86 Percent of Health Law Enrollees Receive Subsidies, White House Says

New York Times – by Robert Pear

WASHINGTON — The Obama administration said Tuesday that 11.7 million Americans now have private health insurance through federal and state marketplaces, with 86 percent of them receiving financial assistance from the federal government to help pay premiums.

About three-fourths of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the website for the federal insurance exchange. The other 2.9 million people are in states that created and operate their own exchanges.  

Sylvia Mathews Burwell, the secretary of health and human services, underlined the importance of subsidies for people in states using the federal exchange — subsidies that could be withdrawn if the Supreme Court rules against the Obama administration in a pending case.

Administration officials suggested that more than seven million people could lose subsidies, making insurance unaffordable, if the court ruled that such assistance was unavailable in the federal exchange. The plaintiffs contend that the Affordable Care Act does not allow subsidies in the federal exchange.

In Florida, nearly 1.6 million people have selected or been automatically re-enrolled in health plans — the largest enrollment of any state in the federal exchange — and 1.5 million of them qualified for subsidies in the form of tax credits, which averaged $294 a month.

In Texas, 1.2 million people selected or were re-enrolled in health plans, and one million of them qualified for financial assistance averaging $239 a month. In North Carolina, 560,400 people selected health plans in the federal marketplace, and 515,500 of them qualified for subsidies averaging $315 a month.

Consumers in the federal exchange paid an average premium of $101 a month after tax credits, and 55 percent of them paid monthly premiums of $100 or less after tax credits, the administration said in a new report.

For people in states using HealthCare.gov, tax credits averaged $263 a month and reduced the premium by 72 percent, on average. That is similar to the share of premiums paid by employers for their workers’ family coverage.

The latest enrollment period began Nov. 15 and ended Feb. 15, but the administration has extended the deadline or granted a special enrollment period to some people who began their applications before the deadline or just discovered that they would owe a tax penalty because they were uninsured in 2014.

The rush to sign up before the deadline was less significant this year than last. Nearly one-fifth of sign-ups in the federal exchange occurred in the last month of enrollment, compared with one-half in the comparable period of 2014.

Dr. Meena Seshamani, director of the Office of Health Reform at the Department of Health and Human Services, said that 6.7 million people had marketplace coverage at the start of the latest enrollment period. So it would appear that five million more people signed up. But the total of 11.7 million people with marketplace coverage could decline as some fail to pay premiums and have their coverage terminated.

Numbers in the new report suggest that the administration is struggling to sign up members of minority groups. Of those who selected a plan, 11 percent were Latinos, the same proportion as last year, and 14 percent were African-Americans, down from 17 percent last year, the report said. Blacks and Latinos are much more likely to be uninsured than are non-Hispanic whites.

But Dr. Seshamani said, “The data on race and ethnicity should be interpreted with great caution since more than one-third of enrollees do not provide these data.”

Some experts had predicted that people with marketplace coverage would continue their coverage in the same health plans. But many switched plans, indicating that they were active shoppers looking for better coverage or better value.

Of the 4.2 million people who had coverage in the federal marketplace in 2014 and 2015, about 1.2 million, or 29 percent, switched to a different plan.

“This is a much higher proportion than seen in other programs,” like Medicare’s prescription drug coverage, or in employer-sponsored health plans, said Kevin Griffis, a spokesman for the Health and Human Services Department.

Larry Levitt, a senior vice president of the Kaiser Family Foundation, said some data in the report suggested that consumers were shifting to lower-cost plans. “These enrollees are very, very price-conscious,” he said.

Almost 3.3 million people ages 18 to 34 are signed up for marketplace coverage. They account for 28 percent of people selecting health plans for 2015, the same proportion as last year, the administration said. Insurers covet consumers in this age group because they tend to be healthy, and their premiums provide revenue to help pay claims for others.


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