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Reform Update: Analysis finds disparities in success of states' exchange signups


By Paul Demko
Posted: January 27, 2014 - 3:30 pm ET
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Significant disparities are developing in states' success at signing up individuals for coverage through the state and federal exchanges, according to a new analysis, and the gaps don't consistently reflect which states have embraced or opposed the Patient Protection and Affordable Care Act.

During the initial 15 weeks of the open-enrollment period, just 3% of those eligible to purchase coverage in Mississippi signed up for a plan. By contrast, 54% of those eligible to buy private coverage in Vermont purchased insurance, according to a new analysis of enrollments by the McKinsey Center for U.S. Health System Reform.

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Among the 10 states with the highest number of enrollments, the percentage of eligible residents signing up ranged from 4% in Texas to 16% in California.

There are also significant disparities in how much progress states are making toward enrollment targets detailed in a Sept. 5 memo from the CMS (PDF). Connecticut has already surpassed its goal of 33,000 enrollments by the close of the March 31 window. New York also made significant progress in the initial 15 weeks of enrollments, reaching 72 % of its target, while North Carolina signed up 56% of its goal.

At the opposite end of the spectrum was Massachusetts' exchange, which has been plagued by technical problems, with just 2% of targeted enrollments.

The results confound what one might expect given the range of enthusiasm for the Affordable Care Act among those states. Massachusetts and New York both established state-based exchanges and have vigorously promoted the online marketplaces, while officials in North Carolina have largely been hostile to the reform law.

McKinsey's analysis also provides further evidence that the insurance pool is skewing significantly older than demographics would suggest. Among those who signed up for private coverage, 35% were between 55 and 64 years old. That's despite the fact that individuals in that age bracket make up just 16% of eligible consumers. By contrast, individuals aged 18 to 34 accounted for just 26% of signups, despite representing 43% of the eligible consumer pool.

The McKinsey report looked at only the 2.2 million enrollments that HHS officials detailed in a Jan. 13 report (PDF). On Friday, federal officials announced that 3 million people have now signed up for private health plans through the state and federal exchanges. That's roughly 40% of the goal of 7.2 million enrollments by the close of the sign-up period March 31.

McKinsey also released the latest results from its periodic survey of individuals eligible to purchase coverage through the state and federal exchanges. The research firm polled more than 4,500 individuals in November, December and January. Of those, 28% indicated that they had purchased individual coverage. But just 11% of the individuals who bought insurance reported that they were uninsured in 2013.

The numbers were slightly better for individuals who were surveyed in January. Of those 1,040 respondents, 36% reported that they had purchased coverage. The most common barrier cited to obtaining coverage was affordability, with more than half of respondents citing cost as an impediment. Technical problems with the online marketplaces also continued to hinder enrollments, with 30% of respondents citing technical challenges as a barrier.

Judges order UnitedHealthcare, medical societies to find solution to dispute

Judges for the U.S. Court of Appeals' Second District in New York have ordered UnitedHealthcare and the Fairfield and Hartford county medical societies in Connecticut to find a solution to their legal dispute and bring it before the court next week.

After a Jan. 21 hearing, the court ordered both sides to participate “at the earliest possible opportunity” in the court's Civil Appeals Management Program and file a statement Feb. 4 indicating the results, “if any,” of that conference. The conference is scheduled for Jan. 30, the Fairfield County Medical Association reported.

The associations sued after the Minnetonka, Minn.-based insurance company dropped some 2,200 doctors from its Medicare Advantage network last fall. The cuts were scheduled for Feb. 1, and a preliminary injunction stopping them was issued in December. UnitedHealthcare appealed that decision.

The insurer, the largest Advantage carrier in the U.S., has said winnowing its networks is necessary to ensure that the plans remain sustainable as the CMS carries out reimbursement cuts called for under the Patient Protection and Affordable Care Act. –Andis Robeznieks

Follow Paul Demko on Twitter: @MHpdemko


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