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Analyst: They cleaned the health market window

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One of the side effects of state and federal health reform efforts is the creation of new databases.

Since the Patient Protection and Affordable Care Act (PPACA) came along in 2010, the Centers for Medicare & Medicaid Services (CMS) have added databases showing everything from how much medical device makers pay to physicians’ favorite charities to how much individual bronze-level health insurance plans in North Dakota cost.

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Similarly, California has a state law, based on a 2012 bill, Assembly Bill 1082, that now requires the California Department of Insurance and the California Department of Managed Health Care to merge health plan and health insurer enrollment figures into a single report.

In the past, California reported traditional health insurance and health maintenance organization enrollment separately, and analysts like Katherine Wilson had to do the best they could to piece a complete picture of the market together.

Wilson recently created a whole-California-market analysis for the California HealthCare Foundation, and she said in a recent interview that one of the outcomes of transparency efforts has been a clearer picture of the market. 

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Wilson found that enrollment in the state’s commercial health insurance market increased to 2.2 million, from 1.5 million, in the individual market, and fell to 11.8 million, from 12.4 million, in the group market.

About half of the people who had individual health coverage in California in 2014 bought their coverage through the state’s Covered California PPACA exchange, Wilson reported.

Wilson said in the interview that one point revealed by the whole-market data was that off-exchange individual health insurance enrollment held steady.

“The other half is staying the course,” she said. 

In the past, California insurers were famous for holding premiums for healthy people low with aggressive medical underwriting, and aggressive efforts to rescind the policies of enrollees who filed big claims.

Now, PPACA forbids insurers from using personal health status other than age and tobacco use when deciding whether to issue policies and when pricing policies.

In the past, “so many people were locked into coverage,” Wilson said. “I wonder how competitive the individual market really was.”

Now, enrollee flow may change, because consumers will realize that they can more easily move from one plan to another, Wilson said.

Wilson sees a lack of data on enrollment in self-insured employer plans as one major gap. She would also like to get better data from the state regulators themselves on whether the individual coverage consumers have is exchange coverage or off-exchange coverage.

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