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Friday, January 31, 2014

Q&A with Ron Pollack: Insight into the Latest Health Insurance Marketplace Enrollment Numbers

Talia Schmidt


A new and widely circulated Health & Human Services report indicates that approximately 2.2 million people bought health insurance through the marketplace through the end of December, 2013 (3 million, as of late January)—the first half of the inaugural open enrollment period. These figures paint an encouraging picture of enrollment—momentum is building. A marked increase in December enrollment figures supports this, as December’s enrollment figures in state-run marketplaces were more than three times greater than the total enrollment for the previous two months. And in the federally facilitated marketplace, the figures for December were even higher—nearly eight times higher than the total enrollment for the two preceding months.

We’ve turned an important corner, and the trend points to even stronger enrollment numbers in the second half of the open enrollment period. But there is still much work to do: recent research confirms that many people who may be eligible for health coverage remain unaware of their options and, more importantly, about the financial assistance available to help them to help pay for their health care—a key boost toward affordable health care.

We sat down with Families USA Executive Director, Ron Pollack, for some insight into what the future holds for buying health insurance during the open enrollment period.

Q:           What do you think accounts for the surge in people buying health insurance in December?

A:           I’m not surprised by this. It’s reasonable to expect more people to buy coverage now that has improved its operations. And it was reasonable to expect that people would take some time at the outset of open enrollment to assess their options, learn more about what is available to them, and think about which plan fit their family budget and health care needs. And, of course, the end of December was a crucial deadline for people who wanted insurance to start on January 1.

Some of the people who enrolled had received termination notices stating that their health insurance plan would be out by the end of the year. With their current health insurance plan (and let’s remember that the policies that got cancelled were substandard policies that offered poor value to consumers), this group of consumers turned to the new marketplaces. This helped them avoid a gap in coverage. Consequently, the second half of the open enrollment period will see the numbers surge even more.  These were substandard plans, such as plans that established arbitrary limits on how much the insurers would pay out in a year or a lifetime when a major illness or accident occurred. These were like Swiss cheese insurance policies, and many people upgraded their coverage before the end of the year.

But despite the fact that there was a surge in enrollment in December, we shouldn’t think that our job is done with respect to public education about the Affordable Care Act. The reason we’re not seeing more people enroll is because those who are skeptical or fearful of health insurance need to see that the new health system is different and better than the old model. When people who were uninsured tried to buy insurance in the past, they often encountered problems (cost, confusing paperwork, coverage denials because of a pre-existing condition, or coverage that was just simply too expensive). These health care consumers found that their needs weren’t being met. Now, these same people need to move past those negative experiences because, you’ve got to understand, the Affordable Care Act changes all of that.

You’ll recall that the same thing happened with Medicare Part D—the law passed in 2003 that gave Medicare recipients prescription drug coverage—when the beginning of enrollment didn’t see as many new enrollees, but picked up significantly by the end of the open enrollment period. And the same was true with Massachusetts’ health care law. Over time, enrollment increased. Data from a state-funded survey called the Massachusetts Health Insurance Survey indicate 372,000 state residents were uninsured in 2006, or 6.4 percent of the state’s population. As of 2010, Massachusetts boasted the lowest rate of uninsured people in the country.

Q:           What would you say to someone who is currently uninsured?

A:           Too many people without insurance don’t know how the financial subsidies can benefit them. If you’ve had a bad experience with your health insurance company, then you might view health insurance as unaffordable or even unattainable. It is our job to bridge that information gap. You now have the peace of mind in knowing that you can buy health insurance that is comprehensive and affordable. This insurance comes with strong protections for you that ensure that the insurance company doesn’t discriminate against you, turn you down, or fail to use your health care dollars wisely.

Also, the health system never included financial assistance (premium tax credits) to help you  buy health insurance before—that’s entirely new. Now, we have new help that makes health coverage affordable.

Q:           What significant trends have you seen in the first half of the open enrollment period?

A:           There are two important trends that I see so far. The first is that the states running their own health insurance marketplaces have seen higher enrollment numbers than those using a marketplace run by the federal government. I think that’s because these states tend to be the most interested in making the Affordable Care Act work. Therefore, because high enrollment is a critical part to success, these state-based marketplaces have made enrollment and outreach a priority—and they’re more successful at consistently reaching people.

The federal government has also given state-based marketplaces more money for outreach (such as advertising) and for enrollment navigators and assistors than federally run marketplaces. So I’d say that the advertising for state-based marketplaces has been considerably more effective because they have greater resources.

Here’s the breakdown of which states run their own marketplaces.

  • 17 states (including the District of Columbia) are running their own health insurance marketplace
  • 27 states are run by the federal marketplace (
  • 7 states are participating in partnership exchanges.

The second trend that I’m seeing is that the vast majority of people who have completed the enrollment process – 79 percent as of the end of December, 2013 –have qualified for financial assistance to help pay for their health plan. This is important because it confirms what we know about the people who lack insurance: most people who are uninsured need help paying for coverage in order to buy it. Financial assistance may ultimately be the most important factor in making enrollment successful, and we need to make sure that people know about it.

Q:           Opponents have criticized the enrollment effort for not convincing enough young adults to buy coverage, claiming that more of them need to buy into the system to make it sustainable. Is this accurate? And if so, what more needs to be done to reach this demographic?

A:           First, we need to make young adults aware that they are eligible for financial assistance (premium tax credits) in paying their monthly premiums

Second, we need to understand where these young adults are coming from. This key demographic often falls into one of three situations:

  1. They’re continuing their education
  2. They don’t have a job
  3. They’re working in an entry-level job that pays less than jobs held by people who have been employed longer

In any of these scenarios, being able to pay for health care remains the priority. Because young adults typically have the lowest incomes, the amount they’ll receive in financial assistance is the greatest. So young adults will disproportionately benefit from these health subsidies. The bottom line is to make sure they learn about availability of these substantial subsidies.

The President challenged Americans during his State of the Union speech earlier this week to help someone they know get covered. We agree that this is a priority. Worrying about getting sick and how to pay exorbitant medical bills, or struggling just to see a doctor, is no way to live. And because of important provisions in the Affordable Care Act, such as financial help for those with low incomes, you don’t have to.

The vast majority of people who have completed the enrollment process – 79 percent as of the end of December 2013 – have qualified for financial assistance to help pay for their health plan. This is important because it confirms what we know about the people who lack insurance: most people who are uninsured need help paying for coverage in order to buy it.

This blog was written with the assistance of Editor Talia Schmidt.