Advocates track Ohio's subsidized enrollment

States and the federal government are tracking their marketplace exchanges, unsure of how many individuals will ultimately sign up or the total amount of outlays required for premium tax credits. Families USA, a nonpartisan advocacy group, recently drilled down to estimate subsidized-enrollment potential for several states.

For example, it found 2.4 million potential enrollees in New York and 2.5 million in Texas. The group also estimates that 916,000 people in the state of Ohio have the opportunity to enroll in exchange plans with subsidies.

U.S. Senator Sherrod Brown (D-Ohio), who spoke in a press conference announcing the Ohio report, says that he will purchase an exchange plan himself. It’s a milestone 20 years in the making within his political career. A supporter of the Patient Protection and Affordable Care Act (PPACA), Brown never signed up for the health plan offered to congressional leaders, deliberately waiting for national healthcare reform that makes coverage more affordable and available to Americans, he says.

“I spent a lot of time talking to individual people in Ohio concerned about healthcare because they don’t have insurance or have inadequate coverage,” Brown says. “We hear story after story of people frustrated with their healthcare coverage.”

Ohio-a swing state-remains undecided on legislation to expand Medicaid eligibility. Republican Governor John Kasich supports the expansion but is considering an alternative similar to the Arkansas model.

In Arkansas, Democratic Governor Mike Beebe hammered out an alternative arrangement for Medicaid expansion with conservative lawmakers, under which, newly eligible residents would enroll in private coverage plans instead of the traditional program. The Centers for Medicare and Medicaid Services approved the waiver in late September, allowing the state to expand coverage to those with incomes under 133% of federal poverty level, using federal PPACA funds.

Financial assistance

Ron Pollack, executive director of Families USA, says subsidies offered in Ohio’s federally operated exchange are designed so those who need the most financial help will receive it. For example, a family of three with an income of $29,000, or about 150% of federal poverty level, will pay $1,172 annually toward the total premium.

“If they go into the new marketplace, we estimate the premium they will need to pay is $8,250, however, they will receive a subsidy of almost $7,100, picking up the lion’s share of the premium cost,” Pollack says.

On October 1, when the exchange opened for enrollment, the host site was so overwhelmed with traffic that most of the functions were not working well enough for consumers to completely sign up for coverage plans. However, the payer participants are offering robust plan choices at all the metal levels.

For example, a 27 year old adult in Cuyahoga County, where Cleveland is located, could purchase a SummaCare PPO Bronze plan for $193.07 a month before tax credits, according to the Department of Health and Human Services database. But the consumer would also have a choice of 18 other Bronze plans, both HMO and PPO, with varying premiums.

Col Owens, co-chair of the Ohio Consumers for Health Coverage advocacy group, says Ohio gained approval from the Department of Health and Human Services to maintain a certain amount of responsibility for plan management and regulation of insurance in the state’s federally operated exchange.

“It’s federally run with a state punch,” Owens says.

Pollack believes Ohio will want to operate the insurance exchange on its own in time.

And insurance coverage makes a difference not just in offsetting charity care for providers or broadening the risk pool payers, but in health outcomes as well.

In 2008, Families USA produced a report showing that two working-age Ohioans die each day because of their lack of health insurance, which amounted to an impact of 750 deaths in 2006.

Families USA also found that under health reform, there are more than 5 million individuals in Ohio with pre-existing conditions that otherwise might have been denied coverage, as well as approximately 97,000 young adults that have gained insurance through their parents’ plans. In addition, insurers paid out $486,681 in medical-loss-ratio rebates in Ohio so far.