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Wednesday, April 25, 2018

April 25, 2018

Covered California Analysis Shows Major Declines in New Enrollment Nationally and Identifies Policies That Could Lower Premiums in 2019



  • Enrollment in the federally facilitated marketplace has dropped 9 percent over the past two years, with a nearly 40 percent drop in new enrollment, while enrollment in state-based marketplaces remained steady during the same period.
  • Early data on off-exchange enrollment indicates that an additional 1.6 million unsubsidized middle-class Americans also left the off-exchange market over the past two years.
  • Increased federal investments in marketing and outreach, from assessments collected for that purpose, could reduce premiums by 3.2 percent from 2019 to 2021 and save Americans $6.6 billion in premiums.
  • Failure to act within the next few months will directly contribute to premium increases that could exceed 30 percent in many states in the federal marketplace.
SACRAMENTO, Calif. � A new Covered California analysis finds enrollment in the federally facilitated marketplace (FFM) has dropped 9 percent over the past two years, driven by a nearly 40 percent drop in new enrollees, while the number of consumers signing up for coverage through state-based marketplaces (SBMs) has remained steady over that time.

The report, Individual Insurance Markets: Enrollment Changes in 2018 and Potential Policies That Could Lower Premiums and Stabilize the Markets in 2019, finds that the dramatic decrease in new enrollees in the federal marketplace, which coincides with decisions to pull back on marketing for federal marketplace states, will likely mean a less-healthy consumer pool and higher premiums to cover the sicker enrollees.

�Enrolling new consumers every year is critical to maintaining a healthy consumer pool and keeping premiums low,� said Peter V. Lee, executive director of Covered California. �The drop in new enrollees at the federal level is deeply concerning and can be tied directly to recent policy decisions to not spend resources available to promote enrollment � leading to increased premiums for millions of Americans who do not get federal subsidies.�

Lee noted that the administration canceled its marketing during the last week of open enrollment in 2017 and then dramatically scaled back its marketing and outreach efforts during the most recent open-enrollment period.

�We are seeing the results of the federal decision to cut marketing by 90 percent: fewer people enrolled, a sicker consumer pool and higher premiums that could leave many � particularly those who do not get any financial help � priced out of coverage,� Lee said. �With health insurance companies making decisions in the coming months about whether to participate in 2019, and what to charge, the time is now to take action to protect millions of consumers from unnecessarily high rates.�

Similar to Covered California, the FFM has collected revenue from its health plan assessment � amounting to $1.2 billion in 2018 � that does not require any appropriation and can be used in a variety of ways. Covered California allocates one-third of its assessment revenue to marketing and outreach, and if FFM did the same, it would invest more than $400 million, which should lower premiums by 2.3 percent in 2019 and save consumers and taxpayers $1.6 billion. Maintaining this investment over three years would lower premiums by an average of 3.2 percent and save an estimated $6.6 billion during that time.

�Insurance needs to be sold, and it does not make any sense to let that money go unused when millions of Americans are at risk of higher premiums,� Lee said. �The administration needs to act like a business and recognize that now is not the time to continue its policy of cutting back on marketing, which will directly result in higher premiums for millions of middle-class Americans.�

A previous Covered California analysis found that in the absence of Congressional action, premium increases in the individual markets will likely range from 12 to 32 percent in 2019 and cumulative premium increases from 2019 to 2021 will range from 35 percent to more than 90 percent in some states. (Read the full analysis here: https://coveredcanews.blogspot.com/2018/03/national-analysis-projects-2019-premium.html.)

While subsidized consumers would be insulated from premium increases, which would also increase the amount of financial assistance they receive, unsubsidized consumers would bear the full weight of the higher premiums. Covered California previously estimated that 6 million Americans on the individual market, both on- and off-exchange, do not receive subsidies and have a median income of $75,000.

Covered California noted that in addition to restoring and increasing investments in marketing and outreach, there are other policies that could protect consumers from significant premium increases. They include funding a state-based reinsurance program and expanding the existing subsidy program to make coverage more affordable for consumers.

Covered California sent the analysis, along with a letter detailing Covered California�s observations and experiences, to Secretary Alex Azar of the U.S. Department of Health and Human Services and Administrator Seema Verma of the Centers for Medicare and Medicaid Services.

