Report details health reform’s reception in Washington

Washington’s new online health insurance marketplace, one of the nation’s most successful, has provided early answers to some of the biggest questions in federal health care reform. For example: Do people want government-subsidized coverage? Spartan coverage, or more comprehensive coverage? Will younger people sign up, making the insurance pool healthier so rates won’t shoot through the roof?

Friday, the state’s Health Benefit Exchange released a 12-page statistical report, containing demographic details about those who have enrolled so far.

The report changes the subject, from the initial furor about technical glitches, to the human and economic questions that will determine how successful reform might be in the longer run.

The heavy traffic speaks to the level of consumer interest. Paying customers gravitated strongly to “silver” plans with a higher level of coverage. As expected, initial signups were weighted to older people who tend to have more health issues, but officials pronounced themselves pleased with the level of signups, so far, from the hard-to-persuade “young invincibles” between 18 and 34.

During its first month of operation, Washington’s Health Plan Finder attracted 498,006 unique visitors. Of those, 118,531 (24 percent) created an account – the first step in getting coverage.

Medicaid, the government-funded plan for low-income people, attracted 51,379 completed signups in October. More than 40 percent of those qualified for coverage immediately. For the rest, Medicaid coverage begins Jan. 1 – thanks to Washington’s decision to expand Medicaid effective next year, from a plan that benefits mostly children to a plan that also covers adults up to 138 percent of poverty level.

With Medicaid now to be available for adults, 74 percent of the newly signed up clients ranged in age from 18 to 64.

Of the new Medicaid clients, 5,415 live in Spokane County; 485 Spokane County residents so far have purchased a private insurance plan on the Health Plan Finder site.

Completed signups from those who will purchase an insurance policy have been few – a surprise to no one, since payments for a policy effective Jan. 1 don’t have to be made until Dec. 23. Though the first months’ numbers are small, the hard data in Washington’s report will attract attention from those wondering how the new system is being received, and how well it may work in the end:

• 21,671 completed their application to buy a health insurance plan, but have not yet submitted their payment.

• 72,136 are partway though the application process, but have not made final decisions about which plan to buy.

• 1,516 paid for a new insurance plan and either did not qualify for a tax credit to reduce their premium, or did not seek financial help.

• 4,835 paid for a new plan and did qualify for a tax credit. The credits are available up to 400 percent of federal poverty level (annual income of $45,960 for one person, $94,200 for a family of four).

• The paid-up customers divided this way, by age: 18-25, 5 percent; 26-34, 18 percent; 35-44, 19 percent; 45-54, 20 percent; 55-64, 37 percent.

• 64 percent of the completed purchases were for a Silver plan covering 70 percent of average medical needs. Gold plans, covering 80 percent, attracted only 16 percent of buyers. Bronze plans, covering 60 percent, attracted 21 percent.

• 57 percent of the enrollments, for both Medicaid and purchased insurance, were from women.

Why is Medicaid dominating enrollments in the early going? Because so many uninsured people have lower incomes, making them eligible for Medicaid, said Michael Marchand, communications director for Washington’s Health Benefit Exchange, which operates the Health Plan Finder website.

Similarly, among paying customers, the largest numbers by far are at lower income levels, between 150 and 200 percent of poverty. This also is the level at which federal subsidy levels are the highest.

The Silver insurance plans appear to be hitting a sweet spot with consumers, Marchand said, because they reduce the out-of-pocket costs from co-pays and deductibles. This is due to federal cost-sharing subsidies, which are available in Silver plans but not for the cheaper Bronze plans. The cost-sharing subsidies, a seldom-mentioned feature of the Affordable Care Act, are in addition to the tax credits which reduce consumers’ premiums. Both are calculated automatically as consumers browse the site, based on a consumer’s income.

What’s with the number of women? “The car industry came to this realization some decades ago,” Marchand said. “A lot of times women are the leaders for financial decisions in the household. Women view the importance of having their health taken care of more so than men. But it’s not so easy getting a man to go to the doctor short of blindfolding him, gagging him and getting him in the trunk.”

It’s still early, said Marchand, to know from Washington’s data whether the pool of people purchasing insurance will include enough healthy younger people to hold rates down for all ages. Market research, he said, has made it clear that “the 18 to 25 group is very hard to reach; they have to be hit with the message many more times before they take action, than any other group.” Older people, who have experience with the cost of health care, grasp the need more quickly, he said. “I actually thought (signups among) 55 to 64 would skew even higher.”

By December or January, he said, after consumers have had more time to study and make their choices, the picture will become more clear.

What about technological glitches, the cause for so much controversy at the national level? Washington’s website barely worked on Oct. 1, the first day, but its functionality and traffic took off quickly after that. The startup problems, Marchand said, resulted from bottlenecks between different parts of the site; those problems went away as technicians made the internal “doorways” wider so they could process more data.

Developers continue listening closely to feedback, he said – from users who call the help line, insurance brokers and insurance companies whose products are being sold on the site. The most recent enhancements, he said, have been to error messages that give users more descriptive, immediate feedback when they make mistakes while filling out the website’s forms. The goal is to fix problems early, he said, before the traffic really takes off later in the year.

At the toll-free call-in center for the Washington exchange, 145 more people are being hired, to reduce wait times which averaged 24 minutes during the first week of November. Questions customers are asking when they telephone the call center, Marchand said, are getting more complex as people get closer to their final decisions.

Traffic, Marchand said, continues to rise. He predicts many consumers will not make purchasing decisions until December when the payment deadline arrives, and others may even wait into the new year, since the enrollment window for 2014 remains open until March.

According to insurance brokers consulted by The Spokesman-Review, it’s wise for consumers to take their time; health insurance policies deserve careful scrutiny, brokers say, so that consumers wind up with plans that include the hospitals and doctors they need. If a particular hospital or doctor is not among a plan’s “preferred providers,” the consumer will be asked to shoulder a bigger percentage of the provider’s fees.