Wednesday, December 04, 2019

GetCoveredNJ hits cable TV with its first ad

This time last year, an email correspondent who closely watches the New Jersey ACA marketplace was tearing his hair out for the lack of TV advertising by state agencies working to boost enrollment. New York was flooding the airwaves with ads; NJ was invisible.*

The then-young Murphy administration entered Open Enrollment season flying high on a newly enacted reinsurance program and state-based individual mandate that together had reduced individual market premiums 9% below 2018 levels. While the Trump administration had gutted federal spending on enrollment assistance, from $1.9 million in 2016 to $300,000, the state was kicking in $800,000 for assistance and outreach.

Yet on-exchange enrollment lagged 2018 totals, finishing 7% down, compared to a 4% average drop in 39 states using the federal exchange, By this point (week 5), it was down 14% year-over-year (in all 9 states, a calendar discrepancy between 2017 and 2018 led to a sharp closing of the apparent gap in the final week).

In retrospect, the on-exchange drop was predictable. The reduction in base (unsubsidized) premiums led to an increase in premiums for subsidized enrollees who sought plans cheaper than the benchmark (second cheapest silver) plan. Premium decreases in the ACA marketplace usually have that effect, because they reduce spreads between the benchmark and cheaper plans, and the benchmark determines the size of the income-adjusted subsidy.

The drop was partly offset by an increase in off-exchange enrollment in ACA-compliant plans -- that is, enrollment by people who don't qualify for subsidies**. By the second quarter of this year, the apparent enrollment drop was completely offset by improved retention, with total individual market enrollment up 1.6% over Q2 2018. But that recovery probably hasn't wiped out the impression that the state's investment in outreach failed to bear fruit -- although it may well have, as we have no way of knowing where enrollment would be in its absence.

This year the state is investing $2 million in enrollment assistance, tapping funds from insurer user fees that became available because the state is establishing its own exchange, allowing the state to tap a portion of those fees in this transitional year. Perhaps that money freed other funds for increased advertising. Last night, my email interlocutor wrote excitedly that GetCoveredNJ is on the cable airwaves with an ad.

On the whole, it's good simple messaging:  Open Enrollment ends Dec. 15. Make sure you're covered. Most people who need coverage are subsidy eligible. It's NJ law to have coverage or face a tax penalty. Visit

But a piece of misinformation slips in when the narrator intones, "Last year, nearly 8 in 10 New Jerseyans got financial help to lower their costs."  It's true that 76% of New Jersey residents who enrolled via -- 193,000 as of the end of Open Enrollment -- got financial help. But that's less than 2% of "New Jerseyans." In fact only 54% of individual market enrollees as of Q1 2019 were subsidized, as 30% of enrollees bought off-exchange. (The off-exchange plans are ACA-compliant, as New Jersey bans noncompliant plans.)

Does this matter? Yes. There's confusion about the impact and reach of ACA programs. The individual market serves about 3% of state residents.  It's admittedly hard to be accurate in very short space about who's targeted, especially since you're addressing potential Medicaid enrollees too -- I struggled with this myself when editing fliers for a local group last year. But a state shouldn't be putting out misinformation.  Amending to "Last year, nearly 8 in 10 New Jerseyans who enrolled in marketplace plans got financial help to lower their costs" would add two seconds to the video. Unfortunately, it wouldn't add very usable information: since NJ is in transition to unveiling its own state exchange next year, and the ad is pushing people to the informational rather than to the federal exchange, the text can't simply say "...who enrolled via" -- which would add usable info.  But better to avoid outright misspeaking.

Continued tracking of state enrollment is likely to generate some mistaken conclusions this year. In 2020, premiums in the state's individual market rose 8.6% on average, more or less reversing last year's reductions. Conversely, though, premium spreads from the benchmark improved for the subsidized, for whom the cheapest silver and cheapest bronze plan premiums will go down this year after rising in 2019. Subsidized enrollment may accordingly uptick, though it's been lagging last year's pace so far, and unsubsidized enrollment may fall, as it did in 2018 when premiums spiked. If on-exchange enrollment does rise, some may attribute that rise to increased advertising and enrollment assistance. Those efforts may help -- but the effects of cheaper silver and bronze plans for the subsidized will likely also have an impact. As for off-exchange enrollment, that's state-reported, and likely not available until June of next year.

Update: through week 5, NJ enrollment is down 14.5% compared to same time last year. That's probably too much to make up in a late surge.

Looks like New Jersey's reinsurance trade-off paid off (10/29/19)
Surprise!  New Jersey's ACA marketplace outperforms the national market (8/22/19)
New Jersey off-exchange enrollment rose in 2019: Did cheap off-exchange silver help? (6/18/19)
Is New Jersey's unsubsidized marketplace enrollment migrating off-exchange? (12/12/18)
New Jersey's Disappointing 2019 ACA enrollment: Some perspective (1/4/19)

* That's partly because NJ has almost no independent TV market, and partly because New York runs a state-based ACA exchange, and so has its own funding source (user fees from participating insurers) for advertising and outreach. New Jersey, which still uses the federal exchange while in transition to establishing a state-based exchange, has handed those dollars to the federal government, which under Trump has gutted advertising (by 90%) and enrollment assistance funding (by 84%).  This year, the state exchange is technically a state-based exchange on the federal platform. As such, it was able to eschew a federal cut to the fee charged to insurers for using the exchange, and to use the fee difference for enrollment outreach.

** About a quarter of on-exchange New Jersey enrollees are also unsubsidized

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