View a copy of the letter: https://www.coveredca.com/news/pdfs/04-25-18-CoveredCA-AzarVermaLetter.pdf.

Read the full analysis: http://hbex.coveredca.com/data-research/library/CoveredCA_2018_Individual_Market_Enrollment_4-25-18.pdf.

About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.
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Thursday, March 15, 2018

March 15, 2018

Covered California Names Terri Convey New Director of Its Outreach and Sales Division


�         Convey will oversee Covered California�s sales strategy in both the individual and small-business markets.
�         She will lead Covered California�s Outreach and Sales Division to promote in-person enrollment, which supports more than 17,000 certified enrollment assisters and 800 storefronts across the state.
�         Convey brings extensive experience to Covered California, having previously worked as Aetna�s sales director for strategic initiatives and contact-center solutions, along with Humana and Coventry Health Care.

SACRAMENTO, Calif. � Covered California Executive Director Peter V. Lee announced the board of Covered California�s appointment of Terri Convey as the director of the Outreach and Sales Division.  

Convey will oversee Covered California�s sales strategy in both the individual and small-business markets, including working with thousands of insurance agents and other certified enrollers to ensure Californians have in-person assistance. She will also promote efforts to encourage consumers to keep their coverage once enrolled and renew their health insurance plans. The field sales program includes Covered California Certified Insurance Agents, Navigators and agency staff.

Convey arrives at Covered California from Miami, Florida, where she has been a high-ranking officer with Aetna, Humana and Coventry Health Care. She has worked in the health care industry for almost three decades.

�Terri�s years of experience in health care � including her work as the sales director of individual and public exchange for Aetna in Florida � make her a perfect fit for Covered California,� Lee said. �She has worked extensively with brokers, agents, sales teams and service center employees.�


Convey will lead Covered California�s system that supports in-person enrollment and works with more than 17,000 certified assisters who help consumers understand their health insurance choices and sign up for coverage.

Covered California�s robust enrollment network includes more than 14,000 independent insurance agents, who work in neighborhoods across the state and speak a variety of languages, and more than 800 privately run storefronts where consumers can get free and confidential assistance.

Covered California provides agents with field-based outreach support staff, enhanced training and communications programs, a certified agent and enroller service center, a storefront and events program, a mobile-enhanced consumer-referral tool and access to branded collateral. Effectively supporting the certified enroller community across the state has been critical to successful enrollment efforts and has led to more than 50 percent of all consumers being enrolled with the support of person-to-person assistance from agents and other enrollers.

Convey will also be tasked with continuing the growth of Covered California for Small Business, which has experienced a double-digit membership increase for the third consecutive year. Currently, more than 43,000 individuals have insurance through Covered California for Small Business, representing a growth of approximately 27 percent in membership from the previous year.

Convey graduated from the University of Miami with a Bachelor of Arts degree in English and has worked in health plan sales since 1989. After spending the first half of her career in large-group sales, she has held management roles in small-group and individual sales since 2003 and was intricately involved with Aetna�s efforts on Florida�s exchange through last year. The annual salary for Convey�s position is $189,996 and she will be reporting to Chief Deputy Executive Director Doug McKeever. She will start at Covered California on April 2.
About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.
Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

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Thursday, March 8, 2018

March 08, 2018

National Analysis Projects 2019 Premium Hikes of 30 Percent in Some States and Cumulative Increases of 90 Percent or More in the Next Three Years

  • Due to ongoing federal uncertainty, premium increases for every state could range from 12 to 32 percent in 2019.
  • The cumulative premium increases from 2019 to 2021 could be between approximately 35 and 90 percent.
  • Due to specific conditions unique to their region, 17 states are at greater risk of experiencing cumulative premium increases of 90 percent or more, and an additional 19 states could be at risk of experiencing hikes of 50 percent or more.
  • Several policy actions at the federal and state level, including reinsurance, could reduce premium increases and help millions of middle-class Americans maintain their coverage and access.
SACRAMENTO, Calif. � A new analysis finds that every state in the nation is at risk for higher than normal premium increases due to continued policy changes and uncertainty at the federal level. In the absence of any federal action to address the current environment, the report estimates that premium increases across the nation could range from 12 to 32 percent in 2019 and have a cumulative premium-increase total between 35 and 94 percent by 2021 (see Table 1: National Projections of Individual Market Premium Changes: 2019-2021).

