The Affordable Care Act has resulted in the biggest statewide gain in health insurance coverage in decades, but the number of uninsured Ohioans remains cavernous as open enrollment in the health insurance marketplace kicks off next week.
Nov. 1 marks the beginning of the third year of open enrollment in Ohio’s federally-facilitated online health insurance exchange at HealthCare.gov, where consumers can sign up for subsidized health insurance plans or determine their eligibility for Medicaid under the state’s expanded eligibility requirements.
Increased insurance coverage under the law has cut the number of non-elderly, medically uninsured Ohioans by two-thirds — from about 1.3 million before the marketplace opened for business in 2013, based on enrollment data from the U.S. Department of Health and Human Services.
As a result, Ohio’s uninsured rate dropped to 8.4 percent last year from 11 percent in 2013 — lower than the rate in all but nine other states, according to estimates released last month by the U.S. Census Bureau.
But there are still about 450,000 uninsured Ohioans, most of whom are income-eligible for tax credits to help purchase coverage in the marketplace, or who meet expanded eligibility requirements for Medicaid, now available at no cost to most able-bodied Ohioans earning up to 138 percent of the federal poverty level.
“We’ve made a lot of progress in getting people enrolled,” said Trey Daley, the Ohio state director of Enroll America, a nonprofit helping the uninsured enroll in marketplace plans or Medicaid. “The uninsured rate has fallen to around 8 percent now, so we kind of see this next open enrollment period as first-and-goal at the eight yard line, and we want to get the rest of that 8 percent covered.”
No matter how affordable the plans might be, health insurance simply isn’t a priority for many people struggling just to put food on the table.
Laniyah Madison said she works part-time for a friend who runs her own hair salon, but she has been unemployed and uninsured for most of the past two years.
The 30-year-old Dayton resident is single, has no children and said she rarely gets sick, so any “extra” money she gets she spends on paying down her student loan debt and trying to build up her savings to cover major expenses.
“I need to get my car fixed,” she said. “I have to get my car fixed and a few other things before I could even think about buying health insurance.”
Madison is not alone.
According to the Robert Wood Johnson Foundation, only 26 percent of those who are uninsured say that they are doing well financially. Nearly 80 percent have less than $1,000 in savings, and about half have less than $100 in savings.
But without health insurance, many people’s financial situations could be even worse next year, said Megan Massey, a certified navigator in Dayton who has been trained to help consumers explore their coverage options sign up for health insurance in the marketplace.
Next year, the penalty for being uninsured will rise dramatically to the greater of either $695 or 2.5 percent of taxable income. That’s compared to a fine of $325 or 2 percent of income this year for someone without coverage for a full 12 months.
“I hate to use scare tactics on people, but the penalty is going to be quite extensive next year,” Massey said. “People need to realize that the $695 fine is just the minimum penalty. If 2.5 percent of your income is greater than that, you could end up paying a lot more.”
Massey, who works for a company called Resolute, which has offices at 389 Shaw Ave., also noted the fines — which will be collected by the Internal Revenue Service as a tax penalty — apply to each member of a family.
“Imagine if you’re married and have children, the fine is going to be even more expensive,” she said. “But for a very large percentage of families in the Dayton area, they are going to be able to find coverage in the marketplace that’s going to be close to what the penalty cost.”
Rising rate plans
Daley said many of those who remain uninsured are simply unaware or misinformed about the cost, eligibility rules and financial assistance available to the vast majority of people who sign up for Medicaid or marketplace coverage.
“Our challenge is to make sure that people have accurate, complete information about the financial assistance that is available to them so they understand how affordable these new options are,” Daley said.
Average monthly premium costs for marketplace plans will rise about 13 percent next year, from just over $374 this year to about $422, based on an analysis by this newspaper of final rates approved by the Ohio Department of Insurance.
But those are prices before advanced premium tax credits subsidies from the federal government are applied.
Premium subsidies in Ohio averaged $255 a month this year and were available to more than 85 percent Ohioans in the marketplace, according to HHS figures. That brought the average premium actually paid to about $145 a month.
Still, local health insurers acknowledge that while enrollment in their marketplace plans has grown, price can be a stumbling block in attracting a new wave of uninsured and hanging on to those currently enrolled.
“Price is a huge decision-maker for many people,” said Steve Ringel, president of the Ohio market for Dayton-based nonprofit CareSource, which sells marketplace plans in Ohio, Indiana and Kentucky and will begin enrollment in West Virginia next month.
As a result, CareSource — which has more than 46,000 marketplace members, down from about 60,000 at the beginning of the year — has positioned itself to be either the lowest-cost or second-lowest-cost insurer in each state where it sells its CareSource Just4Me brand marketplace plans, Ringel said.
“Most of our customers are in relatively stable financial situations, but they’re not rich by any stretch of the imagination,” he said. “They need affordable health care insurance, and that’s always been our focus. As we look around, we see that most of our members are heavily subsidized. That means the financial load that they are going to be bearing is typically going to be $100 or less per month.”
Premiums for a large segment of local marketplace consumers will be even lower next year.
According to Ringel, CareSource marketplace customers in Dayton will see an average 2.4 drop in average premiums next year, before subsidies, while the company’s average premium statewide will rise by about 3 percent.
Dayton-based Premier Health — southwest Ohio’s largest hospital network, which also sells health insurance in the state marketplace — will drop average premiums for its marketplace health plans by about 0.12 percent next year, according to its final rate filing with the state.
“The plans is designed to give value to our members for their health care needs,” said Diane Ewing, a Premier spokeswoman. “It is a local plan with services that are provided by physicians that are from our region, and that also adds value.”
While some marketplace premiums will be lower next year, prices can vary dramatically, and at least two of the largest providers in the marketplace have requested double-digit rate increases. In addition, high deductibles for some plans make the cost of using insurance hard to swallow for many people, which is why it’s important to shop around, experts say.
Open enrollment runs through the end of the year and is the only time of year when consumers can apply for cost assistance, switch plans, or enroll in a new marketplace plan, which are the only plans are eligible for tax subsidies.