Wednesday, March 16, 2016

How's New York's ACA marketplace doing? (updated)

In Kaiser's newly updated estimates of  the percentage of potentially eligible residents each state has enrolled in health plans through its ACA marketplace, New York gets short shrift.

According to Kaiser's measure, New York's health exchange is at just 26% capacity. But that's because the state launched a Basic Health Plan (BHP) that provides ultra low-cost insurance* to residents with incomes up to 200% of the Federal Poverty Level (FPL) who are not eligible for Medicaid. About 155,000 enrollees in the BHP (dubbed the Essential Plan) would have been eligible for subsidized private plans had the state not launched the BHP.

As I mentioned yesterday, Kaiser's more meaningful measure is the percentage of the subsidy-eligible population that each state has enrolled in subsidized private plans (because those who don't qualify for subsidies mainly buy off-exchange).Kaiser updates that metric bi-annually, but hasn't done so yet in the wake of the 2016 enrollment period. But based on its last estimate of the subsidy-eligible population in each state, we can take a stab at New York's current success rate.

Last September, before New York launched the Essential Plan, Kaiser estimated that the state had 532,000 residents potentially eligible for private plan subsidies. The Essential Plan currently has 379,559 enrollees. But 225,000 of them are in a special category: they are legally present noncitizens that the state was previously enrolling in Medicaid purely on its own dime (see note below**). Roughly 155,000 Essential Plan enrollees would have fit Kaiser's "potentially eligible population" for subsidized private plans last fall. In fact, most of them probably were in private plans.***

In addition, in 2016, New York enrolled 271,964 residents in private plans through its ACA exchange. According to HHS' spreadsheet of state level data, 54% of those private plan enrollees were subsidized, or a little shy of 147,000.  Add that to the 155,000  Essential Plan enrollees who would have been eligible for subsidized private plans last year, and approximately 302,000 enrollees in the two programs meet Kaiser's "potentially eligible" criteria.  That's 56.7% of 532,000, Kaiser's previous "subsidy-eligible" estimate. In other words, about 57% of New York's population that would have been eligible for subsidized private plans as of last fall are now enrolled either in such plans or in the Essential Plan [updated and corrected, 3/19 -- previously I missed the spreadsheet data].

That's as compared to 50% of the potentially eligible NY population enrolled as of  Sept. 30. But that was after 7-plus months of attrition. This year's total will also drift down as the year progresses.

Nationally, some 70% of the subsidy-eligible population as estimated by Kaiser is enrolled in private plans through the marketplace. So New York does lag the country as a whole (especially Florida, which appears to be at over 100% capacity among the subsidy-eligible), if these estimates are right. But not to the degree that Kaiser's current measure suggests.

As for Kaiser's broader measure of the percent of potentially eligible marketplace population enrolled (including the unsubsidized): add the 155,000 BHP enrollees who were formerly marketplace eligible to the marketplace total, and about 427,000 are enrolled in the two programs. That's 41%, compared to a national average (according to Kaiser) of 46%

* The Essential Plan is offered with 0 premium to eligible residents with incomes below 150% FPL, and for $20 per month for those in the 150-200% FPL range. Co-pays are minimal.

** Those who were transferred from Medicaid  are legally present noncitizens subject to the federal five-year bar on federally-funded Medicaid enrollment. A lawsuit forced New York to pick them up in 2001.  The ACA provides that noncitizens subject to the 5-year bar are eligible for private plan subsidies even if their income is below the eligibility threshold. That means they're also eligible for the BHP, with full federal funding. The transfer was thus a giant windfall for New York that went a long way toward funding the BHP.

*** A spox for New York State of Health, the state's ACA exchange, told me that 160,000 current Essential Plan enrollees were enrolled in subsidized private plans in 2015. Assuming that 225,000 were transferred from Medicaid last April, as the Greater New York Hospital Association reported, I don't think that 160,000 (or 155,000 -- the current total may reflect some attrition) could have been past enrollees in private plans. That would mean that no uninsured citizens enrolled in the BHP this year.

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