�The challenges to our health care system are threatening to have real consequences for millions of Americans,� said Peter V. Lee, executive director of Covered California, the sponsor of the study released today. �The prospect of 30 percent premium increases in 2019 and hikes of over 90 percent over the next three years threatens access to coverage for millions of Americans.�

Table 1. National Projections of Individual Market Premium Changes: 2019-2021


The analysis, �Major Indicators of Individual Market Stability Highlight High Premium Increases for States in Coming Years,� (http://hbex.coveredca.com/data-research/library/CoveredCA_High_Premium_Increases_3-8-18.pdf) is a national economic analysis of potential premium increases, state-by-state impacts and estimates of positive effects of federal policies. The report was informed by actuaries at health insurance companies and academics at the University of California, Los Angeles; the University of California, San Diego; and Harvard University, as well as a review of recent published reports. In addition, Milliman provided actuarial modeling related to the potential impact of instituting a federal state-based invisible high-risk pool or reinsurance program. The analysis was sponsored by Covered California as part of its efforts to understand future trends and inform the national policy discussion.

Milliman�s complete report on the potential impact of reinsurance can be found here: http://hbex.coveredca.com/data-research/library/Milliman_Reinsurance_Program_Estimates_2-14-2018.pdf.

The analysis also identifies steps that can be taken to reduce the risks of these significant premium increases. Among the solutions is an analysis of the positive impact that a federal reinsurance program could have in 2019 if implemented soon.

�We project that a nationwide reinsurance program with annual funding of $15 billion could result in average premium reductions of 16 to 18 percent,� said Robert Cosway, consulting actuary at Milliman. �Lower premiums would affect both consumers and the amount that the federal government pays in the form of tax credits. The marginal cost of the reinsurance program would be much lower than $15 billion when you consider the reduction in the cost of the federal government�s tax credit payments.�

Previous Covered California analysis has shown that because reinsurance programs result in lower premiums and lower expenditures for premium subsidies, a program funded with $15 billion would have a net cost to the federal government of only $5 billion due to reduced Advanced Premium Tax Credit spending.

Other policies that could reduce premiums or promote stability include a return to providing direct federal funding for the required cost-sharing reduction subsidies, which help low-income consumers with lower copays and deductibles. Increased spending in federal marketplace states on marketing to promote enrollment among healthier individuals would yield a very positive return on investment, with the beneficiaries of that investment being federal taxpayers. New state policies could promote enrollment and protect consumers from new health insurance products that have huge gaps in coverage and may siphon off healthier people from individual market risk pools.

In addition to the projected premium increases, the analysis uses key indicators of marketplace stability to assess which states are more or less likely to be at risk of experiencing catastrophic rate changes.

According to the report, every state is at risk of cumulative premium increases of at least 35 percent over the next three years. Seventeen states could face premium increases exceeding 90 percent during that time, and an additional 19 states could face increases of 50 percent or more. These increases could be due to a variety of factors, including the recent decision to remove the federal penalty for being uninsured, the administration�s attempt to introduce new short-term plans that may damage the overall risk mix of consumer pools by siphoning off healthy consumers, and the continued underinvestment in federal marketing and outreach.

�We commissioned this work to shed light on the variation in the potential impact of policy changes such as the removal of the penalty, cuts in marketing in federal marketplace states and new products like association health plans and short-term, limited-duration health plans,� Lee said. �Health care is local, and the impacts of changes in federal policy will play out differently across the nation. The conclusion is that there are no �winners� � rather, the range of impacts is from bad to very bad.�

Using key risk indicators to help gauge the overall health of a marketplace, the analysis examined the situation each state faces based on its risk score and enrollment trend.

  • Centers for Medicare and Medicaid Services (CMS) risk score: Measures the overall health of the consumer pool in the state�s individual market � based on the individual�s demographic and health-status information � and how it compares to the national average. A negative number means the consumer pool is healthier than the national average.
  • Enrollment trend: The number of consumers enrolled in a marketplace plan. While there are many ways to look at trend, for the purpose of simplicity this analysis examined the change between 2017 and 2018 enrollment.

