Virginia 2018 enrollment update
- Open enrollment for 2018 coverage ended on December 15, 2017.
- SEP through March 1, 2018 for Aetna, UHC, & some Optima & Anthem members who lost coverage on 12/31/17.
VA health insurance overview
More than 400,000 people in Virginia enrolled in private plans through the exchange for 2018. And more than a million people in Virginia are covered under Medicaid and CHIP—an increase of 8 percent since late 2017, despite the fact that Virginia has not expanded Medicaid under the ACA, and has not made Medicaid available to hundreds of thousands of people who would become eligible if Virginia were to expand Medicaid. Expansion is under consideration in 2018, but remains uncertain.
If the ACA were repealed, there would be 685,000 fewer insured Virginians in 2019, according to an Urban Institute estimate. Currently, there are about 863,000 uninsured; there would be about 1.5 million uninsured if the ACA were to be repealed.
Virginia health ratings
Virginia was rated 25th among the 50 states and District of Columbia on The Commonwealth Fund’s 2017 Scorecard on State Health System Performance, down one spot from 24th in the previous edition of the Scorecard. The state placed in the second quintile all five categories – Access, Prevention & Treatment, Healthy Lives, Avoidable Hospital Use & Costs, and Equity.
Details about how the state scored on various metrics within each of those categories are available on Virginia’s state scorecard.
The 2015 edition of America’s Health Rankings placed Virginia slightly higher at 21st, and the stated moved up another two spots in the 2017 edition of the rankings, coming in at 19th. Low per capita public health funding was among Virginia’s biggest challenges, but its rating was positively impacted by relatively low uninsured rates, access to dentists, and the number of children who received vaccinations. And Virginia is one of the only areas in the country where the obesity rate declined slightly from 2015 to 2017.
For more details on overall public health and specific diseases in Virginia, check out the 2016 listing of Key Health Data About Virginia, compiled by Trust for America’s Health. You can also see county-by-county health rankings in this interactive map created by the Robert Wood Johnson Foundation.
2018 health insurers and rate changes
Virginia’s health insurance exchange has been fairly robust ever since 2014, with numerous carriers offering plans in the exchange. Two insurers left at the end of 2017 (Aetna and UnitedHealthcare), but there are still seven insurers offering plans for 2018. However, nearly half of the state’s counties have just a single insurer (Anthem/Health Keepers) offering plans in the exchange, as most insurers have focused on localized coverage offerings for 2018. The following insurers are offering individual plans in Virginia’s exchange for 2018:
- Group Hospitalization and Medical Services
- Health Keepers (Anthem)
- Kaiser Foundation Health Plan of the Mid-Atlantic
- Piedmont Community Healthcare (and Piedmont HMO)
Average approved rate increases for 2018 ranged from 35 percent to 81 percent, but that included an additional premium load on silver plans to account for the fact that the Trump Administration eliminated funding for cost-sharing reductions in October 2017. Most exchange enrollees are receiving premium subsidies that grew to offset the higher premiums, but people who pay full price for their coverage (including anyone with off-exchange plans) likely found it to be less affordable in 2018.
How has Obamacare helped Virginia residents?
Prior to ACA implementation, the uninsured rate in Virginia was 12.3 percent, according to US Census data. The uninsured rate has not dropped as much as it would have if Medicaid had been expanded in Virginia, but it had still fallen to 8.7 percent by 2016.
Although Medicaid has not been expanded, total enrollment in Virginia Medicaid and CHIP has grown by 8 percent since 2013, due in part to the outreach and enrollment assistance from the exchange—people who were already eligible for Medicaid have found out about their eligibility and received assistance with the enrollment process.
As of 2017, there were more than 300,000 people receiving premium subsidies in the Virginia exchange. The subsidies averaged $317.26/month, making coverage affordable for people who would otherwise not be able to afford it. The premium subsidies are much larger in 2018, because premiums increased so much. The benchmark plan on which subsidies are based is a silver plan, and silver plan rates rose considerably in Virginia for 2018. But because the ACA’s premium subsidies increase to keep pace with the benchmark premium, hundreds of thousands of Virginia residents still have access to affordable individual market coverage, despite the rate increases.
Virginia enrollment in qualified health plans
HHS estimated that 470,998 Virginians were eligible for exchange plans in 2015 and that 355,017 of them were eligible for premium subsidies. By the end of 2015 open enrollment, 385,154 people had finalized their enrollment in qualified health plans through Virginia’s exchange, the sixth highest total enrollment among the 34 states where HHS is running the exchange.
