Health coverage enrollment hits home stretch

health-insurance Tyler LaReau is an independent insurance agent in Norman. He’s a fan of the Affordable Care Act (ACA) — he likes what it does for people. “I put my political beliefs aside,” he said. “I don’t care. It’s the law of the land, and let’s see how many people we can help.”  

I asked Tyler what he thought the biggest obstacle was to enrollment. He didn’t hesitate: “Education. We’re fighting an uphill battle… We don’t have many people that, once we explain it to them, don’t think this is a good thing.”

A recent report suggests most American adults are unaware of most of the ACA’s main provisions; only between forty and sixty percent of respondents know, for example, that the ACA eliminates discrimination against people with preexisting conditions by insurance companies. But when Oklahomans with preexisting conditions visit Tyler’s office and find out that they can’t be charged more or discriminated against, “they’re ecstatic that they can’t be turned away.”

Tyler and I spoke in mid-February, not long after the ACA’s January enrollment numbers were released. In January, nearly 10,000 Oklahomans selected a marketplace plan, bringing the cumulative total since October to 24,667 – about one-third of Oklahoma’s projected total enrollment. Nationwide, over four million people enrolled through, helping to drop the US uninsured rate dropped to its lowest point in five years. Open enrollment for 2014 closes at the end of March, and across the country, insurers like Tyler are gearing up for a strong surge in the remaining month.

Oklahoma Marketplace Enrollment by MonthTyler said he’d enrolled people in 350 plans since December 1, 2013, although because plans can include dependents, the total number of discrete individuals enrolled could be much higher. He noted that in the last month, the proportion of enrollees who were young adults jumped significantly. Nationwide, the enrollees within the coveted 18-34 age bracket constitute 25 percent of total enrollment. In Oklahoma, young adults are 26 percent of enrollment.

While those numbers for younger enrollees are still well below the White House’s 40 percent target, it’s on par with Massachusetts’s young adult enrollment numbers when the state expanded health insurance in 2006. Furthermore, January’s increase in young adult enrollment was the largest increase for any age group that month: nationwide, 318,000 young adults enrolled in January alone, compared to 489,000 from October to December. Similarly, in Oklahoma, 2,814 young adults enrolled in January – up from 3,600 in the prior three months combined.

In Oklahoma, as nationwide, women have out-enrolled men: In January in Oklahoma, 56 percent of enrollees were female (versus 44 percent male). This may be because women have traditionally been underinsured – in 2012, less than half of women (48 percent) were able to get insurance through their jobs, as opposed to 57 percent of men. Additionally, some analysts say men could just be procrastinating. Their enrollment may increase closer to the March 31 deadline.

About three-quarters of those who applied online in Oklahoma were found eligible for some form of financial assistance. Financial assistance on the marketplace comes in two primary forms: tax credits and cost-sharing subsidies. Tax credits are available to enrollees who earn between 100 and 400 percent of the federal poverty level (FPL) – between $11,670 and $46,680 per year for a one-person household, or between $23,850 and $95,400 per year for a family of four.

Chart via Pennsylvania Health Access Network
Chart via Pennsylvania Health Access Network

The second form of financial assistance, cost-sharing subsidies, are only available for silver plans (recall that health insurance offered on the marketplaces has four tiers: bronze, silver, gold and platinum). Enrollees with incomes at or below 250 percent of FPL ($29,250 for a single-person household, or $47,125 for a family of four) qualify for the subsidy, which effectively increases the insurance companies’ share of the expense from 70 percent to as much as 94 percent. This can knock the monthly payment for a family of four from $400 to $40.

The cost-sharing subsidy is, in Tyler’s words, “a big deal.” Most applicants – 65 percent in Oklahoma, 61 percent nationally – choose silver plans. “They’re almost in tears, they’re so happy,” he says.

He estimates that about 5 percent of the people who have called his office trying to enroll were surprised to find that they are too poor to qualify for financial assistance – Oklahomans earning below 100 percent of FPL ($11,670 for a single-person household, $23,850 for a family of four) aren’t eligible for any financial assistance on the health insurance marketplace. Because Governor Fallin has chosen not to accept federal funds to extend health care coverage to low-income Oklahomans, they are stuck in a coverage crater, making too much to qualify for Medicaid and too little to get tax credits on the marketplace.

When I asked Tyler if he’d encountered any enrollees who were angry about having to buy insurance, he waved it off. “By the time we’re done, it’s like they’ve melted.”

“Look at the facts,” Tyler said. “Look at what this can do for you.”

OK Policy intern J.Christopher Proctor contributed to this post.

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Carly Putnam joined OK Policy in 2013. As Policy Director, she supervises policy research and strategy. She previously worked as an OK Policy intern, and she was OK Policy's health care policy analyst through July 2020. She graduated from the University of Tulsa in 2013. As a student, she was a participant in the National Education for Women (N.E.W.) Leadership Institute and interned with Planned Parenthood. Carly is a graduate of the Oklahoma Center for Nonprofits Nonprofit Management Certification; the Oklahoma Developmental Disabilities Council’s Partners in Policymaking; The Mine, a social entrepreneurship fellowship in Tulsa; and Leadership Tulsa Class 62. She currently serves on the boards of Restore Hope Ministries and The Arc of Oklahoma. In her free time, she enjoys reading, cooking, and doing battle with her hundred year-old house.

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