When taken together, these �risk indicators� provide strong signals of whether a state will be more or less likely to have higher premium increases and market instability.

While subsidized consumers would be insulated from these increases, which would increase the amount of financial assistance they receive, unsubsidized consumers would bear the full weight of the higher premiums. A previous Covered California study estimated that 6 million Americans on the individual market, both on- and off-exchange, do not receive subsidies and have a median income of $75,000.

�Lower-income Americans will be largely shielded from these price hikes, but the real-world consequence for middle-class Americans who do not receive any financial assistance in the form of tax credits is that many will be priced out of having health insurance,� Lee said.

The analysis, which provides a snapshot and projection for potential premium hikes for each state, is available in an interactive map: http://hbex.coveredca.com/data-research/data-viz/individual-market-risks-by-state-2019/.

Figure 1: National Overview: State-by-State Interactive Mapping of Premium Increase and Instability Risk

The report finds that all states are at risk of high cumulative premium increases over the next three years, but based on the two indicators, the relative risk of increase differs.





About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.
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Thursday, March 1, 2018

March 01, 2018

Statement: Covered California�s Executive Director Addresses Harvard Study on Impact of Eliminating Individual Mandate on Enrollment and Premiums


SACRAMENTO, Calif. � Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, �Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,� published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

�The removal of the individual mandate penalty could result in 378,000 fewer Californians with health insurance in the individual market, including approximately 250,000 who are currently insured through Covered California. The drop in those with insurance would be even greater because there would also be drops in Medi-Cal, California�s Medicaid program, since consumers often find out they are eligible for Medi-Cal while shopping for coverage through Covered California. While California would continue to have a stable individual market, and we have the reserves and flexibility to adjust for this impact, the impacts would be real and significant for California�s consumers. Californians would be paying increased premiums, and some of those who go without insurance could face big medical bills when unforeseen health events occur.

�The consumers who leave the market would be rolling the dice, hoping they would remain healthy, but the fact is that many of them will lose that bet. We know that life can change in an instant, and an illness or injury can be a moment away for all of us. While we all think we won�t be the ones to get sick or injured, the reality is that if 378,000 Californians decide to go without insurance, about 60,000 of them (one out of six) are likely to need medical care that will cost them more than $10,000. The real penalty is not what the IRS will collect through the coming year for being uninsured, but rather showing up at the hospital with no insurance and leaving with a massive debt.

�In addition, with a less-healthy consumer pool, California�s individual market could be facing premium increases for 2019 of 12 to 16 percent � with the biggest driver being the removal of the individual mandate. Increases at this level are bad news for consumers, but Californians would be in better shape than most of the nation would be. This study finds that four out of five Californians would opt to keep their coverage even with the penalty going away, and here we will once again be leaning in with a major marketing campaign to promote enrollment.

�The impact in many other states, however, is likely to be far worse. The removal of the penalty in those states will be compounded by the absence of effective marketing and the prospect of new skimpy insurance products, which would cause healthier people to leave the individual market. Premiums in many states could spike 30 percent in 2019 alone, with large increases in future years absent effective federal or state policies.

�While consumers who receive financial help � in California and across the nation � would be shielded from those rate changes, unsubsidized consumers would have no such protections. These are middle class Americans with a median income of $75,000 � approximately 800,000 in California and 6 million across the country � who would be forced to pay the entire increase or would risk being priced out of coverage.

�It is important to note that in addition to the removal of the individual mandate penalty, a variety of other factors are causing instability in the individual markets across the country, including the cuts in marketing and outreach in many states, and the prospect of short-term or limited-duration plans that fail to protect consumers or provide meaningful coverage.

�There is still time for policy makers to address these issues before they become a crisis for millions of Americans in 2019. However, just as there is not a single reason for the uncertainty we face, there is not a single solution. There is a range of things policy makers should consider doing now to protect consumers and provide certainty for health insurance companies, including a federally supported reinsurance program, increased investments in marketing and other state-based solutions.

�Lawmakers should seriously consider these steps before we turn back the clock to a time when consumers had Swiss-cheese coverage, meaning they thought they had coverage until they sought to use it, or were turned away for having a pre-existing condition.�

Click here to see the study: https://www.healthaffairs.org/do/10.1377/hblog20180223.551552/full/.

