Interactive graphic below
Connecticut’s health insurance exchange is nearing its goal of getting 100,000 people signed up for coverage this year.
But how close it is to another key goal -- substantially reducing the number of state residents without health insurance -- remains unclear.
A central aim of the federal health law commonly known as Obamacare was to get the uninsured covered. But the application for Connecticut’s exchange, Access Health CT, doesn’t ask whether people have coverage at the time they’re applying.
The application used on the federal exchange site, healthcare.gov, doesn’t ask either, and federal officials haven’t provided data on the number of enrollees who were uninsured.
That's left some critics of the health law wondering about how effective it's been.
“If you’re going to claim that you’re solving the problem of uninsured, you should be able to demonstrate that you’re solving the problem of uninsured people,” said Rep. Rob Sampson, a Wolcott Republican who is the ranking member of the legislature’s Insurance and Real Estate Committee.
Sampson doubts that Connecticut's exchange is dramatically lowering the number of uninsured residents. Instead, he thinks, “What we have is the shift of people that we had on the individual market [to] the exchange.”
Among people buying private insurance on the exchanges nationally, one recent survey by the consulting firm McKinsey & Co. found that just 11 percent had been uninsured in 2013.
Access Health officials hope to gain some insight into the previous insurance status of their customers later this month. The exchange's application asks for information about applicants' existing insurance carrier, which CEO Kevin Counihan said is a "pretty good proxy" for whether the person had insurance. The exchange will run a query on how people answered that question this month, he said.
Counihan said he suspects that between one-quarter and one-half of the exchange’s enrollees were uninsured before signing up for private insurance or Medicaid.
Census figures show Connecticut has about 310,000 uninsured residents, or about 8.8 percent of the population, although the exchange is using a lower figure from the Kaiser Family Foundation that suggests the state has 286,000 uninsured residents under 65. Counihan expects that enough people without coverage will sign up that the uninsured rate will dip below 8 percent.
Who's shopping CT's exchange?
So far, about 94,000 people have signed up for private insurance or the state’s expanded Medicaid program through Access Health. (That figure doesn’t include “organic” Medicaid growth -- that is, people who signed up for parts of the Medicaid program that predated the health law. The federal government asks exchanges to include that information in their tallies, and Access Health officials have used an estimate of 10,000 additional organic Medicaid enrollees, although the exact number is not clear.)
If the uninsured don’t make up the bulk of exchange customers, who would?
Chances are, many are people like Robert J. Harrity Jr., whose family had bought coverage through the state’s individual market until receiving a notice in September that their policy was being discontinued.
As of late November, 63,698 people in Connecticut were in a similar situation, with insurance plans slated to be discontinued, either because they didn’t meet the new requirements of the Affordable Care Act or because the carriers had decided to stop offering them. (The total number of people with discontinued plans was higher, but many chose to either renew their plans early or buy a similar plan before Jan. 1, meaning they didn't need to look for a new policy.)
More than 4,000 other state residents were left in need of new coverage because two smaller health programs have been or will be discontinued. One, the state-run Charter Oak Health Plan, covered 3,546 people in December, its last month in existence. Another 765 people were covered in November by the Connecticut Pre-Existing Condition Insurance Plan, a federally subsidized program for people with medical conditions that was slated to end Dec. 31 but has been extended until March 31 for existing members.
**This figure refers to people who signed up for private insurance plans or the expanded Medicaid program. It does not include people who signed up for Medicaid coverage available before Obamacare.
There are other potential exchange customers in the state, too, beyond the uninsured, like those who had individual-market plans but decided to buy a policy through Access Health instead, or people whose employers stopped offering coverage.
How many uninsured will sign up?
Even those who are optimistic about Obamacare's chances of substantially reducing the number of uninsured don't expect everyone who needs coverage to sign up this year. But just how many will remains an open question.
According to data released last week by the polling firm Gallup, 53 percent of uninsured Americans said they planned to get health insurance, while 38 percent said they’d pay the fine that many people will have to pay for not having coverage.
Gallup previously reported that its research suggested that the nation’s uninsured rate had dropped modestly in January, when many of the new coverage provisions of Obamacare took effect, from 17.3 percent to 16.1 percent. The uninsured rate fell the most among people who were unemployed, nonwhite or ages 35 to 64. But because fluctuations in the uninsured rate aren’t unusual, it’s not clear if the drop is the result of the health law, Gallup methodologist Jenna Levy wrote.
Was it worth it?
Harrity, whose old plan was discontinued, is among those wondering how many of the exchange customers were uninsured. To him, if the number is relatively small, the cost of Obamacare and the disruption it caused to the rest of the insurance market won't have been worth it.
Because Harrity and his wife are self-employed, they bought their own insurance for years. Their most recent plan had a $2,500 deductible. Because their children are grown, they excluded benefits like maternity and pediatric coverage to keep costs down. And they were careful to buy a PPO plan that allowed them to see a wide range of doctors.
Harrity, who lives in North Haven, became eligible for Medicare last year, but when their old plan was discontinued, his wife needed coverage, so they shopped on the exchange. The plan they bought costs about 22 percent more than their old policy, and covers benefits they had previously chosen not to buy.
“The disruption was not worth it," he said. "We have significantly higher costs and insurance…that has features we don’t need. We considered the old policy a good one with features we valued and deductibles we could afford.”
Harrity thinks the high deductibles in exchange plans are likely discouraging the uninsured from signing up, even if they would get financial assistance with their premiums. He’s also critical of the way the law has been rolled out, noting that while many of the uninsured speak Spanish, the Spanish-language exchange website was delayed.
Sampson said one of the main reasons people have been uninsured is cost, and that the health law does little to lower the cost of health care or insurance. Instead, he said, it largely shifts costs around, from some consumers to others.
Changes for the insured, too
Counihan said that it’s still early to make judgments. The exchange is still accepting applications through the end of next month, and officials expect a surge in late March. The implementation of the health law is a three- to four-year process, not something that will be complete in a matter of months, he said.
And while one goal is to get the uninsured covered, Counihan said it wasn’t the only aim of the health law.
“A key part of the [Affordable Care Act] is trying to make an expensive product more affordable through the subsidies,” he said. “When you say is it worth all the market disruption for that, I think it has to be looked at not just on the uninsured level but also on the affordability level.”
Just over 70 percent of the people who signed up for private insurance through the exchange so far qualified for federal financial assistance to subsidize their premiums.
And nearly 44 percent of the private insurance enrollees earn incomes low enough that they also qualify for subsidies to help cover their cost-sharing expenses like copays and deductibles too. Of about 48,740 people who signed up for private insurance, 21,341 have incomes below 250 percent of the poverty level, or the equivalent of $28,725 for a single person and $58,875 for a family of four.