With Covered California’s announcement Wednesday that 1.57 million Californians selected health plans during its third open enrollment period, at least one health care expert believes that the nation’s bellwether state in implementing the Affordable Care Act is now essentially running in place.
Although the latest numbers don’t say how many people have paid for their plan to complete their enrollment — the only figure that really counts and which will be available in a few months — some experts say that the net gain from last year’s 1.3 million total could be minimal.
Roughly one of 10 people who sign up for an exchange plan don’t complete their enrollment. So Covered California’s projected total for the latest enrollment period could easily wind up around 1.4 million — about 100,000 more than last year.
“The national numbers showed only an 8.5 percent increase in Obamacare enrollment during the 2016 open enrollment,” said Robert Laszewski, a nationally renowned health care policy expert. “It is clear that Obamacare enrollment is plateauing both in California and nationally.”
But Laurel Lucia, a policy analyst at the UC Berkeley Center for Labor Research and Education, said that although she expects Covered California enrollment to plateau in a few years, “It’s still too early to know without better data whether it is already plateauing in California.”
Despite Covered California’s $29 million marketing campaign to publicize the exchange, many uninsured Californians continue to say they can’t justify paying for health insurance, even if they have to pay a large fine for remaining unprotected.
The penalty for anyone who did not sign up for a 2016 plan is a lot steeper this year: $695, or 2.5 percent of income, whichever is higher.
Lucia said even those who qualify for a subsidy may struggle to buy insurance because the subsidy amount set by the federal government does not account for regional differences in the cost of living.
“In areas in California with high housing costs, some Californians have less room in their budget to spend on health care,” Lucia said.
Wednesday’s news comes on the heels of a state auditor’s report that continues to characterize Covered California as a “high risk entity” because its financial sustainability depends entirely on enrollment. But, as Wednesday’s unofficial numbers suggested and Tuesday’s auditor’s report noted, future enrollment is both unpredictable and based on factors outside of the exchange’s control.
Moreover, because the exchange will exhaust its more than $1 billion in federal funding by September, it will have to support itself through revenues based on the $13.95 monthly fee it collects from each plan sold through the exchange.
But if Covered California’s enrollment numbers don’t budge much and the exchange doesn’t meet its revenue goals, the auditor’s report said, it will have to increase those monthly fees on the plans, use its reserves or cut costs.
Asked about the early numbers, Covered California spokeswoman Amy Palmer on Wednesday would only say that the total of new enrollees “was at the high end of our forecast, and with the younger mix of consumers we feel very good about the enrollment and the mix.”
The exchange set a goal of enrolling 295,000 to 450,000 Californians who had never brought insurance through the exchange before.
“We very deliberately did not say where we would be at the end of open enrollment, having gleaned in our second year that you don’t renew every single person who enrolled,” Palmer said.
Last year, Covered California projected that enrollment would be 1.7 million, but came up 400,000 short.
During a brief telephone call with the media on Wednesday, Peter Lee, executive director of Covered California, did not focus on enrollment numbers, other than saying that about 440,000 people were new enrollees. And, he said, the “vast majority of renewing consumers seem satisfied,” noting that 88 percent of them stayed with the same health plan.
This third enrollment period also saw a 37 percent increase in younger enrollees from the ages of 18 to 34, compared with 29 percent during the first open enrollment period in 2013-14.
Blue Shield of California has taken the lead from Anthem Blue Cross of California in Covered California’s market share, with 28 percent. Anthem has 25 percent, followed by Kaiser Permanente with 24 percent and Health Net with 14 percent. Eight other health plans rounded out the difference.
While the open enrollment period ended Jan. 31, “special enrollment” continues year-round. Consumers can sign up for a plan within 60 days of certain life events such as marriage or birth of a child, or the loss of other health coverage because of changing or losing a job.
Enrollment in Medi-Cal, the government health care plan for the poor and disabled, is year-round.