About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered
California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.
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Tuesday, February 13, 2018

February 13, 2018

Covered California Thanks Two Departing Board Members and Welcomes New Governor�s Appointees to Board


SACRAMENTO, Calif. � Covered California Board Chair Diana Dooley on Tuesday thanked two departing members of the Board of Directors and welcomed two new members appointed by Gov. Jerry Brown to oversee the agency.

Dr. Sandra Hernandez and Jerry Fleming will serve on the board, taking the places of Marty Morgenstern and Genoveva Islas, who have served since 2015.

Dooley said Morgenstern and Islas will be missed.

�We want to thank both Marty and Veva for the time and effort they have devoted to helping Covered California build an organization that has helped millions of people get affordable health care,� said Dooley. �They both have served the people of California with dedication and a steadfast commitment to putting the needs of consumers first.�

Today, Gov. Brown appointed (https://www.gov.ca.gov/2018/02/13/governor-brown-announces-appointments-13/) Sandra Hernandez and Jerry Fleming to serve on Covered California�s board.

Hernandez and Fleming will join Dooley, Paul Fearer and Art Torres as members of Covered California�s Board of Directors.

Peter V. Lee, executive director of Covered California, said the organization is grateful for the leadership of the departing board members.

�Marty and Veva joined us right after our second open-enrollment period, and their expertise and commitment helped Covered California maintain its momentum and strength,� Lee said. �We want to thank them for everything they have done.�

�We also look forward to welcoming Jerry Fleming and Sandra Hernandez, who bring not only broad and deep expertise in health care, but also tremendous insight into how to ensure Covered California continues to reach and effectively serve the rich diversity of California�s population,� Lee said.

Since 2014, more than 3.4 million people have purchased health insurance through Covered California, and nearly 4 million have enrolled in the state�s Medi-Cal program. Together, the gains have cut the rate of the uninsured in California from 17 percent in 2013 to a historic low of 6.8 percent as of June 2017.

Consumers can still sign up for health care coverage if they experience a life-changing event, such as losing their health insurance, getting married, having a child or moving. For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Eligible consumers who are interested in signing up should go to www.CoveredCA.com where they can get help to enroll. They can explore their options and find out if they qualify for financial help by using the Shop and Compare Tool. They can also get free and confidential enrollment assistance by visiting www.coveredca.com/find-help/ and searching among 800 storefronts statewide, or more than 17,000 certified enrollers who can assist consumers in understanding their choices and enrolling, including individuals who can assist in other languages. In addition, consumers can reach the Covered California service center by calling (800) 300-1506.

Consumers who qualify for Medi-Cal can enroll year-round.

About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.
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Wednesday, February 7, 2018

February 07, 2018

Covered California Finishes Fifth Open Enrollment Strong � New Sign-ups of 423,484 up 3 Percent Over Last Year

Click for Espa�ol
  • More than 50,000 people selected health insurance plans through Covered California in the final three days of open enrollment.
  • Covered California has now served more than 3.4 million consumers since 2014.
  • The number of renewing enrollees dropped slightly, in part due to Covered California encouraging unsubsidized Silver plan enrollees to shop off-exchange.
  • Consumers made smart choices for 2018, picking Gold plans in many cases to get the best value for themselves and their families.
  • Subsidized consumers paid less for health coverage in 2018 than 2017 due to the protective effect of their subsidy rising to offset higher premiums, while unsubsidized consumers in the individual market � both in and out of Covered California � saw their costs rise.
  • Without action by Congress, unsubsidized consumers nationwide could see their costs rise steeply in 2019 and find coverage increasingly unaffordable. 
SACRAMENTO, Calif. � Covered California announced Wednesday that more than 50,000 new consumers selected a plan during the final three days of open enrollment, bringing its overall total to 423,484 plan selections, which represents a 3 percent increase over last year.

