State-based public health insurance exchanges seem to be doing better than the HealthCare.gov exchanges at attracting consumers who have a choice about where to shop.
State-based exchanges that use HealthCare.gov for qualified health plan (QHP) enrollment are somewhere in between.
Analysts at the U.S. Department of Health and Human Services (HHS) have published data supporting those conclusions in a batch of Patient Protection and Affordable Care Act (PPACA) exchange activity for the period from Nov. 15, 2014, through Nov. 16, 2015.
HHS has had a hard time getting the state-based exchanges to report activity data in the same way, and it is missing some types of data, such as data on use of the PPACA premium tax credit program, for several states, including California.
But the report gives some support for the idea that state-based exchanges may be closer to their residents and more effective at outreach in some ways than exchanges run from Washington.
In terms of raw QHP selection numbers, the best exchange QHP markets have been HHS-run exchange states: 1.3 million of the 9.5 million exchange enrollees live in Florida, and 978,890 live in Texas. Both are HHS-run exchange states.
But another performance indicator is the percentage of the exchange QHP enrollees who are buying their coverage without help from the PPACA premium subsidy tax credit and could buy coverage off-exchange. PPACA now imposes the same medical underwriting restrictions on off-exchange coverage as it imposes on exchange QHPs.
The subsidies are available only to consumers who earn 400 percent or less of the federal poverty level.
The share of exchange QHP business coming from non-subsidy customers has been 13 percent in the HHS-run exchange states, 30 percent in the state-based exchange states, and 19 percent in the states with state-based exchanges that use the HealthCare.gov enrollment system.
In many states, PPACA exchanges have tried to reach out to traditional agents and brokers, and much of the exchange QHP business may be coming in through producers. Producers who are working as exchange agents may happy to build relationships with relatively high-income consumers by helping them buy exchange QHPs. Other producers may object to seeing the PPACA exchanges court relatively high-income customers.
To learn more about where the exchanges have won over higher-income insurance shoppers, read on.
10. Washington state and Illinois: 22 percent.
Washington state QHP selectors: 117,705.
Illinois state QHP selectors: 286,888.
Washington state has a state-based exchange, the Washington Healthplanfinder exchange, and Illinois ended up having HHS handle enrollment. But officials in both states have supported the exchange program, and the exchanges in both states have attracted an above-average share of non-subsidy customers.
9. Connecticut: 23 percent.
Connecticut QHP selectors: 91,139.
Connecticut's Access Health CT won a reputation for running enrollment so well that some other state-based exchanges switched to Connecticut's system. It has attracted an above-average percentage of non-subsidy customers, but not as high a percentage as in some other states with state-based exchanges.
8. New Mexico: 24 percent.
New Mexico QHP selectors: 43,054.
HHS classifies New Mexico as a state that has a state-based exchange but uses the HealthCare.gov enrollment system. That exchange does worse at attracting non-subsidy business than some state's with pure state-based exchanges but better than most of the states with pure HHS-run exchanges.
7. Arizona: 24 percent.
Arizona QHP selectors: 169,178.
Arizona wavered back and forth between running its exchange and letting HHS do the job. So far this open enrollment period, Arizona has been the HHS-run exchange with the second highest percentage of non-subsidy customers.
