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Regulation and Compliance > State Regulation

California PPACA exchange enrollment plateaus

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(Bloomberg) — Obamacare-loving California led the nation in embracing the Patient Protection and Affordable Care Act (PPACA), and in enrolling its citizens for 2014 PPACA exchange plan coverage.

This year, however, sign-ups for private exchange plans in California, New York and other states that opted to build and run their own insurance markets has stagnated. Yet in more conservative parts of the country that declined to participate and where enrollment is run by the U.S. Department of Health and Human Services (HHS) system, sign-ups have surged.

That includes Florida, where Gov. Rick Scott opposes the law. After a 2012 Supreme Court decision affirming it, Scott said that “the entire act should have been held invalid.” For 2015, 1.6 million Floridians chose insurance plans sold through the federal system, 62 percent more than a year before, according to an analysis by Charles Gaba, a blogger in Bloomfield Hills, Mich., who has accurately predicted enrollment under the law.

The final 2015 enrollment numbers are likely to change. The regular 2015 exchange plan open enrollment period started Nov. 15, was supposed to end Feb. 15 in most of the country, and is now winding down as enrollment period extensions expire. HHS has announced a special enrollment period for people who say they learned about the PPACA individual tax penalty system when they filed their 2014 taxes.

But, at this point, the numbers that are already in look especially strange because California had more uninsured people than any other state in 2013, the year before the health law’s insurance expansions began — 5.8 million, according to the Kaiser Family Foundation, a health research group. About 3.6 million people were uninsured in Florida.

New York, which like California runs its own enrollment system, saw modest growth with about 407,000 enrolled, 37,000 more than a year ago, in a state with 1.8 million uninsured people. In California, enrollment was flat, with about 1.4 million signed up — the same as in 2014.

In the 37 states that used the U.S.-run website, growth in sign-ups from 2014 to 2015 ranged from 25 percent to 81 percent, according to Gaba. Among states that run their own exchanges, only Massachusetts and Hawaii did better — in part because those two states struggled with technology failures in 2014.

Medicaid may be one reason why. Any comparison of enrollment in California and Florida should include people in the program for low-income people, said Dana Howard, a spokesman for Covered California, the agency that run’s the state’s state-based exchange.

California and New York both expanded Medicaid to cover the working poor in 2014. Florida, Georgia, North Carolina and 19 other states didn’t, and as a result some low-income adults in those places who would have been eligible for Medicaid are instead enrolled in private coverage. California’s uninsured population has been halved since last year, including its Medicaid expansion, Howard said.


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