With an already low uninsured rate, Delaware has seen incremental gains since the Affordable Care Act took effect. When 2017 open enrollment began on November 1, an estimated 54,000 Delaware residents were uninsured and the state had its sights on enrolling them all.
While the outcome of the 2016 presidential election has left some wondering if they need to buy health insurance. While president-elect Trump has promised to repeal it when he takes office, the Affordable Care Act still applies and 2017 open enrollment runs through January 31. Here, we’ve addressed some questions you may have about the new administration’s plans as they relate to open enrollment and what you might expect in the months and years to come.
Delaware health ratings
In 2015, the Scorecard on State Health System Performance ranked Delaware 15th in the nation for overall health. 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. 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.
2017 health insurance plans, rates
Two health insurance companies offer individual plans through Delaware’s exchange: Highmark Blue Cross Blue Shield of Delaware and Aetna, which lists its PPO and HMO divisions as separate entities for rate filings. Delaware is one of four states where Aetna will continue to offer exchange plans in 2017; the carrier will exit most exchanges at the end of 2016.
Approved average rate increases for 2017 are as follows:
- Aetna Health (HMO): 23.6 percent
- Aetna Life (PPO): 22.8 percent
- Highmark BCBS of Delaware: 32.5 percent
Nationwide, rates increased an average of 25 percent. Subsidies will help eligible exchange enrollees offset the rate hikes.
How has Obamacare helped Delawareans?
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.
Given its population and relatively low uninsured rate prior to ACA implementation, Delaware has seen the sixth smallest reduction in percentage of uninsured since 2013. The state’s uninsured population decreased by 3.1 percentage points to 7.4 percent from 2013 into 2015.
Monthly Medicaid enrollments have grown by an average of 12,643 people (6 percent) in Delaware since expansion took effect.
Delaware enrollment in qualified health plans
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.
Delaware and the Affordable Care Act
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.
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.
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, several CO-OPs announced their closure or intent to close and several others are predicted to follow.
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 2015, about 8 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 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.
Other state-level health reform legislation: