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发帖数: 29846 | 1 http://www.forbes.com/sites/theapothecary/2014/05/10/new-mckins
Avik Roy , Forbes Staff
One of the principal flaws in the coverage of Obamacare’s exchange
enrollment numbers to date has been that the press has not made distinctions
between those who have “signed up” for Obamacare-based plans, and those
who have actually paid for those plans and thereby achieved enrollment in
health insurance. A new survey from McKinsey indicates that a large majority
of people signing up are now paying for their coverage. This is progress
for the health law. But the survey still indicates that three-fourths of
enrollees were previously insured.
Two months ago, I wrote about a prior McKinsey survey that found that the
vast majority of people signing up for individual-market coverage in 2014
were previously insured, and that of the minority who had been previously
uninsured, only 53 percent had paid their first month’s premium.
McK enroll Feb 2
The upshot of that figure was that of the people shopping for coverage on
their own who had actually enrolled in a new plan in 2014, the vast majority
had been previously insured. Another way to say that is that for all of the
talk about 7-million this and 8-million that, the Obamacare exchanges’
expansion of coverage to the uninsured was far smaller.
New data: 83% of previously uninsured have paid up
The new McKinsey report, authored by Amit Bhardwaj, Erica Coe, Jenny Cordina
, and Ruchira Sara, indicates that the proportion of uninsured individuals
paying for coverage has shot up, from 53 percent in February to 83 percent
in April. For previously insured individuals, the percentage of payers
increased from 86 to 89 percent.
The survey data was collected from 2,874 individuals whose incomes made them
ineligible for Medicaid: above 100 percent of the Federal Poverty Level in
states that haven’t expanded Medicaid, and above 138 percent in states that
have. (For a childless adult, this means incomes above $11,670 or $16,105,
respectively.) 1,434 of those polled—roughly half of the sample—were
previously uninsured, of which 83 percent were eligible for exchange-based
subsidies.
McK enroll Apr 1
53 percent of those who enrolled in 2014 coverage did so by renewing their
2013 plan or enrolling in a plan before the January 1 deadline that made
many old plans illegal. The remainder of enrollees “selected a new 2014 ACA
plan,” of which nearly two-thirds signed up through an ACA exchange.
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Only 22% of Obamacare sign-ups are paid, previously uninsured enrollees
However, the proportion of individuals purchasing ACA plans who had been
previously uninsured remained low. In February, McKinsey reported that only
27 percent of those selecting a new 2014 plan were previously uninsured; in
April, the proportion was 26 percent.
McK enroll Apr 2
Combining that with the payment figures: of the people signing up for new
ACA plans in 2014, only 22 percent were previously uninsured individuals who
have paid for coverage and therefore enrolled in health insurance. That’s
a meaningful improvement from February’s 14 percent figure, but it’s still
low.
Combining all of this data: of the 8 million sign-ups on the exchange, we
can only be confident that around 1.7 million are previously uninsured and
enrolled. We can add another 865,000 or so for those purchasing coverage off
the exchange, for a total of 2.6 million previously uninsured individual-
market enrollees.
McKinsey data consistent with feedback from insurers
Earlier this week, representatives of the insurance industry testified
before the House Energy and Commerce Committee regarding enrollment trends
in the exchanges. Four of the five witnesses stated that more than 80
percent of their sign-ups had paid for coverage. That’s consistent with
what McKinsey found, and also with my own discussions with insurers.
Last week, the E&C Committee published a report indicating that only 67
percent of signer-uppers had paid; however, their data included in the
denominator people who have yet to pay because their payments aren’t yet
due.
Bottom line: Exchanges are having modest impact on the uninsured
Obamacare is beginning to expand coverage to the uninsured; however, it’s
far from clear that the exchanges specifically are a primary engine. At most
around 930,000 people have gained coverage from Obamacare’s under-26 “
slacker mandate” (not 3 million, as is commonly suggested); another 3
million or so have gained coverage from the law’s expansion of Medicaid.
Approximately 2.6 million previously uninsured individuals have obtained
coverage through the ACA exchanges and the related off-exchange individual
markets; however, the off-exchange purchases are mostly unsubsidized, and
therefore can’t necessarily be credited to Obamacare.
What the exchanges appear to be doing is mainly helping people who were
previously insured. If you’re 62 years old, say, and your income is $30,000
, and you were paying for your own coverage before, you’re now eligible for
plans that are much cheaper for you, thanks to taxpayer-funded subsidies
and higher premiums for young people.
Of course that means that other people are paying more. “My old plan was
canceled under Obamacare,” an exasperated Californian told me last week. “
The new Obamacare plan costs twice as much, and the deductibles are higher.
And yet Obama is counting me as one of his 8 million people!” But hey—at
least he has maternity coverage.
* * *
UPDATE: In the original version of this piece, I described the McKinsey
survey as only polling individuals with incomes between 100 and 400 percent
of FPL. In a follow-up correspondence, the authors of the study have
indicated to me that the survey did include individuals with incomes above
400 percent of FPL. The article has been revised accordingly.
READ AVIK’S NEW BOOK, How Medicaid Fails the Poor (Encounter, 2013),
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INVESTORS’ NOTE: The biggest publicly-traded players in Obamacare’s health
insurance exchanges are Aetna (NYSE:AET), Humana (NYSE:HUM), Cigna (NYSE:CI
), Molina (NYSE:MOH), WellPoint (NYSE:WLP), and Centene (NYSE:CNC), in order
of the number of uninsured exchange-eligible Americans for whom their plans
are available. |
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