THE AFFORDABLE CARE ACT’S MARKETPLACES Results From The First Three Months

Sara R. Collins, Ph.D.Vice President, Health Care Coverage and Access The Commonwealth Fund

SABEW: The Business of Health CareNew York, NY

January 22, 2014

Exhibit 1. Trends in Cumulative Number of Individuals Who Have Selected a Marketplace Plan Through the

Federally-facilitated Marketplace (FFM), October 1 to December 28, 2013

Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.

THE COMMONWEALTH

FUND

Exhibit 2. More than 2 Million People Have Selected or Enrolled in Marketplace Plans, as of Dec. 28, 2013

Eligible for marketplace plansHHS Report (12/28)

Selected a marketplace plan*HHS Report (12/28)

Eligible for Medicaid/CHIP

HHS Report (12/28)

State-run marketplaces

1,794,708 956,991 833,389

Federally facilitated marketplaces

3,345,090 1,196,430 751,120

Total in all marketplaces

5,139,798 2,153,421 1,584,509

CBO 2014 enrollment projection

7,000,000 7,000,000 9,000,000

Percent of CBO 2014 enrollment projection

73.4% 30.8% 17.6%

*People who have selected a marketplace plan may or may not have paid their premiums, and thus finalized their enrollment. Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf; and state websites.

TX

FL

NMGA

AZ

CA

WY

NV

AK

OK

MSLA

MTWA

OR ID SD

ND

MNWI

MI

AR

OH

AL

PA

NY

ME

MA

NHVT

HI

UTCO

KS

NEIA

MO

IL IN

KY

WV VA

NC

SC

DCMD

DE

NJ

CTRI

TN

Percent of three month enrollment target reached by 12/28/2013

<50%

50%-<75%

75%-<100%

100%+

Exhibit 3. Ten States Have Reached or Exceeded Their Three Month Marketplace Enrollment Target as of Dec. 28, 2013

Source: Memo from Marilyn Tavenner, CMS Administrator, Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014, September 5, 2013, http://waysandmeans.house.gov/uploadedfiles/enrolltargets_09052013_.pdf; Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

Exhibit 4. Trends in Cumulative Number of Young Adults Who Have Selected a Marketplace Plan Through the

Federally-facilitated Marketplace (FFM), October 1 to December 28, 2013

Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.

50–6428%

19–3441%

35–4931%

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Exhibit 5. Distribution of Marketplace Visitors and Marketplace Enrollees by Age

Note: Segments may not sum to 100 percent because of rounding.Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013 and Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.

18-3424%

35-4415%

45-5422%

55-6433%

<186%

Adults who selected a marketplace plan

50–6428%

19–3441%

35–4931%

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Exhibit 6. More than Three-Fourths of Visitors Report Being in Excellent, Very Good, or Good Health

Don’t know or refused

1%

Health status

Note: Segments may not sum to 100 percent because of rounding.Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013.

Excellent17%

Very good37%

Good23%

Fair17%

Poor6%

Exhibit 7. By Dec. 2013, More Adults Who Visited the Marketplaces Found It Easy to Compare Plan Benefits and Premiums

How easy or difficult was it to compare the … of different insurance plans?

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Dec. 2013

Oct. 2013

Dec. 2013

Oct. 2013

Dec. 2013

Oct. 2013

26

20

18

25

19

25

27

31

23

27

32

33

22

14

30

21

24

19

16

19

21

16

20

11

Note: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding.* Potential out-of-pocket costs from deductibles and copayments. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013.

3058

3752

3451

Percent

Benefits covered

Premium costs

Potential out-of-pocket costs*

Somewhat easy Very easySomewhat difficultVery difficult or impossible

4351

5142

3854

Exhibit 8. Adults Who Visited the Marketplaces Continued to Report Difficulties Finding a Plan with the Type of Coverage They Needed

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Note: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding.* Potential out-of-pocket costs from deductibles and copayments. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013.

How easy or difficult was it to find…?

Dec. 2013

Oct. 2013

Dec. 2013

Oct. 2013

19

21

27

19

39

40

33

38

20

14

19

16

17

16

17

21 38

30

56

61

Percent

A plan with the type of coverage you need

A plan you could afford

Somewhat easy Very easySomewhat difficultVery difficult or impossible

60 36

3758

Exhibit 9. Marketplace Plan Selection by Metal Level and Financial Assistance Status, October 1 to December 28, 2013

Percent of individuals who selected a plan

Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.

Metal Level Financial Assistance0

20

40

60

80

100

1

20

79

60

2113

7 Yes No

PlatinumGoldSilverBronzeCatastrophic

Exhibit 10. A Majority of Adults Who Have Visited the Marketplaces Rate Their Experience as Fair or Poor

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Excellent or good Fair or poor Don't know or refused0

25

50

75

100

27% 70% 3%29% 69% 2%

Oct. 2013 Dec. 2013

Overall, how would you describe your experience in trying to get health insurance through the marketplace in your state?

Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013.

Percent

Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace

Once39%

More than once59%

Adults ages 19–64 who are uninsured or have individual coverage and went

to marketplace more than once

How many times did you visit the marketplace—did you visit once, or more than once?

Exhibit 11. A Majority of Adults Who Visited the Marketplaces Went More Than Once; Three of 10 Said Their Experience Improved Over the Course of Their Visits

Improved29% Stayed

about the same52%Got

worse18%

Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013.

From your first visit to your last visit, did your experience in trying to get

health insurance through the marketplace in your state…?

Don’t know or refused

2%

Exhibit 12. A Majority of Adults Potentially Eligible for Coverage Who Have Not Yet Enrolled Say They Are Likely to Shop for Coverage by March 31, 2014

Adults ages 19–64 who are uninsured or have individual coverage* and who have not gone to marketplace, or went to marketplace but did not apply or did not enroll

The enrollment period for health insurance in the marketplaces ends on March 31, 2014. How likely are you to go to/go back to the marketplace by March 31, 2014, to enroll in a health

plan or find out if you are eligible for financial help to pay for your plan or for Medicaid?

Fair or poor

Excellent, very good, or good

50–64

35–49

19–34

Total

10

8

9

7

10

8

18

33

31

27

30

28

25

22

16

26

25

23

42

33

39

35

33

36

Percent

Somewhat likely Very likelySomewhat unlikelyVery unlikely

Notes: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding.* Respondents with individual market coverage who said they had received an offer from their insurance carrier to renew their plan for 2014 and said they planned to keep their policies were excluded from this analysis. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013.

Age

Health Status

37

39

32

40

41

28 67

55

55

61

58

59

Acknowledgements

David BlumenthalPresident

Michelle DotyVice President

Survey Research and Evaluation

Tracy GarberSenior Policy Associate

Health Care Coverage and Access

Petra RasmussenSenior Research Associate

Health Care Coverage and Access