Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020 Donna - PowerPoint PPT Presentation

Wisconsin Enrollment Trends and ACA Outlook Plan Year 2020 Donna Friedsam October 2019

ACA Plan Selections for Plan Year 2019 Plan Selections As of 12/15/ 2018 Total Consumers Selecting Plans 205,118 Consumers with APTC 176,908 (86%) Consumers with CSRs 86,060 (42%) Average Premium statewide (before APTCs) $700 Average Premium statewide (after APTCs) $161 Average APTC among consumers receiving $625 APTCs Average Premium for Consumers receiving $97 APTC

Plan Selections: Open Enrollment Trend 2016-19  Effectuated enrollment refers to those consumers who pay select a plan and pay their first month premium to activate their coverage.  In 2019, 94% of Wisconsin consumers who selected an ACA Marketplace plan went on to effectuate their enrollment, resulting in 193,303 actual plan enrollments in February 2019. 2019 ACA Plans Number Percent of Open Enrollment Number of Effectuated Coverage of Plan Plan Plan Year Plan Selections Selections Selections (Enrollment Period Length) Effectuating Coverage through 193,303 94% OE 2017 (12 weeks) 242,863 February 2019 Consumers with Premium 171,386 89% OE 2018 (6 weeks) 225,435 Subsidies (APTCs) OE 2019 (6 weeks) 205,118 Consumers with Cost-Sharing 82,745 43% Reductions (CSRs)

ACA Marketplace Plan Selections during open enrollment have decreased statewide during the past two years, with the pull back of federal resources, reduction in weeks available, and other factors. Wisconsin QHP Selections 250,000 242,863 239,034 240,000 230,000 225,435 220,000 207,340 210,000 205,118 200,000 190,000 180,000 OE 2014-15 OE 2015-16 OE 2016-17 OE 2017-18 OE 2018-19 Wisconsin QHP Selections 207,340 239,034 242,863 225,435 205,118

Net Net Net Net Change Change Change Change Net ≥100% - >150% - Net Change >250% - >300% - Net Change ≤150% ≤200% >200% - ≤300% ≤400% Change Total The decreases have FPL FPL ≤250% FPL FPL FPL Other FPL occurred predominantly 2015 - 19 (17,086) (9,644) 1,176 2,236 15,714 5,382 (2,222) among the lowest income % change - 27% - 18% 4% 11% 68% 32% - 1% groups, while the number of consumers with Trend in Plan Selections by Income Group incomes over 200% FPL 80,000 has increased. 69,320 70,000 63,439 62,773 60,000 59,759 53,554 52,805 52,553 46,353 50,000 47,659 43,161 40,000 38,783 38,245 38,121 35,519 34,305 33,465 33,052 32,581 31,405 30,000 26,294 23,568 23,069 22,860 21,933 20,000 19,697 10,000 - 2015 2016 2017 2018 2019 ≥100% - ≤150% FPL >150% - ≤200% FPL >200% - ≤250% FPL >250% - ≤300% FPL >300% - ≤400% FPL

Plan Selections by Income Range, 2015-2019 Other FPL 100% 4.2% 5.0% 8.2% >300% - ≤400% FPL 10.9% 14.6% 90% 14.0% >250% - ≤300% FPL 11.1% 18.6% 80% >200% - ≤250% FPL 18.9% 13.6% 9.5% 11.0% >150% - ≤200% FPL 11.1% 70% 9.7% 10.7% ≥100% - ≤150% FPL 15.1% 16.0% 60% 16.7% 14.6% 15.9% 50% 25.5% 25.0% 40% 23.2% 21.6% 21.0% 30% 20% 30.6% 29.0% 25.8% 26.1% 22.6% 10% 0% 2015 2016 2017 2018 2019  Lowest income range consumers (100 - 150% FPL) account for a declining proportion of Marketplace consumers.  Consumers with incomes >200% FPL account for an increasing share of Marketplace plans, with consumers in the 300- 400% FPL range increasing the most.

Adult BadgerCare and SSI-Medicaid Trend, 2013-2019 250,000 Parents/Caretakers 226,060 Childless Adults 200,000 SSI 148,007 150,000 131,446 101,709 112,444 100,000 50,000 19,172 0 Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19  Adult enrollment in BadgerCare and SSI-Medicaid has remained flat or declined since 2017.  The decline in ACA Marketplace enrollment by lower income adults in 2017-2019 was not balanced out by any increases in BadgerCare or SSI-Medicaid enrollment.

