Enrollment below target for insurance marketplace, on track for private option


LITTLE ROCK — With Monday’s enrollment deadline for the Arkansas Health Insurance Marketplace looming, only 33,569 Arkansans have enrolled, a number well below initial projections, state officials said Thursday.

But officials said enrollment is right on track for the private option — which has no enrollment deadline — with just under 150,000 Arkansans having applied and been found eligible for the program and about 106,000 having completed enrollment.

Officials have said in the past they expected 250,000 to obtain insurance through the private option and another 250,000 to obtain insurance through the exchange outside of the private option.

The private option is Arkansas’ program that uses federal Medicaid money to subsidize private insurance for people earning up to 138 percent of the federal poverty level. People who earn too much to qualify for the private option can obtain federal subsidies to buy insurance through the insurance marketplace, or exchange, if their earnings are within 400 percent of the federal poverty level.

State Insurance Commissioner Jay Bradford said Thursday technical problems with the federal marketplace website initially slowed enrollment outside the private option.

“They’re playing catch-up. I don’t think the state of Arkansas under the private option is playing catch-up. I think that they’re basically right on time,” Bradford told reporters after testifying before the House and Senate committees on public health welfare and labor.

The Obama administration has said the enrollment deadline for the insurance exchanges will be extended beyond Monday for people who have begun the process but have not been able to complete it.

“That will increase that 30,000 enrollment there, based on how many people have started the enrollment process,” Bradford said. “And typically people wait till the last moment, especially younger people. So that would be probably very good for people who have waited a little long but still have a second chance of securing protection.”

A second enrollment period for the insurance marketplace is expected to begin next fall. Bradford said he still expects 250,000 Arkansans to enroll eventually, but “it will just probably take longer than the original projections.”

The state Legislature has blocked the state Insurance Department from promoting the marketplace, which “certainly would be a factor” as well, Bradford said.

Because it cannot promote the exchange, the Insurance Department has lowered a grant request for the marketplace from $10.8 million to $1.45 million.

During the committee hearing, state Surgeon General Joe Thompson testified that the private option appears to be achieving its goals, including reducing uncompensated care at hospitals, based on anecdotal evidence.

“We’ll work to try to get you a real number there, but from multiple hospitals it’s in the multiple hundreds of thousands of dollars that they’ve seen a reduction in uncompensated care, January-February this year compared to January-February last year,” Thompson said.

Some legislators cited a study that found emergency-room visits by low-income people in Oregon increased after the federal Affordable Care Act went into effect. They asked what was being done in Arkansas to reduce unnecessary ER visits, which was one of the goals of the health care overhaul.

Thompson said that for many who have lacked insurance in the past, the ER by necessity has been their only source of care, so “it’s a consistent education and consistent message we’re going to have to give over the coming months, that your best place to get care is not the emergency room.”

State Medicaid Director Andy Allison said a fact that has been lost in news reports on the Oregon study is that the appropriate use of health care saw a bigger increase than inappropriate use of emergency rooms did.

Thompson also told the panel the board of directors of the health insurance marketplace has taken “an important step” by offering the job of executive director to Cheryl Smith, former director of Utah’s insurance exchange. Smith has not yet said whether she will accept the offer.