More Data Needed on Actual Number of New Enrollees and Decrease in the Uninsured  

New figures released by federal officials yesterday show that nearly 3.3 million people picked a private health insurance plan through the federal Marketplace by February 1, including more than 56,000 in Wisconsin. In addition, slightly over 60,000 Wisconsinites who applied through the Marketplace were found eligible for Medicaid or the Children’s Health Insurance Program (CHIP).  However, many of the people in those two groups aren’t actually enrolled – in some cases because they hadn’t paid a premium yet, and in many other cases because of the postponement of eligibility changes in Wisconsin until April 1.

There are a number of gaps in the data and various caveats that one should note about what to make of some of these preliminary numbers. However, before getting into the weeds, I think the major takeaway from the new data is that a large number of people in Wisconsin and elsewhere are gaining access to health insurance, yet there is still a lot of progress to be made to bring about a substantial drop in the percentage of Wisconsinites who are uninsured.

Back in September, the Centers for Medicare and Medicaid Services (CMS) issued a memo laying out national and state targets for private enrollment through the Marketplace, on a month-by-month basis. Nationally the number of people who have selected a plan is 75% of the way to that 4-month target (of 4.4 million people), but the Wisconsin figure is 15% above the CMS goal for our state. (See the table in this updated and interesting NY Times resource, which is incorrectly dated Jan. 13th.)

As I indicated a month ago, I think it’s good news that Wisconsin is ahead of the early targets that CMS set, but I suspect that might be explained by goals that don’t carefully account for all the state-level variables. It appears to me that the standard for our state was based primarily on the number of uninsured Wisconsinites, without taking into consideration the fact that Wisconsin has a large pool of adults in BadgerCare who need to switch over to private coverage.

The current CMS figures don’t show how many of the people who were found eligible and have selected an insurance plan have actually paid their first premium. I strongly suspect that that percentage is much lower in Wisconsin than most other states because of the number of current BadgerCare participants who used the Marketplace in November and December to select private plans, but have delayed paying their first premium because of the 3-month extension of their BadgerCare coverage (which is not only a better deal than a Marketplace plan, but also disqualifies them from eligibility for Marketplace subsides until April 1).

A somewhat disappointing part of the new data for Wisconsin is that just 20% of the initial sign-ups are in the age range of 18-34, compared to 25% nationally.  (See the NY Times analysis.)  I think that could be because substantial segments of the early sign-ups in Wisconsin are coming from parents who have been participating in BadgerCare and older childless adults who will either be losing BadgerCare Core coverage or have been on the waiting list.  Although I don’t think Wisconsin is significantly behind other states in signing up young adults, much more outreach is needed to this demographic.

Here are some of the other figures from the first four months of Marketplace data for Wisconsin:

• 56% of the people who have selected a private plan are female.
• 4% are children and, as noted above, 20% are age 18-34.
• 32% are age 35-54, and 43% are age 55-64.
• 70% of Wisconsin participants chose a silver plan, versus 19% bronze, 10% gold, just 1% platinum, and 1% chose a catastrophic plan.
• 89% of the Wisconsinites who have selected a plan are eligible for federal financial assistance (compared to 82% nationally).

In Wisconsin and nationally, the number of people who have completed applications and been found eligible to enroll in the Marketplace is still more than twice the number of people who have selected a Marketplace plan, although that ratio has come down a bit.

One of the numbers to use with caution is that the Marketplace has found 60,085 Wisconsinites to be eligible for Medicaid or CHIP coverage.  Keep in mind that most of those people are probably adults without dependent children, and they remain ineligible to actually get coverage until April 1.  Also, problems with the federal software last year (coupled with delays in initiation of state software changes) appear to have resulted in some errors in determining BadgerCare eligibility. I suspect that a number of people will be notified by the state in April that they need to move to Marketplace plans in May.

In summary, the current numbers aren’t as complete as we would like and are likely to be in a state of flux for the next few months.  But they clearly show a very strong level of public interest in getting health insurance, as well as significant progress in making that happen.

Jon Peacock