New Consumers and Re-enrollees: Trend 2015-2019  The proportion of re-enrollees has 100% increased steadily and substantially.  Many re-enrollees continue to rely on 80% 55.8% 54.1% active reenrollment, rather than relying 73.7% 62.2% 60% 80.9% on automatic processes. 40%  This reflects the need to re-assess 44.2% available plans, premiums, and 20% 38.0% 26.3% 21.4% 19.1% available subsidies every year. 0% 2015 2016 2017 2018 2019 New Consumers Re-enrollees Re-enrollees: Active and Automatic, 2015-2019 100% 25.8% 26.3% 28.4% 32.5% 80% 46.0% 60% 40% 74.2% 73.7% 71.6% 67.5% 54.0% 20% 0% 2015 2016 2017 2018 2019 Active Re-enrollees Automatic Re-enrollees

Plan Selections, New and Re-enrollments, Plan Year 2019 Active Re-enrollees 74% New Consumers Re-enrollees 19% 81% Automatic Re- enrollees 26%  Over 80% of Re-enrollees for Plan Year 2018 switched plans, while for 2019 plan switching declined to about 41%.  This likely reflects the 2017 federal change in CSR policy and the initiation of silver-loading for Plan Year 2018, along with the departure of some QHPs from the market for Plan Year 2018. Active Re-enrollees Active Re-enrollees who Switched Plans who Remained in the Same Plan or a Crosswalked Plan PlanYear 2018 81.7% 18.3% Plan Year 2019 41.0% 59.0%

Plan Selections by Income Level, Plan Year 2019 Other FPL 11% ≥100% - ≤150% FPL 22% >300% - ≤400% FPL 19% >150% - ≤200% FPL 21% >250% - Plan Selections by Metal Level, Plan Year ≤300% FPL >200% - ≤250% FPL 2019 Catastrophic 11% 16% Platinum 0.9% Gold 0.2% 13.8% Bronze 35.8% Silver 49.3%

Consumers with CSR 80.0% 58.5% 54.0% 51.1% 43.5% 42.0% 60.0% 40.0% Consistent with the changing income composition of Marketplace consumers, a declining proportion 20.0% qualify for Cost-Sharing Reductions (CSRs), which 0.0% require income <250% FPL. 2015 2016 2017 2018 2019 • With the decline in CSR- linked consumers, an Plan Selections by Metal Level, 2015 -2019 increasing proportion of 100% 0.0% 4.3% 4.6% 11.4% 13.8% consumers select bronze 80% and gold plans, while a decreasing proportion select 68.3% 54.1% 49.3% 60% 70.6% 70.5% silver plans. 40% • This trend also likely reflects 20% 35.8% 33.4% the effect of silver loading in 27.0% 22.7% 23.5% premiums after 2017, and 0% 2015 2016 2017 2018 2019 the ability of consumers to apply their APTCs to other Bronze Silver Gold metal levels.

Plan Selections by Age, Plan Year 2019 For the 2019 plan year, Age < 18 23% of consumers 6% Age 18-25 selecting plans 8% statewide are in the 18- 34 year age range. Age 55-64 38% Age 26-34 15% Age 35-44 15% Age 45-54 18%

120.0% Plan Selections by Age Group, 2015-2019 100.0% Consumers in the 33.0% 34.4% 31.8% 36.2% 38.1% 80.0% 55-64 age range account for an increasing share of 60.0% ACA Marketplace 20.0% 19.3% 21.1% 18.6% plan selections. 17.9% 40.0% 14.0% 14.2% 14.3% 15.2% 14.5% 17.0% 16.3% 15.9% 15.5% 17.0% 20.0% 9.0% 8.7% 8.2% 7.7% 8.8% 7.0% 6.8% 6.3% 6.1% 3.6% 0.0% 2015 2016 2017 2018 2019 Age < 18 Age 18-25 Age 26-34 Age 35-44 Age 45-54 Age 55-64

Uninsured in 2013 and 2017: Before and After the ACA Took Effect  About 5.4% of residents were uninsured in 2017, down from 9.1% in 2013.  Persons without insurance decreased by about 207,877 people, a reduction of about 40%.  Decreases in the number of uninsured people occurred across all income levels. Wisconsin Uninsured 2013 and 2017, Residents for Whom Poverty Status is Determined 600000 Total 513,552 500000 213,232 400000 Total 305,675 ≥200% FPL 300000 93,195 149,169 138-199% FPL 200000 59,086 207,125 100000 <138% FPL 97,420 0 2013 2017

Who is Still Uninsured?: Wisconsin Residents who Remained Uninsured, ACS 2017 Total Number of Uninsured Individuals, By Income Total Number of Uninsured 25.0% 21.1% 18.9% Individuals, By Age 20.0% Children under the age of 19 make up 15.0% 96,593 59,912 about 17% of the remaining 7.6% 10.0% uninsured, with an estimated 52,599 5.4% 2.5% 5.0% in that age range remaining uninsured 70,611 305,675 78.558 inWisconsin as of 2016. 0.0% <100% FPL 100-199% FPL200-299% FPL ≥ 300% FPL Total Uninsured Under 19 Persons 100-199% FP L most likely to be uninsured: 65 years and years, 52,599 21.1% compared to 2.5% for persons >300% FP L , and older, 3,713 account for 32% of all uninsured Wisconsin residents. But persons above 200% <100% FPL, ≥ 300% FPL , FPL account 19-64, 253,092 19.6% 25.7% for nearly half (49%) of all 200-299% FPL, uninsured 23.1% 100-199% FPL, persons in 31.6% Wisconsin.

Where are the remaining uninsured? https://medicaidpolicy.wiscweb.wisc.edu/data- resources/

Number of insurance carriers offering plans in Wisconsin, by county, for 2020 through the ACA Marketplace 1 2 3 4 5 6