Insurance Market Trends and State MarketplacesWashington Health Benefit Exchange

June 23, 2016

Larry Levitt

Senior Vice President

Kaiser Family Foundation

LarryL@kff.org

@larry_levitt

8.0

11.7 12.7

16.3

End of OpenEnrollment, 2014

End of OpenEnrollment, 2015

End of OpenEnrollment, 2016

If All States PerformedLike the Top 10

Source: HHS data and Kaiser Family Foundation estimate.

Marketplace QHP plan selections (millions)

22%

25%

26%

26%

28%

35%

46%

61%

61%

65%

66%

74%

Iowa

Minnesota

South Dakota

New York

North Dakota

Washington

United States

North Carolina

Massachusetts

Maine

Florida

District of Columbia

Source: http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population/

Marketplace QHP signups as a share of the potential market in 2016

19%

28%

43%

44%

45%

46%

71%

91%

96%

100%

102%

110%

District of Columbia

New York

Colorado

South Dakota

West Virginia

Washington

United States

North Carolina

Montana

Oregon

Florida

Massachusetts

Source: Kaiser analysis, ASPE

Subsidized marketplace QHP signups as a share of estimated eligibles, 2016

Source: Kaiser Family Foundation analysis of the Current Population Survey.

Eligibility For coverage among the remaining uninsured as of early 2015

171,000 5,160,000

67,000 1,672,000

116,000 2,911,000

99,000 2,654,000

168,000 4,436,000

Washington (621,000) All States ExpandingMedicaid (16.8 million)

Income Too High/EmployerOffer

Unauthorized Immigrant

Tax Credit Eligible

Medicaid-Eligible Kids

Medicaid-Eligible Adults

11.7

8.8 7.8

4.9

Plan selections, end of openenrollment, 2015

Effectuated enrollment, end of2015

Plan selections, end of openenrollment, 2016

New

Renewing

Source: HHS data

Churn in marketplace enrollment (millions)

SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)

Most marketplace QHP enrollees satisfied with plans

37%

38%

32%

30%

26%

23%

18%

38%

36%

34%

34%

33%

35%

33%

8%

11%

14%

14%

8%

18%

19%

7%

9%

16%

14%

11%

22%

26%

10%

6%

4%

8%

22%

2%

4%

Choice of hospitals

Choice of primary care doctors

Doctor visit copay

Prescription copay

Choice of specialists

Monthly premium

Annual deductible

Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied Don't know/Refused

AMONG NON-GROUP ENROLLEES WITH MARKETPLACE PLANS: Thinking about your current health insurance plan, how satisfied are you with each of the following?

Note: “Too soon to tell” (Vol.) responses included in Don’t know/Refused category.SOURCE: Kaiser Family Foundation Surveys of Non-Group Health Insurance Enrollees

Among marketplace QHP enrollees, satisfaction with premiums and deductibles has declined since 2014

51%

60%

59%

46%

37%

32%

4%

3%

8%

2016

2015

2014

AMONG NON-GROUP ENROLLEES WITH MARKETPLACE PLANS: Percent who say they are satisfied/dissatisfied with their plan’s…

…annual deductible

59%

64%

68%

40%

32%

27%

1%

4%

5%

2016

2015

2014

Satisfied Dissatisfied Don't know/Refused

…monthly premium

75%

61%

58%

54%

51%

46%

41%

29%

19%

30%

34%

35%

36%

43%

40%

57%

Who says they benefited or were negatively affected by ACA?

