As many as 2.1 million Californians will get subsidized health insurance coverage through the state's new Health Benefit Exchange by 2019, according to a study released yesterday by the UC-Berkeley Labor Center and UCLA Center for Health Policy Research.
Another 1.1 million from the unsubsidized individual health insurance market are expected to join the exchange as well, said UCLA researcher Dylan Roby. That would bring the estimated total to about 3.2 million.
Yesterday's study concluded that the high enrollment rate is dependent, in part, on how effectively the exchange markets itself, Roby said. The base estimate of subsidized participants is only 1.8 million, he said. So if the exchange does an excellent job on marketing and outreach, that number could expand to an "enhanced" total of 2.1 million -- and possibly even beyond that, Roby said.
"I don't think it's a ceiling," Roby said. "Potentially, they could do even better than that. But it's a solid estimate."
The study draws a number of other conclusions. For one, it said as many as 92% of Californians under age 65 will have health coverage by 2019, compared to roughly 84% projected without the Affordable Care Act. Also, an expected expansion of Medi-Cal could mean up to an additional 1.6 million new Medi-Cal enrollees. When added to the high exchange numbers, the study estimated up to 3.7 million Californians could enroll in new coverage by 2019.
According to Roby, if the exchange goes the way health officials hope it will, its market saturation percentage will continue to climb every year after that.
"The hope is, over the years, people will develop a culture of coverage, and hopefully they'll expand on that mark," Roby said. "The exchange has the opportunity to have some high enrollment numbers."
The exchange's success depends on a number of factors, Roby said: simplified enrollment, strong outreach and marketing efforts, cultural competency and effective transition of participants from current state programs to the exchange. But one of the biggest success factors, according to Roby, will be the selling of the exchange, a point emphasized in the most recent exchange board meeting where the results of four focus groups were presented to the board to help frame the marketing effort.
"One of the big things is awareness, and the exchange is doing a good job paying attention to that. Developing that planned-out strategy is crucial, and they're doing that," Roby said. "It's good they're getting started early."
Supreme Court rulings on the Affordable Care Act expected this month could have a variety of impacts on what the exchange is trying to do, Roby said.
"The individual mandate is an important aspect. There will be less demand for insurance if people don't have to pay a penalty," Roby said. "But we still expect that people who want and need health insurance will still take it up."
Roby said a previous UCLA study estimated a loss of 15% to 20% of enrollees without the mandate. But even that estimate depends on how California handles the lack of a federal mandate; the state could pass its own mandate, for instance, or have an open enrollment process to prompt greater participation, Roby said.
"In general, it's not a huge difference, whether the mandate is there or not," Roby said.
The real threat to the exchange would come if the Supreme Court decided to strike down more than that, Roby said. "If they decide that the individual mandate is separable from the law, there will still be money for the exchanges, people will still be buying exchange coverage with federal subsidies," Roby said.
"But they could decide that it's inextricably linked [to the ACA law], and then we don't know how the exchange would be funded, and that would change the game."