PROVIDENCE — HealthSource RI, the state’s Affordable Care Act exchange, reported that paying customers increased by 5 percent in 2018, with 18-34 -year-olds making up 35 percent of new customers, which may help mitigate an expected drop in enrollment when tax penalties for the uninsured zero out in 2019.
“It will certainly help,” said HSRI Director Zachary W. Sherman, provided the younger enrollees stick with the program. “We need to keep them in the marketplace,” Sherman said.
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The overall enrollment increase in Rhode Island’s ACA exchange was among the largest increases in the United States.
In early January, the agency reported enrollees had climbed to 33,021 in the final hours of Dec. 31, 10.5 percent higher than last year. Monday’s report, however, focuses on the number of people who followed up that intent to sign up with payments, said Kyrie Perry, director of communications, marketing and outreach for HSRI.
As of Jan. 31, 2018, 30,637 individuals had both enrolled and paid for 2018 health coverage through HealthSource RI, compared to 29,224 in 2017, according to the agency.
In early January, HSRI reported there were 7,799 new enrollees, which was updated to 8,038 new enrollees on Monday. The new number is a 45 percent increase in new customers over last year, when new enrollees numbered 5,543.
About 35 percent, or 2,814 of new 2018 customers were “young invincibles” age 18-34, up from approximately 25 percent compared to HealthSource RI’s 2017 new population. That age group is an important part of the HSRI system, as it balances the pool of customers with younger, healthier people and distributes risk among enrollees, helping to control insurance rates.
“Young invincibles are good for the overall stability of the market as they are typically healthier and therefore utilize less medical services,” said Sherman. “I am encouraged we saw a big jump in overall new customers this year and that so many younger Rhode Islanders decided to enroll in high-quality, affordable HealthSource RI coverage for the first time.”
Neighborhood Health Plan of Rhode Island saw its market share rising from about 50 percent in 2017 to 70 percent (21,525 individuals) this year. The trend was most pronounced in new customers, who chose NHPRI more than 80 percent of the time. The other 30 percent (9,112 individuals) of 2018 HealthSource RI customers enrolled in health coverage from Blue Cross & Blue Shield of Rhode Island. Sherman said he believes the trend was primarily driven by NHPRI’s lower prices.
HSRI also reported an increase in federal subsidies mitigating much of the increase in rates caused by President Donald Trump’s elimination of Cost Sharing Reduction subsidies.
The loss of CSR payments stood to increase individual rates for Neighborhood Health Plan of Rhode Island plans in HealthSource RI by an average of 13.5 percent over 2017 rates, and at Blue Cross & Blue Shield of Rhode Island by an average of 20.3 percent.
Those increases would have been greater if not for OHIC’s direction to insurance companies to make up the bulk of the lost CSR payments by increasing each insurance company’s silver plan rates, King said.
The federal government is legally required by the ACA to limit premiums for low-income families, who make up most silver plan customers, to less than 10 percent of those families’ income.
“The Affordable Care Act is working in Rhode Island. Nearly every person in the state now has health insurance, and the premiums on HealthSource RI are among the lowest in the country,” said Gov. Gina M. Raimondo in a statement. “Washington’s recent actions will undermine our great progress, putting us at risk of unnecessary price increases, instability and fewer plan choices. It is our responsibility to look for ways for the state to protect against federal threats to coverage and affordability.”
Even with increases in silver plan premiums, HealthSource RI has the lowest-cost “benchmark plan” nationwide in 2018. The benchmark plan is the second-lowest cost silver plan available, determining the amount of financial assistance customers receive. The plan has a $311 premium, according to a chart of such rates across the country created by the Henry J. Kaiser Family Foundation.
However, the phenomena of many silver plans costing more than gold led to a shift in 2018 enrollment by metal levels. HealthSource RI saw a significant reduction in unsubsidized Silver customers, as well as a drop in Silver customers who only receive tax credits.
Ninety-two percent of unsubsidized 2017 silver-level customers who selected a 2018 plan chose a different metal level this year. Most CSR eligible customers stayed in silver plans since their tax credit absorbed most of the premium increase.
About 22 percent of HealthSource RI customers selected a gold plan for 2018, up from 12 percent in 2017. Sherman said this jump was in part attributable to silver customers who were able to apply their subsidies to the higher-level gold plans.
“That allowed a lot of our customers to buy up,” Sherman said.
Rob Borkowski is a PBN staff writer. Email him at Borkowksi@PBN.com.