During the 2016 open enrollment period, the number of Virginia enrollees grew 9.5 percent over 2015 and reached 421,897. Of these enrollees, 37 percent were new to the exchange. By March 2016, effectuated enrollment was 378,838, and 84.2 percent of those individuals were receiving subsidies that averaged $276 per month.
During the first five years of exchange operation, 2016 had the highest enrollment. 410,726 people enrolled for 2017, and enrollment fell again, to 400,015 people, for 2018. A similar enrollment decline ocurred in most of the other states that use the federally run exchange, due in part to the Trump Administration’s funding cuts for exchange marketing, outreach, and enrollment assistance. In addition, confusion about the status of the ACA’s individual mandate may have played a role. The mandate penalty is still effective in 2018; it will be repealed as of 2019. And the shorter enrollment period for 2018 coverage (November 1 to December 15) gave people less time to pick a plan (that same enrollment schedule will be used in future years as well, but people will become more accustomed to it as time goes on.
Virginia and the Affordable Care Act
In 2010, Virginia’s U.S. Senators, Mark Warner and Jim Webb, both voted in favor of the ACA. But the state’s delegation to the U.S. House of Representatives was much more mixed: the six Democratic Representatives voted yes, while the five Republicans voted no.
As of 2018, Warner is still in the Senate, along with Tim Kaine. Kaine is also a supporter of the ACA. In the House, there are seven Republicans and four Democrats representing Virginia. Although most Republicans in the House of Representatives voted in favor of 2017’s American Health Care Act (which would have repealed or changed several major aspects of the ACA), Virginia Rep. Barbara Comstock (R, 10th District) was one of 20 Republican representatives across the country who voted no on the AHCA.
The state elected to default to an HHS-run exchange rather than create its own. Former Governor Terry McAuliffe, a strong supporter of the ACA, took office in 2014 and was very focused on Medicaid expansion. Current Governor Ralph Northam, who took office in 2018, is also a supporter of Medicaid expansion, and campaigned on a promise to expand coverage.
However, the state legislature has a Republican majority (a much narrower majority than they had prior to the 2017 election, but there is still a slight Republican majority in both the Senate and the House of Delegates) and the ACA has been a very contentious issue. Medicaid expansion was under consideration in the Senate as soon as the 2018 legislative session began, but the bill was killed a few weeks later by a Senate committee. Republicans in state legislature are instead pushing to impose work requirements for Virginia Medicaid before they will consider expansion of coverage (the work requirements would apply to the existing Medicaid population, in addition to the population that would be newly-eligible if the state were to expand Medicaid).
Virginia Medicaid/CHIP enrollment
The ACA was written with Medicaid expansion as a cornerstone, but the Supreme Court ruled in 2012 that states didn’t have to comply with this provision, and nearly half the states are still refusing to expand their Medicaid programs. As of early 2018, Virginia remains among the 19 states that have not yet expanded Medicaid.
Virginia’s governor, and his predecessor, have pushed for Medicaid expansion since 2014, but the Republican-led legislature in Richmond has consistently rejected expansion.
For Virginia applicants, Medicaid is only available according to the pre-ACA guidelines: non-disabled childless adults are ineligible regardless of income, and parents with dependent children are only eligible if their household income does not exceed 49 percent of poverty.
Even with such strict eligibility rules, the Virginia exchange had enrolled 48,660 people in the state’s Medicaid program by mid-April 2014. From July 2013 through June 2016, Virginia’s average monthly Medicaid enrollment increased by 1 percent. But by late 2017, Medicaid/CHIP enrollment had grown by 8 percent over where it was in 2013.
An estimated 138,000 people in Virginia fall into the coverage gap, with no access to financial assistance with their health insurance. They would be eligible for Medicaid if the state used federal funds to expand Medicaid to cover everyone with household incomes up to 138 percent of poverty.
But at least for now, there is no financial assistance available for Virginians with incomes below the poverty level that do not qualify for Medicaid under the state’s existing guidelines.
Medicare in the state of Virginia
In 2015, Virginia Medicare enrollment trended slightly lower than the total U.S. population enrolled in Medicare – 16 percent of its total population, compared with 17 percent nationwide. The state spends about $8,127 per enrollee, annually, also just below the national average of $8,970 per enrollee. As of 2009, the state ranks 14th in the nation in terms of total spending.
Virginians who qualify for Medicare can purchase a Medicare Advantage plan instead of traditional Medicare. These private plans offer additional benefits, and 17 percent of Virginia Medicare recipients selected a Medicare Advantage plan in 2017. About 46 percent of Virginia enrollees chose Medicare Part D prescription drug coverage.
State-based health reform legislation
Scroll to the bottom of the page for information on recent state-level bills related to health reform.
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.