't know how many of them there are.  That forthcoming report will show that nationwide, about 70% of the potential subsidy-eligible population has selected marketplace plans, up from 56% last September. But that percentage will probably drift back down to about 60% by year's end.

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