Covered California™ is the state’s marketplace for the federal Patient Protection
and Affordable Care Act (Affordable Care Act). Covered California is charged
with creating a new health insurance marketplace in which individuals and small
businesses can get access to affordable health care. Covered California’s goal
is to enroll as many eligible Californians in affordable health insurance
coverage as possible. Many will enroll in health insurance through Covered
California because they are newly eligible for Medi-Cal or because they can take
advantage of federal premium assistance. Those who make too much to qualify for
premium assistance will still be able to buy plans through Covered California or
in the broader individual market. This fact sheet presents Covered California’s
enrollment forecasts for subsidized coverage and unsubsidized coverage both
through Covered California and the broader market.[1]
In addition, this fact sheet summarizes the California Department of Health
Care Services’ (DHCS’s) forecasts of new Medi-Cal enrollment for 2014. Also
included in this fact sheet is Covered California’s reporting schedule for key
enrollment data. In addition, Covered California is providing an appendix that gives
background eligibility and demographic data for the California market.
Goals and Forecasts
Covered California’s goal and aspiration is,
over time, to help insure all eligible Californians. We recognize and have
planned for the reality that coverage will grow over time. Based on experience
in other states and economic modeling, the forecast enrollment for the first
year of operations is as follows:
·
By the end of the first open enrollment (i.e.,
before April 1, 2014), Covered California expects to have enrolled between 487,000
and 696,000 subsidy-eligible Californians (those eligible for premium
assistance).
·
By the end of the second open enrollment (before
Jan. 1, 2015), Covered California expects to have enrolled between 840,000 and
1.2 million subsidy-eligible Californians.
DHCS has
forecast more than 1 million in new Medi-Cal enrollment for 2014, which is not
subject to the open-enrollment provisions for Covered California health
insurance plans or the individual market, as follows:
·
By the end of 2014, 700,000 who are newly
eligible under the Affordable Care Act.
·
By the end of 2014, 350,000 who were previously
eligible but will benefit from the new streamlined application.
Table 1 displays subsidized and unsubsidized
enrollment forecasts for Covered California’s subsidy-eligible enrollees and
the unsubsidized individual market through January 2018. As noted above, not
all unsubsidized enrollment will occur through Covered California; however, all
enrollees will benefit from Affordable Care Act market reforms, such as the elimination
of pre-existing condition exclusions and annual and lifetime dollar limits on
coverage.
Table 1. Subsidized and Unsubsidized
Enrollment Forecasts: 2014 through 2018
|
April
2014
(Full
Initial Open Enrollment)
|
January
2015
|
January
2016
|
January
2017
|
January
2018
|
Forecast of Subsidized Enrollment
(Base-Enhanced) [2]
|
487,000 - 696,000
|
840,000 - 1,200,000
|
1,110,000 - 1,640,000
|
1,340,000 - 2,000,000
|
1,540,000 - 2,070,000
|
Forecast of Unsubsidized Enrollment [3]
|
|
1,700,000 -1,720,000
|
1,800,000 - 1,820,000
|
1,930,000 - 2,000,000
|
2,010,000 - 2,080,000
|
Data Sources and Reference Tools
The data presented in this fact sheet come
from the California Simulation of Insurance Markets (CalSIM):
·
CalSIM is a model designed to estimate the
impacts of the Affordable Care Act on health care coverage in California. It
was developed by the University of California, Berkeley, Center for Labor
Research and Education and the University of California, Los Angeles, Center
for Health Policy Research. Additional CalSIM data are available at http://healthpolicy.ucla.edu/programs/health-economics/projects/CalSIM/Pages/default.aspx.
Data from CalSIM Version 1.8 are used throughout this document.
Covered California’s Enrollment Data Reporting Schedule
Covered California is committed to regular data reporting
of service levels, call/contact volume and enrollment. Table 2 displays a
schedule of data to be reported on a weekly and monthly basis starting in October
2013. Covered California is also working to schedule reporting of more granular
data, shown in Table 3, about where enrollees go to get assistance with enrolling
(enrollment channel) and key enrollee attributes.
