Health Insurance Coverage Sign-Ups Via ACA Slip in NJ After Earlier Surge

Nearly 40 percent drop-off in January follows big increase in enrollment by state residents in December

Joel C. Cantor
New Jersey sign-ups for health insurance through the Affordable Care Act dropped markedly in January after a big upswing in enrollments in December.

A total of 20,054 state residents chose a plan through the federal insurance marketplace in January, a drop of 36.3 percent from the 31,492 who enrolled in December, based on an analysis of statistics released by the U.S. Department of Health Human Services. The marketplace is intended to be a one-stop shop for residents to buy insurance and learn whether they’re eligible for subsidies.

The four-month total of 54,805 puts the state well below the 362,000 total individual-market ACA enrollments predicted by the Rutgers Center for State Health Policy. That estimate was based on the complete implementation of the ACA and may take years to achieve.

Center Director Joel Cantor, the lead author of the enrollment estimate report, said the January enrollments fell short of where they need to be to meet the marketplace’s share of the estimate, which also included residents who purchase their individual insurance directly from insurance companies outside of the marketplace.

“I would have expected roughly the same or close to the same number” in January as in December, which would have reflected a buildup of momentum, Cantor said.

Cantor said the December enrollment number was likely increased by the large number of people who wanted to enroll in October and November but were thwarted by the problems that were plaguing the marketplace website,

“Maybe that’s why the (December) number’s a little higher – but for the numbers to get where we expect them to be, I would have expected the numbers to be a little higher in January,” Cantor said.

Not all healthcare policy analysts see the January drop as an obstacle.

While Raymond J. Castro, senior policy analyst at New Jersey Policy Perspective, said he was disappointed with the decline in enrollment, he still sees the state as having a chance to meet another short-term goal — the 96,000 people projected by the Congressional Budget Office to be enrolled in New Jersey by March 31.

“We’re making good progress,” said Castro, who acknowledged that he would have liked to have seen a bigger increase in January. “The big question is, are a lot of people waiting until the end of March?”

March 31 is the end of open enrollment in the marketplace for 2014. Those who have disruptions in their insurance coverage, as well as major life events like births or marriages, after that date will still be able to enroll. The open enrollment period for 2015 will begin on November 15.

One potential stumbling block to reaching the enrollment goal is the lack of awareness among state residents of their options under the Affordable Care Act.

Castro noted that South Jersey residents have started to be exposed to advertisements about the federal marketplace through Philadelphia TV stations – those in North Jersey are more likely to see ads about New York’s state exchange, which he said can be confusing to New Jersey residents.

Castro’s organization is a member of New Jersey for Health Care, a coalition that’s been asking Gov. Chris Christie to spend a $7.67 million federal grant for Affordable Care Act outreach programs.

The state received the money to launch a state exchange before Christie opted for the federal marketplace; the state and federal government have been in talks over the money ever since, but time is running out – the state faces a February 22 deadline to spend the money or see it revert to the federal government.

Castro said everyone in the state, from advocates to providers to insurers to members of the public who are aware of the law, has an obligation to help the uninsured learn about their options.

Cantor said that were positive signs in the January enrollment figures.

For example, 73 percent of New Jerseyans who are receiving tax credits to subsidize their insurance purchases are choosing higher-level “silver” plans. That means they are choosing to pay for more coverage than the more minimal “bronze” plans, which were chosen by 10 percent of residents who are receiving subsidies and 21 percent of residents without subsidies.

Under “silver” plans, people are expected to pay 30 percent of their healthcare costs out of pocket, through deductibles, amounts that must be paid before insurance kicks in; copayments, which are charges for particular services; and coinsurance, which is a percentage of the cost for a service that the patient must share with the insurer.
For “bronze” plans, people are expected to pay 40 percent of costs out-of-pocket. There are also “gold” plans, in which people pay 20 percent out-of-pocket, and “platinum” plans, in which they pay 10 percent out-of-pocket.

Generally, the less people pay upfront, the more they pay in monthly premiums.

Cantor said the relatively high percentage of residents choosing at least “silver” coverage “will come as something of a relief to the insurers and also providers, because there was some fear that people who are eligible for financial assistance would try to minimize their costs by jumping into the bronze plans” and then avoid seeking healthcare to reduce out-of-pocket costs.

Castro was also encouraged, noting that the percentage of young people enrolling in the marketplace increased, which will reduce the effect of a disproportionately high number of older – and presumably sicker – people seeking insurance, raising the average premium costs.

Regardless of the drop in the January marketplace enrollment, both Cantor and Castro were encouraged by reported progress through the expansion in Medicaid eligibility.

Of those who visited the marketplace website since October, 104,689 New Jersey residents have been determined to be eligible for New Jersey FamilyCare, the state’s Medicaid program, thanks to expanded eligibility under the ACA.

Cantor said this number was in line with the 234,000 more insured Rutgers estimate for Medicaid expansion, noting that many people not counted in the federal numbers may have enrolled directly through county welfare offices.
Castro described the Medicaid expansion as going “astronomically well,” calling it an “example of what the state can do” when it sets about achieving enrollment increases.

The state role has been a sore point for advocates of expanding access to healthcare. While Christie opted for the Medicaid expansion, he chose not to have a state-based health insurance exchange. Instead, New Jersey joined 26 other states in relying on the federal marketplace.