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Marketplace Enrollment UpdateRural and Public Health Policy Forum 2016
Daniel Derksen MDFebruary 11, 2016
Categories of U.S. Health Spending2014 Total = $3 Trillion
Physician& Clinic
20%
Hospital32%
Other 29%
Rx 10%
Dental 4%Nursing Home 5%
021216 Dan Derksen MDMartin A et al: Health Affairs Jan 2016 Accessed 02/10/16 at: http://content.healthaffairs.org/content/35/1/150.full.pdf+html
One Year Increase Hepatitis C Drugs: $11.3 Billion
Martin A et al: Health Affairs Jan 2016 Accessed 02/10/16 at: http://content.healthaffairs.org/content/35/1/150.full.pdf+html
Physician& Clinic
20%
Hospital32%Other 30%
Rx26%
DentalNursing
Home
33% Private Insurance
Medicare 20%
Medicaid 16%
Other 20%
Out of Pocket 11%
U.S. Health Spending by Payer2014 Total = $3 Trillion
021216 Dan Derksen MD
Martin A et al: Health Affairs Jan 2016 Accessed 02/10/16 at: http://content.healthaffairs.org/content/35/1/150.full.pdf+html
2014 National Health Expenditure Growth
5.3% from 2013
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Medicare established in 1965 in Title XVIII of the Social Security Act “entitlement” $.
Medicare $619 billion spending in 2014, one in $5 spent on Medicare, covers 53 million
seniors, enrollment up 1.5M from 2013
Title XVIII MEDICARE
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Medicaid/CHIP spending $496 billion in 2014Enrollment 66 million
Social Security ActMEDICAID SSA Title XIX (1965)
CHIP SSA XXI (1997)
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Martin A et al: Health Affairs Jan 2016 Accessed 02/10/16 at: http://content.healthaffairs.org/content/35/1/150.full.pdf+html
Enrollment increased 7.7 M from 2013Medicaid Cost Rose 11% from 2013, but the
Per Person Cost Decreased 2%
Marketplace+9 MillionSubsidized
Income < 138% FPL Income 138% to 400% FPL
AHCCCS – AZ Medicaid<138% FPL ($33,465 Family of 4)July-Sept 2013 to Aug 2015 Net Gain
+437,000
AZ MARKETPLACE138-400% FPL ($33,465-$97,200)OE-2 Enrollment + Renewal thru Mar 2015
+154,000
Age <26 Parents’ Plan+2.3 Million
AZ <26 Parents’ Plan+70,000
Demand: Medicaid + OE-2 Marketplace GainU.S. / AZ Enrollment Jan 2014-Aug 2015
UNITED STATES
ARIZONA ACA ENROLLMENT
Medicaid+13.6 Million
Accessed 12/09/15 at: http://www.medicaid.gov/medicaid-chip-program-information/by-state/arizona.htmlhttp://www.aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf
http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population-2015/
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AZ Health Coverage through 2014
Accessed 11/12/15 State Health Facts at: http://kff.org
# covered (%)
Employer Sponsored ESIIndividual (Non-group) Purchase
Private Health Insurance Total
2,835,000333,000
3,268,000Medicaid 1,640,000 (25%)Medicare 911,000 (14%)
Uninsured 827,000 (12%)Total Population 6,700,000
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Change in Arizona’s Uninsured 2013 to 2014
1.2 Million Uninsured (2013) to 827,000 Uninsured (2014)
33% Reduction 2013-14 Accessed 11/12/15 at:
http://kff.org/other/state-indicator/percent-change-in-uninsured-rate-by-federal-poverty-level-fpl-2013-2014/
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ACA Marketplace CoverageTax Credit (Advance Premium Tax Credit APTC)
Buettgens M, Kenney GM, Pan C: Variation in Marketplace Enrollment Rates in 2015 by State and Income. Urban Institute. October 2015. Accessed 01/18/16 at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf424382
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Selection rate = # eligible for ACA tax credit selecting a plantotal # eligible for ACA tax credit
Effectuated enrollment rate = # Eligible ACA tax credit who enrolled & paid first month’s premium
Total # eligible for ACA tax credit
Take up rate = # who enrolled in health insurance offeredtotal # offered health insurance
ACA Marketplace Coveragein those Eligible for a Tax Credit
Buettgens M, Kenney GM, Pan C: Variation in Marketplace Enrollment Rates in 2015 by State and Income. Urban Institute. October 2015. Accessed 01/18/16 at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf424382
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ACA Marketplace AZ Selection Rate March 2015 = 108,000 / 335,000 (32.2%)
ACA Marketplace AZ Effectuated Enrollment June 2015 = 70,350 / 335,000 (21%)
U.S. ACA Selection Rate as of March 2015 = 10M / 24 M (41%)
ACA Marketplace U.S. Effectuated Enrollment June 2015= 8.6 million / 24 million (35%)
ACA Marketplace Coveragein those Eligible for a Tax Credit
Buettgens M, Kenney GM, Pan C: Variation in Marketplace Enrollment Rates in 2015 by State and Income. Urban Institute. October 2015. Accessed 01/18/16 at: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf424382
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U.S. ACA Selection Rate as of March 2015 In those with income <200% FPL (62%)
In those with income 200-300% FPL (29%)
In those with income 300-400% FPL (13%)Note: Lower income (<200% FPL) get higher subsidies
(advance premium tax credits) to make health insurance plan premiums affordable. Avg US Marketplace subsidy: $300/mo
Maricopa County: AZ MarketplaceOpen Enrollment III (OE-3) 11/1/15 to 1/31/16
PHOENIX8 Insurers69 Plans
Pop = 4.1MEst.
Uninsured 450,000
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Pima County: AZ Marketplace 5 Insurers, 28 Plans, 1.0M Pop, Uninsured 115,000
Tucson5 Insurers28 PlansPop =1MUninsured 115,000
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Apache, Coconino, Gila, Mojave, Navajo Counties AZ Marketplace: 3 Insurers, 18 Plans, 0.5M Pop
02/12/16 Dan Derksen MD
Cochise, Graham, Greenlee, La Paz, Pinal, Santa Cruz, Yavapai, Yuma Counties:
AZ Marketplace: 2 Insurers, 15 Plans, 1.0M Pop
02/12/16 Dan Derksen MD
01/14/15 Dan Derksen, MD
Keep your face always toward the sunshine –and shadows will fall behind you. Walt Whitman
