2015 rates and carriers
Sixteen carriers will be selling individual plans in the Ohio exchange during the 2015 open enrollment, up from twelve in 2014. After reviewing plans and rates, the Ohio Department of Insurance announced that the average rate increase for 2015 would be 12 percent in the individual market – a double digit hike that was immediately held up by ACA opponents as evidence of the law’s failure to rein in premiums.
But the Department of Insurance used very basic math in their calculation, and the result is not particularly informative. A weighted average would have been much more helpful, and appears that it would also be significantly lower. In short, people who purchase their coverage through the exchange in Ohio should not expect double digit rate increases for 2015. Many plans will have much more modest increases, or even decreases.
2014 enrollment numbers
HHS will release updated enrollment numbers in November, when the 2015 open enrollment period begins. But by mid-April, 154,668 Ohio residents had completed their Obamacare enrollment, selecting private plans in the exchange.
And by the end of August, 367,395 people in Ohio had enrolled in the expanded Medicaid program in Ohio – surpassing the state’s estimate for this year and next year combined. In addition, by mid-April another 124,195 people had enrolled in Medicaid who qualified based on the old guidelines but had not been previously enrolled. Their enrollment is due in large part to the attention that ACA implementation has brought to the Medicaid program, called the “woodwork” effect.
All told, that’s over 646,000 people in Ohio who obtained new health insurance so far in 2014, thanks to Obamacare. Medicaid enrollment and special enrollment periods are year-round, so the total is likely to be higher by the end of the year.
A report released by HHS in June compared after-subsidy premiums paid by exchange enrollees in the 36 states where HHS is running the exchange. In Ohio, the average after-subsidy premium is $121 per month – significantly higher than the $82 per month average across all 36 states.
Ohio’s after-subsidy premiums are the fourth highest among the 36 states (only New Jersey, North Dakota and Deleware are higher), but the discrepancy is a factor of the enrollees’ incomes and the plans they selected: The ACA completely levels the field for people with the same incomes who select the second-lowest-cost silver plan in their exchanges. But among enrollees who qualify for subsidy, there are significant differences in income, and enrollees are free to apply their subsidies to any “metal” plan in the exchange.
Although the average after-subsidy premiums are higher in Ohio than in most other states, base rates in the Ohio exchange are just slightly lower than the average of the 36 states where HHS is running the exchange. Averaged across all age groups, the lowest cost 2014 bronze plan in the Ohio exchange is $263/month, and the lowest cost silver plan is $304/month.
Medicaid expansion in the Buckeye state
Ohio Governor John Kasich is not an ACA proponent, but he’s long been a supporter of expanding Medicaid in Ohio, which was approved in late October 2013. Eligible residents were able to begin enrolling in expanded Medicaid on December 9, 2013 and the state received 1,165 applications on the first day of enrollment. By August, net enrollment in Ohio’s Medicaid program had grown by more than 367,000 people since the fall of 2013.
However, opponents of Medicaid expansion brought a lawsuit against the Ohio Department of Medicaid and the state’s Controlling Board because the General Assembly was bypassed in the decision to expand Medicaid. The plaintiffs hoped to block the state from expanding Medicaid to cover approximately 366,000 residents who would be newly eligible under the expanded guidelines. But on December 20th, the Ohio Supreme Court sided with Governor Kasich and kept Ohio Medicaid expansion on track.
Exchange history in Ohio
In November 2012, Governor Kasich formally announced that Ohio would not implement a state-run health insurance exchange. In the same letter, Kasich indicated that Ohio would retain control of plan management activities and determining eligibility for the state’s Medicaid and Children’s Health Insurance Plan (CHIP).
CMS announced on November 22 that the technology necessary for applicants to enroll in exchange plans directly through insurers was working and being piloted in three states, including Ohio. The program was summarized in a presentation by Families USA in early March.
Ohio residents can compare plans, determine subsidy eligibility and enroll in coverage at Healthcare.gov.
Leadership’s opposition to the ACA
In June 2013, the Ohio Department of Insurance issued a press release announcing that 14 insurers filed plans to offer more than 200 options for individual insurance, and seven insurers would offer 84 options for small businesses (ultimately, two carriers backed out, leaving 12 in the exchange in 2014). Lt. Gov. Mary Taylor, who also directs the state’s insurance department, stated in the press release that “consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”
Both opponents and supporters of the Affordable Care Act jumped on the press release. Opponents claimed Ohio was the latest example of “rate shock.” Supporters dismissed the announcement for making “apples-to-oranges” comparisons and pointed out that both Kasich and Taylor have been outspoken about their opposition to the ACA.
Taylor is still no fan of the ACA, and is still the Director of the Department of Insurance. In a May 2014 press release, Taylor said that “Obamacare is hitting us harder and driving our costs up significantly.”
Laws were enacted in Ohio to make it more difficult for navigators to be certified, which means that the state has fewer people available to assist applicants, and there was a delay in getting them started as navigators after the exchange opened on October 1.
A private exchange
On June 10, CieloStar announced that it had partnered with the Ohio Chamber of Commerce to launch a private health insurance and benefits exchange, which they said was open for business in early June.
The private exchange in Ohio purports to offer a variety of major medical and supplemental plans for individuals, along with coverage options for small and large groups. Although it remains unclear whether the site can provide real major medical (ACA-compliant) health coverage for individuals – the links for individuals appear to focus mainly on retiree/COBRA benefits, and things like FSAs, HRAs, and HSAs.
Ohio health insurance exchange links
State Exchange Profile: Ohio
The Henry J. Kaiser Family Foundation overview of Ohio’s progress toward creating a state health insurance exchange.