Uninsured And Eligible For The Exchanges
Kaiser Family Foundation completed an analysis of those uninsured who are eligible for Exchange Coverage. https://www.kff.org/private-insurance/issue-brief/marketplace-eligibility-among-the-uninsured-implications-for-a-broadened-enrollment-period-and-aca-outreach/
Nationally, 15 million American citizens and legal permanent residents are uninsured and eligible for Exchange health coverage. Four million are eligible for no cost bronze coverage, but not insured. Five million are eligible for partially subsidized Exchange coverage but uninsured. And 6 million are eligible for Exchange coverage but with no subsidies (e.g. incomes over 400% of FPL) and uninsured.
In California, 1.3 million are uninsured and eligible for Exchange coverage. One hundred and sixty thousand are eligible for no cost bronze coverage, but not insured. Five hundred and sixty thousand are eligible for partially subsidized Exchange coverage but uninsured. And five hundred and ninety thousand are eligible for Exchange coverage but with no subsidies (e.g. incomes over 400% of FPL) and uninsured.
Biden has opened up enrollment (reduced to one month by Trump) for federal Exchanges for the next three months (2/15 to 5/15/21). He will accompany it with enrollment outreach and advertising (decimated by Trump) . This has been done by executive orders. His legislative agenda is to increase premium assistance and cost-sharing subsidies so that the monthly premium for coverage is more affordable and care is more accessible (i.e. copays and deductibles are reduced). He proposes to end the cap for premium assistance at 400% of FPL. He proposes to tie the subsidies to gold plans (80% of expected medical expenses) as opposed to the current silver plan level (70% of expected medical expenses. He also proposes to increase subsidies and reduce consumer/subscriber contributions in the Exchanges.
Covered California will also open up to new enrollment in the Exchanges for the same time frame. Governor Newsom and the California legislature have already increased the state levels of public premium assistance, albeit not nearly as much as Biden is proposing. As compared to states like Texas and Florida, we are far exceeding their enrollment successes; however, as compared to Massachusetts, Minnesota and New York, we in California still have a long way to go. For example 2.8 million Texans are Exchange eligible and uninsured, 1.6 million Floridians are Exchange eligible and uninsured as contrasted with 1.3 million Californians although we have a much larger population. Only 12% of our uninsured are eligible for a free bronze plan in the Exchange; by contrast 1% in Minnesota and 8% in Massachusetts are eligible for no cost bronze plans in their Exchanges.
So where do we Californians need to target our outreach and education and enrollment assistance during the new special enrollment period? People with a high school education or less, people working in construction, the arts and entertainment, recreation and other service sectors, young adults, and Hispanics are disproportionately missing out on the premium assistance already available through Covered California. The Biden proposed improvements in public subsidies will help many more of the uninsured afford coverage and care through the Exchanges; it will reach many more individuals and families with middle incomes who enroll in Exchange coverage.
Prepared by: Lucien Wulsin
Dated: 2/8/21