ACA Implementation: Status Update National Academy of Sciences Roundtable on Health Literacy July 21, 2016 Karen Pollitz, Senior Fellow Kaiser Family Foundation
Figure 1 Eligibility Status of 32.9 million Remaining Nonelderly Uninsured, 2015 15.9% 5.2 m [VALUE] 9.1 m Medicaid eligible Assistance gap 23.8% Marketplace tax credit eligible 7.8 m 21.0% [VALUE] 3.8 m Ineligible for tax credit due to affordable ESI offer/higher income 3.2 m<200% FPL 3.7 m>200% FPL Ineligible due to undocumented status Note: Percentages are based on a total of 32.9 million non-elderly residents that remain uninsured at time of interview 2015, or 12.2 percent of the total non-elderly, civilian non-institutionalized population of the US. Source: 2015 Current Population Survey-Annual Social and Economic Supplement Source: Linda Blumberg et al, Who are the Remaining Uninsured and What Do Their Characteristics Tell Us About How to Reach Them? Urban Institute, March 2016
Figure 2 Most Uninsured Don t Know Enrollment Deadline, Two in Ten Say They Have Been Contacted About Signing Up for Coverage AMONG THE UNINSURED AGES 18-64: As you may know, the health care law requires nearly all Americans to heave health insurance, or else pay a fine. Do you happen to know the deadline for individuals to sign-up for health insurance? Don't know 65% End of 2015 20% End of January 2016 (correct answer) 7% Some other time 3% Deadline already passed 6% AMONG THE UNINSURED AGES 18-64: In the past 6 months, have you been personally contacted by anyone about signing up for health insurance or Medicaid through a phone call, email, text message, or door to door visit, or not? No, have Fell not short been of expectation contacted 80% s [CATEGOR Y NAME] [VALUE] Met expectatio ns NOTE: Don t know category includes those who refused to answer. Some other time category includes 2 percent who said Some other time in 2016 and 1 percent who said 2017 or later. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted December 1-7, 2015)
Figure 3 New Consumer Assistance Infrastructure Enrollment Assistance: More than 5,000 marketplace enrollment assistance programs established Most operational for three years Marketplaces required to finance Navigators; most assister programs are not Marketplace financed Marketplace-funded assisters may not be funded/credited for Medicaid enrollments 1 in 5 had to turn away at least some people who needed help in OE3 2/3 express some uncertainly about future funding In-person help is time intensive, averaging 90 minutes for new participants, 60 minutes for renewing participants Consumer Assistance Programs: Comprehensive help (enrollment, post enrollment) for all state residents 40 state programs established in 2010, no federal funding since 2012 Source: Kaiser Family Foundation Survey of Marketplace Assister Programs and Brokers, 2016 (forthcoming)
Figure 4 Marketplace Plan Enrollment (Millions) 16.3 11.7 12.7 11.1 8.0 8.8 6.3 End of Open Enrollment, 2014 31-Dec-14 End of Open Enrollment, 2015 31-Dec-15 End of Open Enrollment, 2016 31-Mar-16 If All States Performed Like the Top 10 Source: HHS data and Kaiser Family Foundation estimate.
Figure 5 Americans Familiarity With Health Insurance Terms And Concepts: Overall Scores Percent of Americans who got the right answers: 52% Scored 7-10 Correct 20% 28% Scored 0-4 Correct 20% Scored 5-6 Correct 18% 18% 18% 16% 14% 8% 5% 5% 4% 6% 10% 10% 12% 4% 12% 10% 8% 6% 4% 2% 0 1 2 3 4 5 6 7 8 9 10 0% Number of Correct Answers SOURCE: Kaiser Family Foundation, Assessing Americans Familiarity With Health Insurance Terms And Concepts (conducted October 17-27, 2014)
Figure 6 Knowledge of Health Insurance Terms and Concepts Percent who correctly answered each question: Health insurance premium must be paid every month Definition of health insurance premium Definition of a health plan provider network Definition of annual health insurance deductible Ability to appeal health plan denial Definition of the annual out-of-pocket limit Calculate out-of-pocket costs for hospital stay with deductible and copay Not all doctors who provide care at in-network hospital may be in-network Definition of a health insurance formulary Calculate out-of-pocket costs when insurer pays a portion of allowed charges for out-of-network lab test 79% 76% 76% 72% 68% 67% 51% 41% 33% 16% SOURCE: Kaiser Family Foundation, Assessing Americans Familiarity With Health Insurance Terms And Concepts (conducted October 17-27, 2014)
Figure 7 Summary of Benefits and Coverage
