1. THE AFFORDABLE CARE ACT’S MARKETPLACES Results From The First Three Months Sara R. Collins, Ph.D. Vice President, Health Care Coverage and Access The Commonwealth Fund SABEW: The Business of Health Care New York, NY January 22, 2014

2. Exhibit 1. Trends in Cumulative Number of Individuals Who Have Selected a Marketplace Plan Through the Federally-facilitated Marketplace (FFM), October 1 to December 28, 2013 Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

3. THE COMMONWEALTH FUND Exhibit 2. More than 2 Million People Have Selected or Enrolled in Marketplace Plans, as of Dec. 28, 2013 Eligible for marketplace plans HHS Report (12/28) Selected a marketplace plan* HHS Report (12/28) Eligible for Medicaid/CHIP HHS Report (12/28) State-run marketplaces 1,794,708956,991833,389 Federally facilitated marketplaces 3,345,0901,196,430751,120 Total in all marketplaces 5,139,7982,153,4211,584,509 CBO 2014 enrollment projection 7,000,000 9,000,000 Percent of CBO 2014 enrollment projection 73.4%30.8%17.6% *People who have selected a marketplace plan may or may not have paid their premiums, and thus finalized their enrollment. Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf ; and state websites. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

4. TX FL NM GA AZ CA WY NV AK OK MS LA MT WA OR ID SD ND MN WI MI AR OH AL PA NY ME MA NH VT HI UT CO KS NE IA MO IL IN KY WV VA NC SC DC MD DE NJ CT RI TN Percent of three month enrollment target reached by 12/28/2013 <50% 50%-<75% 75%-<100% 100%+ Exhibit 3. Ten States Have Reached or Exceeded Their Three Month Marketplace Enrollment Target as of Dec. 28, 2013 Source: Memo from Marilyn Tavenner, CMS Administrator, Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014, September 5, 2013, http://waysandmeans.house.gov/uploadedfiles/enrolltargets_09052013_.pdf; Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdfhttp://waysandmeans.house.gov/uploadedfiles/enrolltargets_09052013_.pdfhttp://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

5. Exhibit 4. Trends in Cumulative Number of Young Adults Who Have Selected a Marketplace Plan Through the Federally-facilitated Marketplace (FFM), October 1 to December 28, 2013 Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

6. 50–64 28% 19–34 41% 35–49 31% Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Exhibit 5. Distribution of Marketplace Visitors and Marketplace Enrollees by Age Note: Segments may not sum to 100 percent because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013 and Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf 18-34 24% 35-44 15% 45-54 22% 55-64 33% <18 6% Adults who selected a marketplace plan

7. 50–64 28% 19–34 41% 35–49 31% Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Exhibit 6. More than Three-Fourths of Visitors Report Being in Excellent, Very Good, or Good Health Don’t know or refused 1% Health status Note: Segments may not sum to 100 percent because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013. Excellent 17% Very good 37% Good 23% Fair 17% Poor 6%

8. Exhibit 7. By Dec. 2013, More Adults Who Visited the Marketplaces Found It Easy to Compare Plan Benefits and Premiums How easy or difficult was it to compare the … of different insurance plans? Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Note: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding. * Potential out-of-pocket costs from deductibles and copayments. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013. 3058 37 52 3451 Percent Benefits covered Premium costs Potential out-of- pocket costs* Somewhat easyVery easy Somewhat difficult Very difficult or impossible 4351 42 3854

9. Exhibit 8. Adults Who Visited the Marketplaces Continued to Report Difficulties Finding a Plan with the Type of Coverage They Needed Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Note: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding. * Potential out-of-pocket costs from deductibles and copayments. Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013. How easy or difficult was it to find…? 38 30 56 61 Percent A plan with the type of coverage you need A plan you could afford Somewhat easyVery easy Somewhat difficult Very difficult or impossible 6036 3758

10. Exhibit 9. Marketplace Plan Selection by Metal Level and Financial Assistance Status, October 1 to December 28, 2013 Percent of individuals who selected a plan Source: Health Insurance Marketplace: January Enrollment Report, For the Period: October 1, 2013 – December 28, 2013, ASPE Issue Brief, U.S. Department of Health and Human Services, January 13, 2014, http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf Yes No Platinum GoldSilverBronze Catastrophic

11. Exhibit 10. A Majority of Adults Who Have Visited the Marketplaces Rate Their Experience as Fair or Poor Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Overall, how would you describe your experience in trying to get health insurance through the marketplace in your state? Source: The Commonwealth Fund Affordable Care Act Tracking Surveys, Oct. 2013 and Dec. 2013. Percent

12. Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace Once 39% More than once 59% Adults ages 19–64 who are uninsured or have individual coverage and went to marketplace more than once How many times did you visit the marketplace—did you visit once, or more than once? Exhibit 11. A Majority of Adults Who Visited the Marketplaces Went More Than Once; Three of 10 Said Their Experience Improved Over the Course of Their Visits Improved 29% Stayed about the same 52% Got worse 18% Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013. From your first visit to your last visit, did your experience in trying to get health insurance through the marketplace in your state…? Don’t know or refused 2%

13. Exhibit 12. A Majority of Adults Potentially Eligible for Coverage Who Have Not Yet Enrolled Say They Are Likely to Shop for Coverage by March 31, 2014 Adults ages 19–64 who are uninsured or have individual coverage* and who have not gone to marketplace, or went to marketplace but did not apply or did not enroll The enrollment period for health insurance in the marketplaces ends on March 31, 2014. How likely are you to go to/go back to the marketplace by March 31, 2014, to enroll in a health plan or find out if you are eligible for financial help to pay for your plan or for Medicaid? Percent Somewhat likely Very likely Somewhat unlikely Very unlikely Notes: Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding. * Respondents with individual market coverage who said they had received an offer from their insurance carrier to renew their plan for 2014 and said they planned to keep their policies were excluded from this analysis. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, Dec. 2013. Age Health Status 37 39 32 40 41 2867 55 61 58 59

14. Acknowledgements David Blumenthal President Michelle Doty Vice President Survey Research and Evaluation Tracy Garber Senior Policy Associate Health Care Coverage and Access Petra Rasmussen Senior Research Associate Health Care Coverage and Access