AMONG NON-GROUP ENROLLEES WITH MARKETPLACE QHP PLANS: Percent who say they have benefited or been negatively affected by the ACA…

Republicans

Benefited Negatively affected

NOTE: The share who say they neither benefited nor were negatively affected is not shown.SOURCE: Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees, Wave 3 (conducted Feb. 9-Mar. 26, 2016)

Lower-deductible plans

Receiving tax credit

TOTAL MARKETPLACE ENROLLEES

Independents

NOT receiving tax credit

Democrats

High-deductible plans

Average medical deductible, in plans with combined medical and prescription drug deductibles, 2016

$5,765

$3,064

$1,247

$21$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

Bronze Silver Gold Platinum

Average medical deductible in plans with combined medical and prescription drug deductible, 2016

$3,064

$2,491

$709

$221

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

Silver CSR73 (200-250% ofpoverty)

CSR87 (150-200% ofpoverty)

CSR94 (100-150% ofpoverty)

NOTES: CSR73 refers to a reduced cost-sharing plan with an actuarial value of 73%. CSR87 and CSR94 have actuarial values of 87% and 94%, respectively.SOURCE: Kaiser Family Foundation analysis of Marketplace plans in the 37 states with Federally Facilitated or Partnership exchanges in 2016. Data are from Healthcare.gov Health plan information for individuals and families available here: https://www.healthcare.gov/health-plan-information/

$9,751

$1,454

$4,176

$20,379

$7,922

$808

$2,590

$18,148

$0

$5,000

$10,000

$15,000

$20,000

$25,000

All Non-ElderlyHouseholds WithPrivate Insurance

and Income >100%of Poverty

100% to 250% FPL 250% to 400% FPL Over 400% FPL

Liquid Assets

Net Financial Assets

Median liquid and net financial assetsAmong all non-elderly, non-poor households with only private coverage

NOTES: FPL refers to the 2013 Federal Poverty Level.SOURCE: Kaiser Family Foundation analysis of 2013 Survey of Consumer Finance (SCF) data.

Peterson-Kaiser Health System Tracker

256%

32%

-50%

0%

50%

100%

150%

200%

250%

300%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Covered Costs

Paid by Insurance

Spending on Deductibles

Spending on Copayments

Spending on Coinsurance

Workers' Wages

Changing nature of employer health insurance, 2004-2014

Source: Truven Health Analytics MarketScan Commercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

Cumulative increases in health costs, amounts paid by insurance, amounts paid for cost sharing and workers’ wages, 2004-2014

26%

37%

26%

14%

53%

20%

26%

15%

47%

22%

Total adults ages 18-64

Less than $50,000

$50,000 to $99,999

$100,000 or more

Uninsured

Insured

Private insurance, high…

Private insurance, low…

Have a disability

No disability

Shares reporting problems paying medical bills in past year

Percent who say they or someone in their household had problems paying medical bills in the past 12 months:

*High deductibles defined as $1,500 and above for an individual or $3,000 and above for a family.SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)

By household income

By insurance status

By plan deductible

By disability status

75%

32%

26%

Copays, deductibles, or coinsurancewere more than they could afford

Received care from an out-of-network provider, and insurance

would not cover or would only covera portion

Submitted a claim to insurancecompany but the claim was denied

Most who had problems paying medical bills while insured say cost-sharing was more than they could afford

AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS WHO WERE INSURED WHEN TREATMENT BEGAN: Percent who say each of the following was a reason they had problems paying medical bills:

NOTE: Question wording abbreviated. See topline for full question wording.SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)

• Increasing enrollment is key to improving the risk pool and keeping the market attractive to insurers.

• Outreach! Now is not the time to take the foot off the accelerator.

• We are in for bigger premium increases in 2017 in most markets.

– Akin to a market correction to compensate for under-pricing.

– Continued plan switching could keep consumer premium increases down, though there are tradeoffs to this degree of disruption.

• Most counties nationwide have 3 or more insurers participating in the marketplace, but the number of counties with just 1 insurer is growing.

• Many reasons to believe the market is sustainable.

– Substantial and still growing enrollment.

– End of transitional plans (in many states).

– Cushioning effect of premium subsidies.

– Have not yet seen the full effect of the individual mandate.

• Significant changes may be coming federally, depending on the outcome of the election.

Looking ahead