Covered California has provided basic statistics and pretty pie charts on enrollment numbers into the ACA health plans that they offer. But what is left out is the statistical data that economists and demographers would like to have to ascertain if the Affordable Care Act is merely working or if it is actually fulfilling the promise to reduce health disparities in our communities with affordable health insurance.
Demographic enrollment numbers
Covered California has collected an abundance of information through the application process that they have not shared in their latest round of enrollment figures from October 1, 2013 – December 31, 2014. If the demographic data of the applications such as race, ethnicity, zip code, and income were released it would give us a better understanding if the ACA is meeting its goals. Also absent from the latest data are figures on Medi-Cal and the breakdown individuals, families and households with parents in private plans and children in Medi-Cal kids that have been enrolled.
Operational data
The latest data also gives us very little information on how people are enrolling and who is helping them enroll. The methods in which people chose to enroll (e.g. paper, phone, Certified Enrollment Counselor, Certified Insurance Agent) will help not only Covered California, but their partners in directing resources to help underserved Californians enroll. Finally, how many people have just given up applying and why? While those are hard questions to answer, the real success of Covered California will be measured in how they address their failures.
Will Covered California release real statistics?
Below are is list of questions pertaining to the enrollment data that, if answered by Covered California, will provide real information about the effectiveness of the exchange.
Race and ethnicity data
How can we tell if Covered California is really serving the variety of immigrant communities without meaningful data?
- What is the enrollment break down by race and ethnicity into Medi-Cal and private plans?
- What percentage of the different races enrolled with which carrier?
- How many were subsidy eligible versus non-subsidy?
- What is the enrollment data by zip code is for different races and ethnicities?
Household demographics
- What is the percentage of household enrollments versus individual enrollments?
- Are there more families or individuals eligible for Medi-Cal?
- What is the average number of members of a household application?
- How many households are represented in the total enrollment numbers released?
- What is the mean and median income of families and individual enrolling in subsidized plans?
- Which zip codes have the highest enrollment rates?
- What percentage of families are split with the children being Medi-Cal and the parent(s) eligible for a subsidized private plan?
- How many enrollments are for people over 65 years old?
Enrollment motivation
I don’t think the data is necessarily available to answer some of these questions, but they would be a good indicator of the motivating factors for enrollment.
- How many enrollees had health insurance prior to applying through Covered California?
- Conversely, how many new enrollees had no insurance because of either cost or previous denial for pre-existing condition?
- How many households enrolled because their health plans were cancelled on December 31st?
- How many people who had health insurance and enrolled through Covered California and subsequently received either the Advanced Premium Tax Credit or were eligible for Medi-Cal?
Health plan statistics
- What are the enrollment numbers by carrier by plan type: PPO, EPO, HMO?
- What percentage of the Silver plans are Enhanced Silver because of household income?
- What is the race and ethnicity enrollment broken down by health plan?
- How many households have switched health plans because their doctors were not in-network with the originally chosen health plan?
Covered California Operational questions
- How many applications were with paper, online or over the telephone?
- What is the demographic break down of how the people enrolled?
- How many people enrolled using a Certified Enrollment Counselor (CEC), Certified Insurance Agent (CIA), county eligibility worker or with the help of a Covered California call center staff member?
- How many applications were generated through enrollment events for both Medi-Cal and private health plans?
- How many people have duplicate applications entered through Covered California?
- How many applications have been withdrawn or terminated?
- How many accounts were started but the applicant never enrolled in a health plan?
Who is doing the enrollments?
It would also be nice to learn how Covered California is reacting and handling the enrollments.
- What are the top five questions callers are asking Covered California staff?
- How many enrollments by phone are they handling per day?
- How many of the enrollments are from applicants for whom English is a second language?
- How much money has been paid out to Certified Enrollment Counselors?
- What percentage of enrollments from CECs are Medi-Cal or Subsidy eligible?
- What percentage of enrollments from CIAs are Medi-Cal or subsidy eligible?
- Why do the enrollment statistics indicate that some Minimum Coverage health plan enrollments were subsidy eligible when the Catastrophic plans have never been eligible for the Advanced Premium Tax Credit?
Is Covered California serving California?
The raw enrollment numbers from Covered California are nice but they don’t really speak to the overall effectiveness of the exchange.
- Is the exchange just enrolling people who already have insurance and just need the tax credit?
- Are they really enrolling the uninsured and serving chronically under-insured immigrant communities?
These questions and many others may elude Californians as Covered California carefully releases data that will put them in the best possible marketing light as opposed to tackling the tough issue of whether they are actually fulfilling their mission.
Our mission is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value. – California Health Benefits Exchange
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