Last November, the 2013 Colorado Health Access Survey was released with a variety of updated data, including the number of Colorado residents who were uninsured in 2013: about 741,000. That was down from 829,000 two years earlier, but is still 14% of our state population. And it doesn’t include the people who are considered underinsured (spending more than 10% of their income on healthcare costs) – that number was pegged at 675,000 in 2011.

By March 31, Connect for Health Colorado had enrolled 118,628 people in private health plans, and another 158,521 people in Medicaid. It isn’t known yet what percentage of those people were previously uninsured. Connect for Health Colorado has a question that asks whether the applicant was previously uninsured, but it’s an optional question. In a mid-March teleconference hosted by Families USA, Connect for Health Colorado CEO Patty Fontneau explained that about 50% of their enrollees had answered the question, but that as open enrollment progressed, the percentage of people answering that question was dropping. The exchange suspected that people who were previously uninsured were less likely to answer that question than people who were previously insured, simply because there’s so much confusion surrounding the mandate and penalties for people who don’t have health insurance (there’s no penalty for not having had health insurance prior to 2014, but people might not be aware of that and might be hesitant to answer the question if they were previously uninsured).

But based on the people who had answered the question about prior insurance status, Fontneau said that a “good solid chunk” were previously uninsured, including “most” of the new Medicaid enrollees.

While general open enrollment ended on March 31, Connect for Health Colorado is continuing to enroll people who tried to apply by that date but were unable to finish their enrollment for any reason. They’ve extended the enrollment window until April 15, and have said that they will help anyone who contacts them by that date and requests help. If you’re trying to begin the process now, contact us for help with this part of it). In addition, people who are still waiting for a Medicaid eligibility determination will have until May 31 to complete their private plan application if it turns out that they are not eligible for Medicaid.

Medicaid enrollment goes year-round; there is no time frame by which eligible individuals need to enroll in Medicaid. As awareness of Medicaid expansion in Colorado continues to spread, it’s likely that enrollment will continue to grow over the next couple years enhancing the progress covering the uninsured.

In addition, people who experience a qualifying event will be able to enroll in new private plans – both inside and outside the marketplace – throughout the year. Qualifying events that trigger a special open enrollment include marriage, divorce, loss of other coverage that is deemed minimum essential coverage (short-term plans, discount plans, etc. do NOT count as minimum essential coverage), birth, adoption, or moving permanently to a new area where different plans are available.

So enrollment will continue to climb. Especially for the rest of this year, as pre-2014 plans come up for renewal and in many cases are terminated, resulting in a special open enrollment for members. Last month, the Obama Administration announced that non-grandfathered pre-2014 plans could be renewed again in 2014 (they were allowed to be renewed in 2013, and at that time it was believed that all of those non-ACA-compliant plans would need to be replaced with new ACA-compliant plans at their renewal date in 2014). But at this point, we haven’t had clarification yet from the Colorado Division of Insurance on of whether or not they will allow the additional extension (about half the states allowed it last year, and Colorado was one of them). If the state decides to allow the extensions, it will then be up to each carrier to decide whether or not to participate. We’ve talked with two major carriers – Cigna and Anthem Blue Cross Blue Shield – about this, and they both said that they not planning to extend plans past the end of this year (this could still change, but is accurate as of early-April). At this point, it’s all very up in the air. We will continue to update on this as more news becomes available.

To put this into perspective, more than 335,000 Colorado residents received individual policy cancellation letters last fall, but about 92% of them were ultimately offered early renewal instead, allowing the plans to renew in late 2013 and thus remain in force until late 2014. One major Colorado carrier reported that about one-third of the early renewal offers it sent out were accepted by insureds, so we could roughly extrapolate that to say that probably somewhere around 100,000+ people in Colorado opted to renew their old plans in late 2013 (this is in addition to the plans that simply kept their normal renewal date and would be up for replacement throughout this year). Those plans were all scheduled to terminate at the end of this year, and the insureds were going to be shopping for new coverage at that point, either in Connect for Health Colorado or in the private market outside the exchange. If we ultimately remain on that track, there will be a significant influx of people signing up for new ACA-compliant health insurance plans throughout this year, with an especially large crowd joining at the end of the year when all of the early-renewal policies terminate (people who did not opt for early renewal last fall – but whose plans were not terminated at the end of 2013 – have plans that are up for renewal at their normal renewal date this year. If their plan terminates at that point, they will be eligible for a special open enrollment window to shop for new coverage on or off the exchange).

In addition to the current and future Medicaid and private exchange enrollment numbers, we also have to remember that Colorado has a robust off-exchange market. We don’t have any concrete data yet in terms of how many people have secured a new, ACA-compliant individual plan outside of the Connect for Health Colorado marketplace, but it almost certainly adds a considerably chunk to the 277,000 people who had obtained Medicaid or private plans through the marketplace as of March 31. As far as we know, off-exchange enrollment was not extended past March 31 by any carrier in Colorado (or any of the national carriers). So the off-exchange enrollment numbers will only increase for the rest of 2014 when people have a special open enrollment triggered by a qualifying event. But as mentioned above, people are still completing enrollments in private plans through Connect for Health Colorado, and Medicaid enrollment goes year-round.

Any way you slice it, Colorado has certainly made significant progress covering the uninsured over the last few months. And that uninsured number will continue to fall throughout the year. For those who say that new enrollments are only meaningful if they’re for people who were previously uninsured, there’s another part of the picture that’s being missed if we’re just looking at the progress covering the uninsured… A lot of the people who have enrolled in new ACA-compliant plans used to be covered by plans that were far less comprehensive. Thanks to the subsidies available through the exchange, they may now be paying less than they used to pay, for far better coverage. These are people who might have been considered underinsured last year, and are now covered by solid health insurance this year. Definitely an improvement, both for them as individuals and for the hospitals and providers who will treat them. Even though they aren’t among the previously uninsured who are now insured, they are absolutely among the people who are benefiting from the ACA and the new plans that it has created.