Connecticut: Uninsured rate down to 3.8% (Update: Maybe); 43% of individual enrollees still OFF-exchange

Last week I noted that AccessHealthCT, the Connecticut ACA exchange, reported that as of October 1st, they had exactly 95,601 people enrolled in effectuated exchange policies.

This article in the Hartford Courant gives additional, up-to-date data on CT's insurance coverage rate:

Connecticut has its lowest percentage of people without health care coverage ever, according to Lt. Gov. Nancy Wyman and Access Health CT.

Access Health, the state's Obamacare exchange, said 3.8 percent of Connecticut residents, or 137,000 people, are without any form of health insurance.

The U.S. Census reported in September that the number of uninsured Connecticut residents fell sharply in 2014, by 85,000 to 245,000, or 6.9 percent. That was down from 9.4 percent in 2013.

The Census number is the lowest figure it has reported in at least 20 years, and Access Health said its number — determined through an analysis of 2015 coverage by Acturus of Farmington — is an all-time low.

..Following is the breakdown of coverage in Connecticut, according to the Acturus report:

• EMPLOYER-SPONSORED: 56 percent (2 million)
• MEDICAID: 21 percent (760,758)
• MEDICARE: 14 percent (522,587)
• INDIVIDUAL: 4.6 percent (166,933)
• MILITARY/VA: 0.8 percent (29,416)
• UNINSURED: 3.8 percent (137,000)

There's a lot of handy numbers to work with here.

First of all, if the total individual market in Connecticut is 167,000 people, and 95.6K of those are via the exchange, that means that 71.4K are still off-exchange, or 43%. Furthermore, since Connecticut did not allow "transitional" policies to continue after 12/31/13, that means that aside from a small number (?) of "grandfathered" policies, just about all of those 71.4K should be fully ACA-compliant.

I've projected that AccessHealthCT will have appx. 125K QHP selections during 2016 Open Enrollment (OE3). On the one hand, this may look bold, since that's 29.4K higher than their current enrollment level. However, bear in mind that we're talking about selections, not necessarily effectuations; 125K is only 14% higher than the 109,839 QHP selections they reached during OE2. It assumes roughly 83K renewals, plus another 42K new additions drawn from both the 137K uninsured as well as people transferring from grandfathered plans, ESI coverage and so forth.

One troubling point: According to this study, Connecticut currently only has 137,000 uninsured residents total as of this fall. However, the Kaiser Family Foundation study (which is itself referenced in the article and, supposedly, the Acturus study) gives the number as 247,000. Of course, the KFF study was as of the first part of 2015, so some of the reduction is due to many enrollments not going into effect until later in the year...but that's still a 45% difference, which is pretty dramatic.

If the Acturus number is accurate today and is representative of the other states as a whole, that suggests that the Kaiser study, as comprehensive as it is, may be dramatically out of date...and also suggests that there are far fewer uninsured individuals who could potentially enroll via the exchanges than I've been thinking.

UPDATE: Thanks to Arielle Levin Becker for this story, which addresses the discrepancy between the Acturus numbers and other CT uninsured data in more detail:

While state and exchange officials praised the results and said they showed Connecticut has one of the lowest uninsured rates in the country, the estimated uninsured rate comes with some caveats.

Rather than conduct a broad survey, as the Census does, the firm that conducted the analysis used data on insurance coverage and results from a survey of exchange customers. But the analysis didn't include data on the number of people who have coverage through their jobs this year, even though research indicates that the majority of Connecticut residents have employer-sponsored insurance.

Instead, the number of uninsured was projected based on estimates of how many exchange customers were previously uninsured or had dropped coverage, without accounting for changes in employer-sponsored coverage.

The estimate also assumed that people with coverage stayed enrolled for the full year, although experts say it’s not uncommon for people to move between coverage types, or on and off coverage, throughout the year. In the past 12 months, for example, enrollment in Connecticut’s Medicaid program has fluctuated from 758,001 last October to 704,316 in August 2015. Enrollment in plans purchased through the exchange, Access Health CT, dropped from 110,095 in March to 95,601 this month.

Oh for heaven's sake. OK, never mind; the Acturus study seems shaky at best here. It sounds like they double-counted anyone who moved from one type of insurance coverage to another (ESI to QHP, QHP to Medicaid, Uninsured toe Medicare and so forth).