In the weeks leading up to the enrollment deadline, more West Virginians signed up for health insurance under the Affordable Care Act than in previous months, according to Highmark Blue Cross Blue Shield, the state's only insurer participating in the exchange.
As of the March 31 deadline, 20,131 people had enrolled in ACA-compliant plans with the company, it reported Tuesday. Of those, 14,839 people enrolled through the exchange, and 5,292 purchased plans directly through Highmark.
The numbers released were markedly higher than those released March 11, when the company reported that 14,980 people had enrolled in ACA-compliant policies with the company. Of those, 10,970 used the federal exchange and 4,010 went directly through Highmark.
According to the insurance company, the numbers were lower than its original projections.
A spokesperson for Highmark West Virginia said they would not release the projected numbers, calling it "proprietary business information."
Fred Earley, president of Highmark Blue Cross Blue Shield of West Virginia, told the Gazette on March 20 that enrollment numbers for early March were 25 percent below projections.
"As the only provider on the exchange, Highmark West Virginia remains committed to serving our state," Earley said. "Although lower than our original projections, we are pleased with the results, especially considering early technical problems with Healthcare.gov that delayed enrollments."
The Obama administration announced last week that it would allow for another sign-up extension for those who had begun the enrollment process but had not completed purchasing a plan. While there have been many questions raised about how individuals will prove they attempted to purchase insurance online, those who have an incomplete application on the ACA website can still complete the process through mid-April.
According to Perry Bryant, executive director of West Virginians for Affordable Health Care, the numbers from Highmark would represent roughly 20 percent of the 99,000 West Virginians identified in actuarial studies as eligible for plans under the ACA. The number of those who previously were uninsured is hard to determine, though, and Bryant said many of those newly enrolled might previously have been insured. Highmark reported that 63 percent of the 20,131 who enrolled were new to the company, meaning 37 percent had held plans with Highmark previously.
"There is also the problem of account transfers,” Bryant said. “These are people who, if you went to Healthcare.gov and were found eligible for Medicaid, your information was transferred to the DHHR, and, conversely, if you were found eligible for a plan with Highmark, your information was meant for them.
“The last I heard, there were 3,000 people in account-transfer purgatory — who thought they were enrolled with Highmark — but that information has not been released yet."
The slow uptake of those enrolling in private insurance plans stands in contrast with those who have enrolled in expanded Medicaid in the state. Of the roughly 133,500 identified in actuarial studies as eligible for expanded Medicaid in West Virginia, 104,827 have enrolled in the program, according to numbers released Tuesday by the state’s Department of Health and Human Resources.
For Bryant, one of the primary reasons he believes the private insurance numbers have fallen short is Gov. Earl Ray Tomblin's decision to refuse federal aid for a statewide promotional campaign. People under 200 percent of the federal poverty line can qualify for significant savings through federal assistance, Bryant said, and many will see significantly lower deductibles and lower or comparable premiums, but are unaware of the potential benefits of enrolling.
"Had we taken that 100-percent-funded federal campaign, I think that, as impressive as the 20,000 number is, we could have had even higher than that," he said.
Those who opt to buy a Silver Plan and earn below 150 percent of the federal poverty level — $35,325 a year for a family of four — will pay 6 percent of their insurance claims, and those who earn between 150 and 200 percent of the FPL will pay 13 percent, Bryant said. Both are well below what people would have paid for a similar plan before the ACA, he said.
"Your deductible will likely drop considerably if you fall into that category," he said.
Brandon Merritt, a health-policy analyst for the West Virginia Center on Budget Policy, said March had the highest enrollment numbers of any other month in the exchange, which began Oct. 1.
"This is the first formal year of the ACA marketplace, so there was never any anticipation that there would be a 100 percent opt-in to coverage within the first year," Merritt said. "The first couple of years are going to be transitional years, where there are still a lot of things up in the air and a lot of kinks to work out. By 2016, we should have a much better understanding of it. People who want insurance are going to have insurance by that time."
According to Bryant, the federal government will assess those who did not have health insurance for at least nine months in 2014 with a tax penalty of $95 or 1 percent of their annual income, whichever is higher. The penalty rises to $295, or 2 percent of their income, in 2015, and $695, or 2.5 percent, in 2016.
Bryant said those penalties will be deferred until the next tax-filing period and added that those who do not file federal income taxes, those who qualify for Medicaid or those who qualify for religious exemptions will not be assessed a fine.
Reach Lydia Nuzum at firstname.lastname@example.org or 304-348-5189.