Delaware operates its health insurance marketplace, Choose Health Delaware, in partnership with the federal government. Given the state’s small population, state officials deemed this model as most financially prudent. Additionally, Delaware expanded Medicaid under the Affordable Care Act.
With an already low uninsured rate, Delaware has seen incremental gains since the Affordable Care Act took effect. 9.1 percent of the state’s population was uninsured as of 2013, and that had dropped to 5.7 percent by 2016, according to US Census data.
Medicaid expansion has played a role in reducing the state’s uninsured rate, and total Medicaid/CHIP enrollment has increased by more than 24,000 people (about 11 percent) since 2013.
When open enrollment for 2017 coverage began in the fall of 2016, an estimated 54,000 Delaware residents were uninsured and the state had its sights on enrolling them all. Ultimately, enrollment in private plans via the Delaware exchange was slightly lower in 2017 than it had been in 2016, and enrollment decreased even more for 2018, with enrollment dropping another 11 percent.
Delaware’s exchange had two insurers offering coverage in 2017, but Aetna exited the exchanges at the end of 2017 in all four of the states where they offered plans, and the result is that only one insurer — Highmark Blue Cross Blue Shield of Delaware — is offering coverage in the Delaware exchange in 2018. Highmark already insured more than half of the state’s exchange enrollees in 2017.
Delaware health ratings
In 2015, the Scorecard on State Health System Performance ranked Delaware 15th in the nation for overall health. The state maintained the same 15th place ranking in 2017. The ranking was based on several health indicators related to five key measures: Access, Prevention & Treatment, Avoidable Hospital Use & Costs, Healthy Lives, and Equity.
See Delaware’s scorecard for the state’s performance for a detailed look at its performance. Low percentages of uninsured adults and children and few at-risk adults without a routine doctor visit in the past two years were among positive indicators.
The 2015 edition of America’s Health Rankings evaluated Delaware differently, giving it an overall rank of 32nd, which increased to 30th in the 2017 edition of the Rankings. While a relatively low uninsured rate and strong public health funding bolstered Delaware’s overall ranking, several measures placed in the bottom half.
The Scorecard on State Health System Performance and America’s Health Rankings evaluate different indicators. America’s Health Rankings consider more prevention and treatment indicators, on which Delaware received generally high rankings. That difference helps explain the disparity in the overall scores between the two evaluations.
The 2016 edition of Trust for America’s Health also provides a wealth of public health information, but does not provide an overall score. See Key Health Data About Delaware.
Finally, you can see county-level health rankings for Delaware from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
2018 health insurance plans, rates
Two health insurance companies offered individual plans through Delaware’s exchange: Highmark Blue Cross Blue Shield of Delaware and Aetna. Delaware was one of four states where Aetna continued to offer exchange plans in 2017; the carrier exited most exchanges at the end of 2016. But they left Delaware and all of their remaining exchanges at the end of 2017, leaving Highmark as the only insurer offering plans in Delaware’s exchange for 2018.
Highmark implemented an average rate increase of 25 percent for 2018, which included adding the cost of cost-sharing reductions to premiums. The insurer noted that the average rate increase would have been 16.8 percent if the federal government had continued to fund cost-sharing reductions in 2018.
Subsidies help to offset rate hikes for eligible exchange enrollees. Nearly 81 percent of Delaware exchange enrollees were receiving premium subsidies in 2017.
How has Obamacare helped Delawareans?
Delaware already had a lower-than-average uninsured rate prior to ACA implementation, with 9.1 percent of the state’s population uninsured in 2013 (as opposed to 14.5 percent nationwide). By 2016, the state’s uninsured rate had dropped by 35 percent, falling to just 5.7 percent, according to US Census data.
Total Medicaid and CHIP enrollment grew by 11 percent in Delaware from late 2013 through the end of 2017. Nationwide, Medicaid/CHIP enrollment increased by 29 percent during that time, even accounting for the 19 states that did not expand Medicaid. But Delaware’s average household income is higher than the US average, so relatively few people in the state are eligible for Medicaid.
Delaware enrollment in qualified health plans
Delaware has a partnership health insurance marketplace in collaboration with the federal government. The state’s exchange platform is called Choose Health Delaware; however, residents use HealthCare.gov to enroll in coverage.
In Delaware, 14,087 people enrolled in a qualified health plan (QHP) during the first ACA open enrollment period. At 29.1 percent, Delaware ranked 15th among the states and the District of Columbia in terms of the percentage of the estimated total market that actually signed up for QHPs during 2014 enrollment.
