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State Marketplace Directors Predict Big Net Gains in Coverage

By Rebecca Adams, CQ HealthBeat Associate Editor

March 13, 2014 -- Top officials running six state-run health insurance marketplaces said last week that they expect strong gains in coverage over last year, even though they don't know how many people signing up were previously uninsured.

In New York, one state that is trying to track the gains, about 70 percent of applicants reported they did not have coverage when they signed up. The officials on a call with reporters were from California, Colorado, Connecticut, Kentucky, New York, and Washington.

"We don't have net gain numbers but I am absolutely certain it is a huge net gain in insurance," said Covered California Executive Director Peter Lee. California will rely on a statewide survey to determine the coverage gains arising from the health care law. Many in the state also saw their insurance policies expire because the benefits did not meet requirements of the overhaul (PL 111-148, PL 111-152).

California officials have reported separately that 923,832 people had enrolled in Covered California health insurance plans from October 1 through March 9. Another 1.1 million people who applied through the state exchange website were determined to probably qualify for Medicaid coverage, and an additional 968,500 people were enrolled in Medicaid through state or county agencies.

In states such as California and Colorado that have a sense of enrollment pay-up rates, at least 85 percent of people who signed up also paid their premiums. Although New York officials do not get such data quickly from insurers, New York State Department of Health counsel Lisa Sbrana said that officials are hearing similar numbers anecdotally. In Connecticut, 92 percent of individuals who signed up sent in their money, and Washington collects the money at the time of sign-ups, meaning all have paid.

State-run exchanges typically have had more success in enrolling large numbers of people than the federal website that is handling enrollment in 36 states. That is in part because states have more funding available for publicity and state officials are actively recruiting people to sign up.

The officials on the call organized by the advocacy group Families USA said that they do not yet have a sense of how insurers will price their 2015 premiums when the companies submit bids in May. In many states, the percentage of young adults among people signing up is lower than government officials wanted. In California, which makes up about one-fifth of the nation's enrollment this year in the marketplaces, about 26 percent of the sign-ups are in the 18- to 34-year-old range. That is proportional to the general population but below a goal of 40 percent that many officials had hoped for.

Washington Health Benefit Exchange CEO Richard Onizuka said that the percentage of young adults among people signing up for Medicaid are higher than among those enrolling in marketplace plans. He added that the average age of applicants is "creeping down."

Some officials said that they believe that federal financial protections for insurers will hold down premiums in the first few years.

"I can't get too excited about that issue," said Access Connecticut CEO Kevin Counihan about the share of the young adult population in enrollment.

Counihan has touted his state's success running its own marketplace so much that he is now peddling his staff's services to other states for a fee. One state has already expressed interest, he said on the call.

Other state officials also said they are pleased with the implementation so far, although some said it will continue to be challenging, particularly since state exchanges are supposed to be financially self-sustaining in 2015.

All of the officials are gearing up for a busy promotional period heading into the end of open enrollment on March 31 and an expected surge in applications.

"The last weekend will be pretty crazy," said Lee.

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