�With robust marketing and strong partnerships in communities across California, we attracted more people to Covered California to newly enroll in health insurance this year,� said Peter V. Lee, executive director of Covered California. �Another key factor was that those getting subsidies actually had more money to shop with due to the work-around we implemented to make sure the cost-sharing reduction benefit was funded.  With this increased support, we saw new and renewing consumers make smart choices, with many more opting for Gold-tier plans this year compared to last.�

Among those who receive financial assistance, 15 percent of new consumers selected a Gold plan during open enrollment, over three times as many as the 4 percent that selected a Gold plan last year (see Table 1: Covered California Open Enrollment Subsidized Plan Selections by Metal Tier). Covered California�s Gold plans generally have higher premiums but pay 80 percent of consumers� health care costs when they access care. Gold plans were a better value for consumers this year because the premium was lower due to the cost-sharing reduction surcharge that was added only to Silver plans.

Table 1: Covered California Open Enrollment Subsidized Plan Selections by Metal Tier

Lee said the data shows consumers are making wise choices about health insurance.
�If price were the only thing that mattered, consumers would have largely moved to Bronze-level plans, which have the lowest price,� Lee said. �But instead we saw a �gold rush� of smart shopping in 2018, with consumers buying a richer benefit with their increased subsidy dollars.�

The number of new consumers selecting Platinum plans increased from 2 percent to 4 percent, while the number of consumers selecting a Bronze plan increased from 29 percent to 31 percent. Consequently, the number of new consumers selecting a Silver plan dropped from 63 percent last year to 49 percent this year.

The cost-sharing reduction �work-around� was designed to protect the hundreds of thousands of Californians who do not receive federal subsidies. One of the impacts of the cost-sharing reduction work-around was that Covered California encouraged unsubsidized enrollees who had bought Silver plans in 2017 to consider getting the comparable product off-exchange for 2018 and avoid paying the cost-sharing reduction surcharge. �While we�re still analyzing the data, it�s clear that some of the decrease in our renewals was due to consumers moving off-exchange to get coverage,� said Lee. �This fact underscores that our reports only tell part of the story of the individual market in California.�

Lee also offered observations Wednesday about enrollment in the federal insurance marketplace and other state-based exchanges.

�We are seeing remarkable stability in exchanges across the nation. While the federally facilitated marketplace has seen a decline of over 10 percent since 2016, states like California that are served by state-based marketplaces have on average grown by 1.5 percent in the same period,� Lee said. �Dropping enrollment in states that rely on the federal government for marketing and outreach will directly translate to higher premiums due to the worse risk mix. With the potential dramatic rate increases likely in many states, those states that don�t have state-based marketing efforts are at risk of seeing spiraling costs for the unsubsidized, which will likely price millions out of the ability to afford insurance.�

Lee�s comments coincide with new data compiled by the National Academy for State Health Policy (NASHP) that shows that state-based marketplaces� enrollment outpaced that of the federally facilitated marketplace.

�We know that enrollment in the federal health exchange has been hampered by dramatic cuts in marketing and funding for Navigators to help people enroll,� Lee said. �Our preliminary analysis suggests there has been a dramatic drop in new enrollments in the last two years, meaning the federal exchange is not �refilling the bucket� with new enrollees even though their renewals are holding steady.�

Over the past four years, the number of consumers newly enrolling in federally facilitated marketplace states has dropped from 4.7 million in 2015 to 2.5 million in 2018. In particular, in the two years that the current administration has been at least partially responsible for promoting enrollment � which included the decision to reduce marketing during the end of open enrollment for the 2017 plan year and to reduce marketing spending dramatically for 2018 � new enrollment has declined 38 percent (from 4 million in 2016 to 2.5 million in 2018). (See Fig. 1: National Enrollment Trends, New and Total Enrollment .)



�The problem,� Lee noted, �is that new enrollees refresh the risk mix and help keep rates down. Failing to �refill the bucket� at the top � coupled with the rate increases due to ending the individual mandate � means that enrollment in the federal marketplace, and the individual market more broadly, is headed for trouble next year unless action is taken soon.�

Covered California also released analysis of the premium changes for both subsidized and unsubsidized consumers over the past four years (see Fig. 2: California�s Individual Market Premiums for Subsidized and Unsubsidized Consumers, on next page).


That data confirmed how the financial subsidies are bringing health care within reach to the 85 percent of Covered California enrollees who receive subsidies � with their cost of coverage dropping 11 percent in 2018, reflecting an average monthly cost of $116.
At the same time, the data finds that for unsubsidized consumers � buying either through Covered California or directly from the same carriers in the individual market �premiums increased at an average annual rate of 7.2 percent.

