Less than two weeks remain before the end of the Affordable Care Act’s inaugural open enrollment period.
The widespread technical problems that plagued HealthCare.gov during the first months of the open enrollment period have largely been put to rest, and enrollment has begun to climb.
In Wisconsin, despite getting off to an extremely sluggish start with only 877 signups in the first month of open enrollment, 56,436 people had signed up for coverage on the ACA marketplace as of the end of January, putting Wisconsin ahead of the U.S. Department of Health and Human Services’ pre-launch enrollment targets.
“The numbers are robust,” said J.P Wieske, spokesman for the Wisconsin Office of the Commissioner of Insurance.
In September, HHS projected monthly enrollment targets for each state, putting Wisconsin’s cumulative projection for the end of January at 48,980. Wisconsin also beat its monthly target for January – 11,850 – with 15,684 signing up during the month.
What is not yet known, however, is the number of people who have paid a premium for marketplace health insurance. In January, half of Wisconsin’s Obamacare enrollees to that point had paid their first month’s premium. OCI was not able to provide any updated information on what percentage of premium payments have been made.
Wisconsin is one of six Republican-led states, along with Florida, Idaho, Maine, Michigan and North Carolina, that are on pace or better than targets for overall enrollment numbers.
Wieske said the state’s strategy for outreach was on a regional basis, emphasizing in-person outreach over advertising.
“A lot of what (the Wisconsin Department of Health Services) does is not splashy,” Wieske said. “It was more along the lines of, let’s work with counties, let’s work with agents, let’s work with hospitals, let’s make sure people are aware of what their options are, etc. They’ve done a good job of doing that regionally, and not doing it through a top-down standpoint.”
Because enrollment and outreach challenges are varied in different parts of the state, Wieske said, regional enrollment networks have played a big part in getting people covered.
“There’s a big difference dealing with Milwaukee than it is in Green Bay than it is in much more rural areas of Wisconsin,” Wieske said. “Each one of those has different issues and I think we’ve done a good job setting up those regional enrollment networks.”
Claire Smith, DHS spokesperson, said the state agency applied what it learned when Medicare Part D was unveiled, where it found that facilitating a “grassroots approach” to work with various partners in its outreach proved to be effective.
“What we’ve been doing and what we continue to do is develop regional enrollment networks and (execute) a grassroots outreach campaign, both with the Feds through the marketplace and the state with BadgerCare Plus,” she said.
Wisconsin’s rate of enrollment, she said “reflects on our partners on the ground and reaching people in the community and working with trusted organizations that people know.”
Though it appears Wisconsin is ahead of the curve in terms of overall enrollment, one item of potential concern is the age breakdown of the people signing up for coverage on the marketplace.
As of the end of January, 43 percent of enrollees were between the ages of 55 and 64. Just 20 percent of enrollees were between the ages of 18 and 34 – a critical age group to the function of the Affordable Care Act – below the national average of 25 percent, and among the lowest rates in the country.
“That’s going to be an issue,” Wieske said. “It’s certainly something to look at. The argument is that some young folks will sign up late, but we don’t know if that’s going to happen or not. If we see that skewing older, that could lead to premiums going up next year.”
Wieske said the amount of financial assistance for a younger person is going to be lower than it is for an older person.
“We have to watch that,” he said. “If you look at how the ACA is structured as far as cost perspective goes, there’s a skewing toward older folks.”
End of January numbers showed that 89 percent of Wisconsin enrollees were purchasing coverage with financial assistance, ahead of the national rate of 82 percent.
Wieske said that while “the Feds said it would be great for young people,” insurers may be expecting a different outcome. The rates, ultimately, are determined by the insurers, not the federal government.
“If there’s a surprise, there’s going to be assumptions based on what the population is going to be next year,” Wieske said. “You build rates based on assumptions of what rates are going to look like. If it skews older, that’s going to impact costs.”
The HHS enrollment numbers apply only to people who are purchasing private health insurance coverage through the ACA marketplace, and do not include those seeking coverage under Medicaid or Medicare.
Sarah DeRoo, City of Milwaukee health communications officer, said a significant amount of outreach is being done in the city during the month of March, with more than 30 enrollment events across Milwaukee’s regional enrollment network, of which the city’s Health Department is a part.
Mayor Tom Barrett and County Executive Chris Abele proclaimed March “Enroll Milwaukee Month.”
While the open enrollment period is nearing its end, enrollment for Medicaid and BadgerCare in Wisconsin will continue on through the year.
DHS, the Milwaukee Health Care Partnership and the City of Milwaukee Health Department’s outreach efforts will also persist through year’s end.
On April 1, Gov. Scott Walker’s changes to the state’s BadgerCare Plus program will go into effect. These changes involve eliminating a cap on childless adults who can sign up for Medicaid. People earning above the federal poverty level are being moved to the ACA marketplace in Wisconsin and are to purchase their own coverage.
The federal poverty line for an individual is an annual income of $11,490. For a family of four, it is $23,550.
Smith said through the governor’s “entitlement reform plan, all adults in poverty will have access to the BadgerCare Plus plan.”
DeRoo said in Milwaukee, much has been “in flux” with the deadline decision, and that those “newly eligible (for Medicaid) under state changes have just begun to apply.”
Roughly 5,000 people enrolled in Medicaid citywide in 2013. DeRoo said there is a fairly large number of newly eligible residents that plan to sign up.
“The majority of people coming into the Health Department have been Medicaid eligible, which is not surprising to us,” she said. “We are the community safety net. One of the questions we get most is: ‘My BadgerCare Plus is changing. What does that mean for me?'”
Smith said DHS is working closely with the Milwaukee Health Care Partnership to get people the proper coverage in the Milwaukee area.
