The State of California is doing neither the best nor the worst when it comes to enrolling people in individual healthcare plans on its Exchange (Covered California), but it is doing the best job I have seen in releasing detailed information. In particular, it has released detailed information on the the age distribution of enrollees, “metal tiers” being selected by enrollees, subsidization rates, and the distribution of enrollees among insurance companies, and rates of enrollment among different language groups. Let’s look at the data and see what can be learned. And, other states, would you please do what California is doing. You have the data. It’s not that hard to put out the numbers.
As shown in the paired bar graph below, the distribution of enrollees in individual Exchange plans by age in California is weighted far more heavily towards those in the older age brackets. There is, in particular, a dearth of children relative to the large numbers in the population and a disproportionately high number of those in the 55-64 age bracket.
The graphic here is less “bullish” on the enrollment of younger enrollees than Covered California would like to make it appear. This is because in various press releases, Covered California has been comparing the proportion of younger people enrolled against the proportion of younger people in the population and suggesting that they are similar. But this is highly misleading because the relevant statistic is the proportion of younger people in the eligible population. The elderly are not eligible to purchase policies on the Exchange. Thankfully, however, California has released the raw data that lets people do their own analyses. When the results are examined properly, in my opinion, the distribution of the young is more problematic.
Metal Tier Distribution
As noted in an earlier blog entry, a high proportion of purchases of Gold and Platinum policies could be worrisome because those policies are likely to be disproportionately purchased by those in poorer health. These policies generally have significantly less cost sharing than the Bronze and Silver policies. The chart below, taken from data provided by Covered California, shows that this concern has not materialized thus far in California. “Sub.” in the graphic shows policies that are eligible for subsidy under 26 U.S.C. § 36B and possibly under 42 U.S.C. § 18071 whereas “Unsub.” shows policies that are not eligible for subsidy. Silver is by far and away the most popular plan selected. And, contrary to earlier information released by California, which initially got matters backwards, subsidized policies are significantly more prevalent than unsubsidized ones.
The pie chart below shows the distribution of enrollees by insurer. As one can see, enrollment in California has been dominated by large insurers. The top 4 insurers have 96.2% of the market. No small insurers have broken into the top 4. Moreover, some insurers are likely to have problems with the small absolute size of their pool if it does not increase significantly: Valley Health Plan has just 122 people enrolled to date in its health plans; Contra Costa Health Plan has just 178.
California has released information the primary language of enrollees. As shown in the paired bar graph below, the data demonstrates that English speaking individuals are enrolling at a rate significantly higher than those whose primary language is something else. People whose primary language is Spanish, for example, constitute 28.8% of the California population but only 4.6% of persons who have enrolled to date.