Table 2. Enrollment Data Reporting
Schedule
|
Weekly
(Starting Oct. 8, 2013)
|
In-person
enrollment support:
·
Certified county eligibility workers
·
Covered California Certified Insurance Agents
·
Covered California Certified Enrollment Entities
·
Covered California Certified Enrollment Counselors
Service (for individual and for Covered California’s Small Business Health Options Program [SHOP]):
·
Total call volume
·
Average wait time
·
Average handle time
·
Web visits (at CoveredCA.com)
·
Average Web session time (at CoveredCA.com)
·
Referred to county — quick sort
·
Referred to county — other
|
Monthly
(Starting Nov. 15, 2013)
|
·
Subsidized coverage (those who enroll and are
eligible for premium assistance in the form of the federal tax subsidy)
·
Non-subsidized coverage
·
Enrollment in the Small Business Health Options
Program (SHOP)
|
Table 3.
Enrollment Data Reporting Elements to Be Scheduled
|
Enrollment
in Medi-Cal:
·
Newly eligible — effective Jan. 1, 2014
Enrollment
by channel:
·
Certified county eligibility workers
·
Covered California Certified Insurance Agents
·
Covered California Certified Enrollment Entities
·
Covered California Certified Enrollment Counselors
·
Covered California Service Center representatives
·
Self-service online
Enrollment
by key enrollee attributes:
·
Language
·
Race/ethnicity
·
Age groupings
·
Federal poverty level percentage band
·
Metal level (plans are categorized as Bronze,
Silver, Gold and Platinum)
·
Plan
·
County
|
APPENDIX
California Market Background
Eligibility and Demographic Data
As a resource for stakeholders, reporters and
others interested in Covered California’s mission, this appendix provides some
key background information from independent sources on the demographics and
eligibility for insurance coverage of the California market. Specifically, we
provide information on the following five questions:
1.
What does health insurance coverage in
California look like today?
2.
How will coverage expansions benefit
California’s uninsured?
3.
How many people are eligible to enroll in
Covered California?
4.
Where
do the 5.3 million Covered California-eligible individuals get their coverage
today?
5.
What
is the demographic mix, language spoken and geographic distribution of the 2.6
million Californians who are eligible for federal subsidies?
1. What does health insurance
coverage in California look like today?
Figure 1 shows that the majority of
Californians who are under 65 get their coverage through their employer today. The
Affordable Care Act will provide new coverage options for those who are uninsured
and purchasing coverage through the individual market today. (Source: Employee Benefit Research
Institute. 2012. “Sources of Health Insurance and Characteristics of the
Uninsured: Analysis of the March 2012 Current Population Survey.” Issue Brief No.
276. September.) The estimate for the uninsured in this report reflects the
total number of individuals who were uninsured at some point in the year.
Figure 1. Insurance Coverage in California in 2013
2. How
will coverage expansions benefit California’s uninsured?
Figure 2 looks at the uninsured from a
“point-in-time” estimate and describes the 4.6 million currently uninsured
Californians who will be able to get coverage and the source of that potential
coverage: Medi-Cal, Covered California or the individual market. For many,
coverage expansions will come with subsidies to help pay for part or all of the
cost of health care. For those who do not qualify for subsidies, changes to the
individual market will ensure that all individuals can access coverage without
being turned down due to a preexisting condition. (Source: CalSIM Version 1.8, available at http://www.healthexchange.ca.gov/StakeHolders/Pages/CalSIM18Data.aspx.). In addition to this 4.6 million, there are an
estimated 1 million uninsured individuals who will not be eligible for Medi-Cal
or Covered California’s other coverage expansions under the Affordable Care Act
due to immigration status.
Figure 2. Uninsured
Californians by Eligibility for Coverage in 2014
·
A million
uninsured individuals will not be eligible for Medi-Cal or Covered California
due to their immigration status.
·
These data
are point-in-time estimates that capture the state of being uninsured at any
given point in the year. Point-in-time estimates are lower than full-year
estimates, which capture the total number of people who are uninsured
throughout the year.