�An average monthly premium of $503 can be tough for those not getting subsidies,� said Lee. �However, over the past four years we�ve kept premium increases to about 7 percent. Our efforts to enroll a healthy pool of enrollees are paying off in lower increases for those who pay the full premium.�

On Jan. 18, Covered California released a report, �The Roller Coaster for Consumers Continues: The Prospect for Individual Health Insurance Markets Nationally for 2019: Risk Factors, Uncertainty and Potential Benefits of Stabilizing Policies,� which estimates that potential premium impacts for 2019 would likely vary greatly state by state, but could be as high as 30 percent in some states.

�Those who do not get help to buy health insurance � an estimated 6 million people across the country � will not have any protection against those rate increases,� Lee said. �The unsubsidized are too often forgotten, and we know that most are middle class Americans with a median income of $75,000. Many will be priced out of coverage if premium hikes are not held in check.�

Earlier this year Covered California released a study that found the enrollment drop in 2018 nationally could have been even greater if not for a dramatic increase in the news coverage of the enrollment periods and deadlines. Ogilvy, a global leader in communications and media, was commissioned to examine coverage trends for the 2017 and 2018 open-enrollment periods across the country. The report found that mentions of �enrollment,� �enrollment period� and �deadline� increased by 53 percent, 125 percent and 129 percent respectively year over year (see Fig. 3: National News Coverage About Open Enrollment Increased Dramatically Year Over Year).


In the absence of federal or state policy changes, rate increases in California in 2019 are likely to be steep but on the �low end� of the range for states nationally due to the starting relatively healthy risk mix and Covered California�s commitment to maintaining a robust marketing campaign to attract and retain a healthy consumer pool that reduces premiums for everyone.

Lee said federal action to stabilize the individual market could make a big difference for millions of unsubsidized consumers who otherwise will face large rate increases.

Since 2014, more than 3.4 million people have purchased health insurance through Covered California, and nearly 4 million have enrolled in the state�s Medi-Cal program. Together, the gains have cut the rate of the uninsured in California from 17 percent in 2013 to a historic low of 6.8 percent as of June 2017.

Consumers can still sign up for health care coverage if they experience a life-changing event, such as losing their health insurance, getting married, having a child or moving. For more information on special-enrollment rules, visit: www.CoveredCA.com/individuals-and-families/getting-covered/special-enrollment.

Eligible consumers who are interested in signing up should go to www.CoveredCA.com where they can get help to enroll. They can explore their options and find out if they qualify for financial help by using the Shop and Compare Tool. They can also get free and confidential enrollment assistance by visiting www.coveredca.com/find-help/ and searching among 800 storefronts statewide, or more than 17,000 certified enrollers who can assist consumers in understanding their choices and enrolling, including individuals who can assist in other languages. In addition, consumers can reach the Covered California service center by calling (800) 300-1506.

Consumers who qualify for Medi-Cal can enroll year-round.

[1] The NASHP report includes data as reported to the federal government, including more than 388,000 new enrollees who signed up for Covered California during the fifth open-enrollment period and 1.13 million re-enrolling consumers. Covered California reports 423,484 enrollees in order to be consistent with reporting new plan selections in each of the last five years. Not all consumers who sign up during open enrollment end up with effectuated coverage. Complete totals for effectuated enrollment are released in Covered California�s Active Member Profiles at http://hbex.coveredca.com/data-research/.
[2] Data for 2015 through 2017 from Centers for Medicare and Medicaid Services, �Marketplace Open Enrollment Public Use Files�: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/Plan_Selection_ZIP.html
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/2016_Open_Enrollment.htmlhttps://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/2015_Open_Enrollment.html

 Data for 2018 from Centers for Medicare and Medicaid Services, �Final Weekly Enrollment Snapshot For 2018 Open Enrollment Period� (December 28, 2017):https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending and equivalent state marketplace data compiled by the National Academy for State Health Policy.