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Figure 10 Implementation of ACA Transparency Provisions Pending Transparency Reporting Requirements Claims payment policies and practices. Periodic financial disclosures. Data on enrollment. Data on disenrollment. Data on the number of claims that are denied. Data on rating practices. Information on cost-sharing and payments with respect to any out-of-network coverage. Information on enrollee and participant rights under this title. Other information as determined appropriate by the Secretary Effective date was 9/2010 (off marketplace plans); 1/2014 (marketplace plans) Potential for plan ratings, performance measures such as: Reliability and accuracy of claims handling Out of network use/costs for key services, diagnoses
Figure 11 Smaller Shares Say Health Insurance is Good Value Than in Previous Years Would you say your health insurance is an excellent value, good value, only a fair value or a poor value for what you pay for it? Excellent Good Only fair Poor Don't know/refused ALL NON-GROUP ENROLLEES WITH ACA-COMPLIANT PLANS 2016 2015 2014 13% 13% 21% 32% 42% 34% 28% 21% 26% 26% 18% 16% 6% 1% 2% NON-GROUP ENROLLEES WITH MARKETPLACE PLANS 2016 2015 2014 16% 15% 23% 32% 44% 35% 28% 24% 22% 23% 14% 14% [VALUE] 5% 2% AGES 18-64 WITH EMPLOYER- SPONSORED INSURANCE 2016 2014 22% 30% 34% 40% 29% 22% 11% 6% 3% 2% NOTE: Too soon to tell (Vol.) and Don t know how much it costs (Vol.) responses included in Don t know/refused category. SOURCE: Kaiser Family Foundation Surveys of Non-Group Health Insurance Enrollees and Kaiser Health Tracking Polls
Figure 12 Those With High Deductibles Give Plans Lower Ratings AMONG NON-GROUP HEALTH INSURANCE ENROLLEES WITH ACA-COMPLIANT PLANS: Excellent Good Not so good Poor How would you rate your overall health insurance coverage? High deductible plans Lower deductible plans 11% 18% 48% 56% 20% 15% 20% 7% Would you say your health insurance is an excellent value, good value, only a fair value or a poor value for what you pay for it? High deductible plans Lower deductible plans 8% Excellent value Good value Only a fair value Poor value 22% 32% 38% 21% 41% 23% 14% NOTE: High deductible defined as $1500 or higher for an individual or $3000 or higher for a family. Don t know/refused and too soon to tell (Vol.) responses not shown. SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Figure 13 Those in High-Deductible Plans More Likely To Say Out-of- Pocket Costs Are Difficult to Afford AMONG NON-GROUP ENROLLEES WITH ACA-COMPLIANT PLANS: In general, how easy or difficult is it for you to afford the out-of-pocket costs your insurance doesn t cover, like co-pays and deductible? Very difficult Somewhat difficult Somewhat easy Very easy Not applicable (Vol.) Those in high-deductible plans 22% 36% 28% 11% 3% Those in lower-deductible plans [VALUE] 25% 35% 18% 2% NOTE: High deductible defined as $1500 or higher for an individual or $3000 or higher for a family. Don t know/ Refused responses not shown. SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Figure 14 One-Third of Those Who Have Had ACA-Compliant Plans For at Least a Year Have Used Their Insurance More Than 10 Times AMONG THOSE WITH ACA-COMPLIANT PLANS WHO HAVE HAD NON-GROUP COVERAGE FOR AT LEAST 12 MONTHS: In the past 12 months, approximately how many times have you (and the other family members covered by your plan) used your insurance, such as to see a doctor or fill a prescription? Not at all 13% [CATEGORY NAME] [VALUE] 33% Heavy Utilizers Between 1 and 10 times 54% Between 11 and 20 times 20% SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Figure 15 Reported Problems With Current Plans AMONG THOSE WITH ACA-COMPLIANT PLANS WHO HAVE HAD NON-GROUP COVERAGE FOR AT LEAST 12 MONTHS: Percent who say have had any of the following problems with their health insurance plans in the past 12 months: Plan paid less than you expected for a bill you received from a doctor, hospital, or lab Plan would not cover a prescription drug or required a very expensive copay for a drug that a doctor prescribed Were surprised to find out that your plan would not pay anything for care received, that you thought was covered A particular doctor you wanted to see was not covered by your plan A particular hospital you wanted to visit was not covered by your plan Reached the limit on the number of visits or services insurance company would pay for treatment of specific illness or injury 36% 26% 21% 20% 10% 4% Yes to any of the above [VALUE] SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Figure 16 Lack of Awareness About Free Preventive Services AMONG NON-GROUP HEALTH INSURANCE ENROLLEES WITH ACA-COMPLIANT PLANS: As far as you know, under your health plan, do you have to pay any out-of-pocket costs, such as a copay or deductible, for preventive services like vaccinations and blood pressure screenings, or are preventive services paid for completely by the plan? [CATEGORY NAME] [VALUE] Preventive services are paid for by the plan 47% Don't Know/ Refused 20% SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)
Exhibit 17 For more information on the ACA, visit www.kff.org