Open Enrollment Set for Nov. 1 as State Agency Targets Uninsured

The new Oregon Health Insurance Marketplace is targeting counties in northwest Oregon to get at the 116,000 people who could be buying plans on the federal exchange but remain uninsured. While some consumers may re-enroll automatically, massive price spikes at Moda Health and Lifewise may cause a massive shift in the market as consumers opt for cheaper plans at Kaiser, the Oregon Health CO-OP and Providence.

The remaining operations for the state’s insurance exchange appear to have shifted tranquilly from the wreckage of Cover Oregon over to the Department of Consumer and Business Services, with 2015 enrollment at 107,000 people -- up from 70,000 in 2014.

Nov. 1 is the next big date for consumers to pay attention to. That’s when open enrollment for 2016 begins, allowing new consumers to pick a plan and existing customers to shop for a different plan or renew their current one on healthcare.gov through Jan. 31.

Unlike last year, some customers who purchased plans on healthcare.gov last year will be able to have their plans renewed autuomatically, but with huge price differences this year, along with health insurance companies opting to discontinue certain plans, marketplace administrator Berri Leslie told legislators this week that consumers should go back online and look around.

“Our message for folks is to take action -- regardless of your circumstance,” Leslie said.

In addition to those who purchased their 2015 health plans through the exchange, an additional 107,000 people were enrolled directly through a broker or an insurance company -- including 40,000 who would have received subsidies.

Joel Metlen, the spokesman for the exchange, said some of these consumers may have stayed away because of the complications with the old Cover Oregon system, despite a smoothly running healthcare.gov website. “You can start and finish the process online,” he said -- unlike the old hybrid system.

One of the key remaining roles that the state agency has not delegated to the federal government will be to reach these consumers, as well as 116,000 people who are simply uninsured but would be eligible for a qualified health plan. Of those people, 93,000 could receive federal financial assistance to help them offset the cost of the premium and possibly copays and deductibles.

“We’re doing a very targeted campaign to reach those people,” Leslie said. Metlen said they were focusing on a dozen counties with the highest proportion of eligible uninsured and, with the exception of Deschutes County, they are concentrated overwhelmingly in northwest Oregon, including Portland and Salem -- not eastern or southern Oregon.

Silver Plan vs Basic Health Plan

Lawmakers at the presentation were surprised to learn that consumers with an income under 250 percent of poverty ($29,000 for an individual and $61,000 for a family of four) can actually get substantial help offsetting high deductibles and copayments if they choose a mid-grade silver plan. “They don’t pay those ridiculous out-of-pocket costs,” said Rep. Rob Nosse, D-Portland. “They pay some, but they get help.”

Metlen said the exchange would be working with brokers to help pitch these plans rather than the bare-bones bronze plan, which may cost consumers more despite a lower premium, since they won’t get any financial help at the time of purchase. “It’s a pseudo-gold plan,” said Rep. Mitch Greenlick, D-Portland.

The federal subsidies that come with those silver plans may reduce the political demand for a publicly-run Basic Health Plan for individuals and families under 200 percent of poverty, which is currently under consideration at the Oregon Health Authority. But given that Oregon has 93,000 consumers who could be getting subsidies but are still uninsured, a substantial number of people might still find Obamacare’s subsidized insurance option unaffordable.

Greenlick was also concerned whether removing the lower-income people from the exchange would undermine the viability of the market. About 43 percent or 46,000 people who currently buy through the exchange would be eligible for the Basic Health Plan.

Health Equity Gap

Health equity remains an issue in Oregon health insurance coverage. With the exception of Asian-Americans, the state’ communities of color were all under-represented in the marketplace enrollment demographic data.

Although race and ethnicity were unknown for about a third of enrollees, only 3.4 percent of those reported were Hispanic, only 0.6 percent were black and only 0.3 percent were native American, compared to 12.5 percent, 2 percent and 1.8 percent of the total Oregon population for these groups.

Metlen said he was surprised that fewer than 400 American Indians signed up for coverage on the exchange, despite substantial effort. “We’ve been very involved with working with the tribes,” he said. “A lot of their folks are Medicaid-eligible,” -- meaning they are too poor to qualify for subsidized insurance.

The same may be true in the state’s Latino and African-American communities, where individuals earn less income than the general population, making them eligible for the Oregon Health Plan.

The exchange plans to continue the work of Cover Oregon to engage community organizations who are familiar with people from these ethnic backgrounds, as well as develop culturally inclusive literature and Spanish-language advertising.

Moda Health Leads, for Now

Moda Health remains the overwhelming leader of the individual health insurance market, selling 98,000 -- 40 percent -- of 241,000 total plans sold both inside and outside of the exchange. Lifewise Health Plan is second with 45,000 plans, while Providence Health Plan is third at 29,000.

Regence BlueCross BlueShield of Oregon, which has chosen to keep its main brand off the exchange, sold 24,000 plans, second only to Moda Health on the off-exchange market.

Other health insurers have found their own niche -- Oregon’s Health CO-OP has the third-most popular bronze plan, while the other health co-operative, Health Republic, has the only platinum plan. Kaiser Permanente sold one of the more popular gold-level plans.

Moda Health will be hard-pressed to keep its post at the top of the individual health market, as its rates are going up an average of 25 percent. Similarly, Lifewise rates have skyrocketed 35 percent. Thrifty shoppers may gravitate to plans with cheaper 2016 premiums, including Kaiser, the CO-OP and Providence. Zoom Health Plan, a new entry on the exchange for 2016, will have the fourth-lowest cost health plan.

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