Roughly 85 percent of Delawareans eligible to enroll in an exchange plan in 2016 did so. About 82 percent of 2016 Delaware’s exchange enrollees purchased coverage with financial assistance in the form of advanced premium tax credits. Total 2016 enrollment increased 11 percent over 2015. But in 2017, enrollment declined by 2.4 percent. Across all states that use HealthCare.gov, enrollment declined by about 5 percent, due to a combination of higher premiums, insurer exits, uncertainty about the future of the ACA, and the Trump Administration’s decision to cut advertising and outreach for HealthCare.gov in the final week of open enrollment.
And for 2018 coverage, enrollment decreased again in Delaware’s exchange, this time by about 11 percent. Across all states that use HealthCare.gov, enrollment dropped by about 5 percent for 2018, although it grew slightly in states that run their own exchanges. States that use the federally-run exchange had to contend with a much shorter enrollment period for 2018 coverage (while most states that run their own exchanges opted to extend open enrollment, in some cases keeping it as long as it had been in prior years), and sharp reductions in federal funding for exchange marketing and enrollment assistance.
Delaware and the Affordable Care Act
In 2010, Delaware’s U.S. senators both voted “yes” on the Affordable Care Act while the state’s lone representative voted against the law. In 2018, Delaware’s entire Congressional delegation is Democratic, with two Democratic Senators and a Democratic Representative. All three were opposed to the American Health Care Act (AHCA), the bill that Republicans in the House passed in May 2017 in an effort to repeal or change various parts of the ACA.
Then-Gov. Jack Markell supported the passage of the Affordable Care Act and spoke out to applaud the June 2012 Supreme Court decision that upheld most provisions of the ACA. Shortly after the Court’s ruling, Markell announced the state’s plan to operate its health insurance marketplace as a partnership with the federal government.
While some states chose the partnership model as a stepping-stone to a state-run marketplace, Delaware opted for a partnership model as the best balance between control and cost given its small population and potential market size.
Gov. Markell was term-limited in 2016. His successor, Gov. John Carney, Jr., took office in January 2017. Carney is also a Democrat, and supports the ACA.
In March 2016, Delaware became the 15th state to prohibit health insurance companies from discriminating against transgender enrollees on and off exchange, in the individual and group market. The state has also taken steps to limit patients’ out-of-pocket costs for prescription drugs.
Delaware is among the states that expanded Medicaid under the Affordable Care Act. More than 11,200 Delawareans were deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the ACA’s initial open enrollment.
From 2013 to December 2017, Delaware Medicaid enrollment grew by 24,624 people (11 percent) – a significantly smaller increase than in other states where Medicaid had expanded, likely due to the higher-than-average incomes in Delaware (Medicaid expansion eligibility is capped at 138 percent of the poverty level, which is the same income level in all 48 contiguous states; fewer people are eligible in states where average incomes are higher).
Enrollment in Medicaid and CHIP continues throughout the year. Visit the Delaware Division of Medicaid and Medical Assistance website for information about the state Medicaid program and the Delaware Healthy Children Program.
Other ACA reform provisions
While Delaware has embraced many aspects of the Affordable Care Act, no organization in the state engaged in the Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP program offered loans totaling nearly $2 billion to encourage the startup of nonprofits to increase competition in the individual and small-group insurance markets.
Since fall of 2015, most of the original CO-OPs have closed. This has not impacted Delaware, however, as the state did not have any CO-OPs.
Medicare in the state of Delaware
Delaware Medicaid enrollment is 19 percent of its total population; the percentage of enrollees nationwide is 17. Of the state’s Medicare beneficiaries, 84 percent qualify based on age alone while the remainder qualify due to disability.
Delaware residents can enroll in private Medicare Advantage plans instead of Original Medicare. These plans offer additional benefits beyond traditional Medicare coverage. In 2016, about 9 percent of all Delaware Medicare recipients selected a Medicare Advantage plan, compared with 31 percent nationwide. However, 66 percent of the state’s enrollees selected a Medicare Part D plan for standalone prescription drug coverage, a number well above the 45 percent national average.
Delaware health insurance resources
Delaware health reform
Here’s what’s happening legislatively with healthcare reform in Delaware:
- As of June 15, 2015, HHS issued conditional approval for Delaware’s plan to transition from a state-federal partnership exchange to a federally supported state-based marketplace. However, in August, the state officially decided to continue with the state-federal partnership model, citing cost-effectiveness as the reason.
Scroll to the bottom of this page for a summary of recent state-level health reform legislation.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.