Enrollment in health insurance plans offered through the federal Affordable Care Act has fallen by 5% in Indiana, the fifth straight year of declining participation.
The Centers for Medicare and Medicaid Services released data last week showing that 140,931 Hoosiers either selected coverage plans from the federal insurance marketplace or were automatically reenrolled during the open enrollment period in November and December.
For a similar period a year earlier, 148,404 Indiana residents chose plans from private insurers. Slightly more than 139,000 ended up paying premiums to obtain coverage.
Nationwide enrollment dropped 1.5% from a year ago to about 8.3 million people this year.
The federal marketplace is available to people in 38 states who lack access to employer-provided medical coverage or who are not eligible for Medicare, the federal insurance program for people 65 and older.
The Indiana president for CareSource, one of two marketplace insurance providers for the Hoosier State, said his company saw a 30% increase in enrollment to nearly 58,000 paying customers and about 6,000 pending customers.
“I attribute a lot of that to the expansion of our service area,” Steve Smitherman said in a telephone interview. “We did add Lake and Vanderburgh, some of the bigger counties that we weren't previously in.”
Dayton-based CareSource grew its Indiana coverage territory from 79 counties last year to all 92 counties this year. Among the additions are DeKalb and Kosciusko counties in northeast Indiana.
The other federal marketplace provider in Indiana is Chicago-based Celtic Insurance Co., doing business as Ambetter from MHS. Ambetter, which began providing coverage in all 92 counties last year, did not respond to questions from The Journal Gazette about its enrollment.
CareSource increased its average monthly insurance premium by 4.9% this year, while Ambetter raised its average by 18.9%, according to rate filings with the Indiana Department of Insurance. Smitherman said he believes CareSource's smaller premium increase helped boost its enrollment.
Rate filings showed that before tax credits, CareSource's average statewide insurance premium is $533 a month, and Ambetter's is $567.
Smitherman said 71% of CareSource's marketplace customers qualified for income-based federal tax credits that help offset premium payments. He also said his company saw a large increase in the number of people choosing lower-priced insurance plans.
The anti-poverty agency Brightpoint helped more people enroll for insurance for this year than it did for coverage last year, said Amanda Chappell, program manager for the Covering Kids and Families office at the agency.
Chappell's office assisted 57 applicants in northeast Indiana during the 2018 open enrollment period and 70 during the 2019 period.
“While we saw a 42% decrease in the number of people that we helped enroll in Allen County, we saw increases in the number of people that we helped in some of our rural communities including Adams, DeKalb, LaGrange, Wabash, and Wells counties,” Chappell said in an email.
She attributed those increases to outreach efforts by Covering Kids and Families.
“Since there is no marketing happening at a federal level, we have to rely on our personal efforts to notify the community about their options and how we can help,” Chappell said.
She said Covering Kids and Families has developed “more of a known presence” in northeast Indiana.
Federal marketplace enrollment for Indiana peaked at 219,185 customers in 2015, the second year for the program, and has decreased every year since. Factors for the decline have included a strong economy – in which growing numbers of people have access to employer-provided medical insurance – Indiana's expansion of Medicaid coverage for low-income Hoosiers and attempts by the Trump administration and congressional Republicans to repeal the Affordable Care Act.
The health care law had required most people to carry insurance or pay a tax penalty until Congress eliminated the punishment beginning in 2019.
A federal appeals court in Texas ruled in December that without the tax penalty, the law's “individual mandate” requiring coverage is unconstitutional. The Trump administration is adhering to the law until the case is resolved.
But the Trump administration in recent years has cut funding for enrollment assistance, curtailed marketing activities and shortened the sign-up period from when President Barack Obama's administration enacted the Affordable Care Act and oversaw the federal insurance marketplace.