As Affordable Care Act exchanges bring health plans to previously uninsured Americans, there are also market segment transitions that could prove favorable for risk pools.
The rate of uninsurance among working-age adults has dropped notably since public exchanges opened last fall for subsidized health plans and Medicaid, according to a new study by the Commonwealth Fund.
The uninsured rate for Americans ages 19 to 64 declined from 20 percent to 15 percent between July-September 2013 and April-June 2014, with young adults accounting for much of the change, according to the survey.
For 19-to-34-year-olds, the uninsured rate declined from 28 percent to 18 percent as some 5.7 million adults gained insurance -- almost half of the decline across the adult population. In total, the Commonwealth Fund found, there were 9.5 million fewer Americans without insurance by the time the first open enrollment concluded.
These new public marketplace -- through which Americans earning between 100 and 400 percent of the poverty level can buy subsidized insurance and, in 25 states, everyone earning less can enroll in Medicaid -- are starting to chip away at the nation's pre-ACA uninsurance rate of about 16 percent, or some 45 million.
According to the most recent Gallup-Healthways survey, the national uninsurance rate now stands at about 13.4 percent, the lowest since Gallup began tracking the rate in 2008.
Among the Americans getting subsidized private plans and Medicaid, though, are previously-insured consumers -- including those who not long ago were getting employer-sponsored coverage.
More than 60 percent of adults who enrolled in exchange plans and Medicaid were uninsured at least just prior to gaining coverage, the Commonwealth Fund found, but 18 percent of the new enrollees had employer-sponsored insurance and 9 percent had individual policies.
For new exchange plan enrollees, just under 60 percent were previously uninsured, 21 percent were on group plans and 17 percent were on individual plans. For new Medicaid enrollees, 66 percent were previously uninsured, while 17 percent previously had employer-sponsored plans and only 1 percent had individual coverage.
(Source: Commonwealth Fund)
That 20 percent proportion of new exchange enrollees coming from the group market suggests a small though not insignificant migration for low- and middle-income Americans -- consumers, possibly working part time, who previously and still may have access to job-based insurance but find more affordable options in the new individual insurance market.
It may also reflect a sign of shifts among employers, who are more closely calculating the benefit to them and their employees of offering traditional group plans. Earlier this year, Target decided to end its health insurance options for part-time employees and instead send them to exchanges with a $500 contribution, following the likes of Home Depot, Walgreens, Trader Joe's and others.
Employers large and small are clearly interested in defaulting to or offering workers the option of exchanges, public and private, if it means they can lower costs. A recent survey by Prudential Financial found more than half of mid-size and large companies willing to transition to private exchanges.