3. How many people are eligible to
enroll in Covered California?
Covered California is conducting a broad
marketing and outreach campaign to ensure that all individuals who are eligible
for new and expanded coverage understand their options. Covered California’s primary
target of marketing and outreach efforts is the more than 5.3 million
California residents as of 2014 who are either eligible for subsidies or now
benefit from the guaranteed coverage and new insurance protections from the
Affordable Care Act. (Source: CalSIM Version 1.8, available at
http://www.healthexchange.ca.gov/
StakeHolders/Pages/CalSIM18Data.aspx.)
StakeHolders/Pages/CalSIM18Data.aspx.)
These include:
·
2.6 million who qualify for subsidies in Covered
California.
·
2.7 million who do not qualify for subsidies but
now benefit from guaranteed coverage and can enroll inside or outside of
Covered California.
4. Where do the 5.3 million individuals
eligible for Covered California individual insurance get their coverage today?
Most individuals who are eligible for
subsidies in Covered California are currently uninsured, while others purchase
coverage in the individual market. A smaller number of subsidy-eligible individuals currently have employer-sponsored insurance
(ESI), but this coverage is either unaffordable (greater than 9.5 percent of the
individuals’ income) or will no longer be offered on Jan. 1, 2014. Figure 3
shows the current coverage status of those who will be eligible to purchase
subsidized and unsubsidized coverage through Covered California in 2014. (Source:
CalSIM Version 1.8, available at http://www.healthexchange.ca.gov/StakeHolders/Pages/CalSIM18Data.aspx.) Some
important observations based on this data are listed below.
·
The largest subgroup among those eligible are
the 1,550,000 Californians who are currently uninsured who will now benefit
from having federal premium assistance to make health care more
affordable.
·
Among the individuals who will be eligible for
financial assistance through Covered California are 570,000 Californians who
are purchasing health insurance on the individual market today. These
individuals already see the value of carrying health insurance and will see
immediate assistance.
·
Of those who are not eligible for financial
assistance, but do benefit from the new insurance protections, the number of
Californians is approximately equally divided between those who have insurance
today (1,290,000) and those who are uninsured (1,350,000).
·
For the 1,290,000 with insurance today, their
rates may change — going up or down depending on their current coverage, age
and other factors — but starting in 2014 they will be getting insurance that covers
all essential health benefits.
·
For the 1,350,000 who are uninsured, they now
will be able to choose among a range of health plans and different levels of
benefits — and they cannot be denied based on their pre-existing condition.
Figure 3. Covered
California's Target Audience
Eligible
for CoveredCA individual insurance plans
|
|
5. What is the demographic mix, language
spoken and geographic distribution of the 2.6 million Californians who are
eligible for federal subsidies?
Although Covered California directs marketing
and outreach to all of the 5.3 million Californians who are eligible to
purchase in the marketplace, there is an explicit emphasis on reaching the 2.6
million Californians who are eligible for premium assistance and cost-sharing
subsidies through Covered California. By ensuring substantial enrollment among
the subsidy-eligible population, Covered California will be ensuring balanced
risk mix that will ensure lower premiums for everyone in the individual market
going forward. Mirroring California itself, the subsidy-eligible population is
diverse in terms of race/ethnicity, primary spoken language and geographic
distribution (Figures 4 and 5). (Source:
CalSIM Version 1.8, available at http://www.healthexchange.ca.gov/StakeHolders/Pages/
CalSIM18Data.aspx.) Covered California’s marketing and outreach campaign will reach the subsidy-eligible population in their language where they live, work and play, which means that it is reaching out to all parts of California and targeting different populations and languages.
CalSIM18Data.aspx.) Covered California’s marketing and outreach campaign will reach the subsidy-eligible population in their language where they live, work and play, which means that it is reaching out to all parts of California and targeting different populations and languages.
About half of Covered California’s
subsidy-eligible population is Latino, and more than 25 percent primarily speak
Spanish. An additional 13 percent, or 350,000 subsidy-eligible Californians,
speak an Asian language, such as Chinese or Vietnamese, or another language.