 [3] Unsubsidized consumers are those who do not receive financial assistance from the federal government to pay their health insurance premiums. These consumers can purchase inside and outside of the exchange. Unsubsidized consumers in the individual market total 1.15 million, of whom roughly 1 million are in Affordable Care Act-compliant, non-grandfathered plans. See below for more detail about the unsubsidized premiums shown.

 Subsidized consumers are those who receive substantial financial assistance from the federal government to pay their health insurance premiums. The Affordable Care Act requires consumers to purchase through the exchange to receive this assistance. In California, subsidized consumers total approximately 1.2 million people.
Premiums are the actual observed average premiums in Covered California administrative data for renewal and open enrollment plan selections, and the percentage change is the change to the average observed premiums. Year over year, the average premiums shown may be influenced by changes in the population distributions (such as for region, age, metal tier, etc.). Average premiums for the off-exchange market as a whole could differ from the Covered California unsubsidized premiums to the extent that the off-exchange population and plan-choice profiles differ from the on-exchange, unsubsidized profile. Additionally, the 2018 unsubsidized premiums have been adjusted to remove the cost-sharing reduction �surcharge� in Silver, since off-exchange enrollees do not incur the surcharge and Covered California encouraged its unsubsidized Silver enrollees to move off-exchange to avoid the surcharge in 2018.


 About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.


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Wednesday, January 31, 2018

January 31, 2018

Final Day of Open Enrollment! Covered California Will Help Consumers Who Get Caught Up in Surge of Last-Minute Shoppers




  • Covered California�s open-enrollment period ends at midnight tonight.
  • Due to an expected increase in demand today, consumers who start an application before midnight will be able to work with a certified enroller to complete the process on Thursday or Friday.
  • Covered California Service Center representatives are available to help through midnight on the 31st and through 8 p.m. on Feb. 1 and 2.
SACRAMENTO, Calif. � On the final day of open enrollment, with tens of thousands of people expected to sign up for health coverage, Covered California announced it would help consumers �cross the finish line� if they get caught up in the surge of last-minute shoppers.

�Our numbers are very strong this year, and history shows us that thousands of consumers will sign up on the last day,� said Peter V. Lee, executive director of Covered California. �Health care is too important, and we want to make sure that people who want to get covered are not caught up in today�s expected surge of last-minute shoppers.�

Consumers who begin their application by the end of Jan. 31 will have until midnight Feb. 2 to complete the process with the help of a Certified Insurance Agent. They may also get help from a Service Center representative, but only through 8 p.m. on Thursday and Friday. Community enrollment partners such as Certified Enrollment Counselors, Certified Application Counselors and Plan-Based Enrollers will also be able to assist.

Those who finish their application by Feb. 2 will have their health care coverage start on March 1, 2018.

�Our top priority is making sure Californians have the time and help they need to find the Covered California health plan that works best for them,� Lee said. �Covered California has partners who will make enrollment easier than you think, and with the financial help that is available it can be more affordable than you realize.�

A recent Covered California analysis found that the net monthly premiums for enrollees who receive financial help are on average 10 percent lower than what new and renewing consumers paid last year. The lower prices are a result of more financial help being available for consumers who qualify for assistance. The Affordable Care Act is designed to protect consumers by providing more premium tax credits when premiums rise. And for the many Californians in the individual market who do not get financial help, the robust competition has meant that for many, premium increases have been kept in the single digits.

Since 2014, more than 3 million people have purchased health insurance through Covered California, and nearly 4 million have enrolled in the state�s Medi-Cal program. Together, the gains have cut the rate of the uninsured in California from 17 percent in 2013 to a historic low of 6.8 percent as of June 2017.

Consumers interested in learning more about their coverage options should go to www.CoveredCA.com where they can get help to enroll. They can explore their options and find out if they qualify for financial help by using the Shop and Compare Tool. They can also get free and confidential enrollment assistance by visiting www.coveredca.com/find-help/ and searching among 800 storefronts statewide, or more than 17,000 certified enrollers who can assist consumers in understanding their choices and enrolling, including individuals who can assist in other languages. In addition, consumers can reach the Covered California service center by calling (800) 300-1506.

Once open enrollment ends, consumers may sign up only if they experience a life-changing event such as losing their health care coverage, getting married, having a child or moving. Medi-Cal enrollment is year-round.

About Covered California
Covered California is the state�s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California�s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.
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