Ohio has its first look at plans on our Exchange! So, what does that mean to you?

If you have insurance through your job, it means basically nothing1.

For all of the attention paid to the Exchange, it will be the smallest segment of Ohio’s insurance market. Using Kaiser’s State Health Facts, the current breakdown2 is:

Employer: 62%
Medicaid/Public: 14%
Individual: 6%
Uninsured: 19%

There will be basically no change in the number of people getting insurance through their work3. The uninsured and the individual market will be combined, so a quarter of Ohioans will go to the Exchange. Among Exchange users, around 88% will get subsidies or be enrolled in Medicaid.

Here’s what the insurance market will look like next year:

Type of insurance Medicaid expansion No Medicaid expansion
Employer 62% 62%
Medicaid 26% 14%
Exchange 11% 13%
Subsidies 3% 3%
Uninsured 0% 8%

Yes, the GOP blocking Medicaid will push 19% more Ohioans into Obamacare. How do I get those numbers?

If we expand Medicaid, then the uninsured population will go to www.ohioexchange.ohio.gov and enter their household income.

Income (% FPL) Uninsured Individual Market
< 138% Medicaid no premium for private plan
138% – 400% Subsidies partial price on private plan
> 400% Exchange pays full price for private plan

We can estimate the breakdown based on income information of uninsured Ohioans and Ohioans on the individual market. This is as a percentage of all Ohio non-elderly adults.

Income (% FPL) Uninsured Individual Market
< 138% 10% 2%
138% – 400% 8% 3%
> 400% 2% 1%

If Ohio doesn’t expand Medicaid, then people earning 100-138% of poverty will be eligible for Exchange subsidies (which will be more expensive than just giving them Medicaid). People living below poverty, however, won’t get subsidies and will remain uninsured.

7.6% of Ohioans are uninsured and below poverty, while 2.3% are uninsured and earn 100-138% FPL. Without Medicaid, that 2.3% will get Exchange insurance.

All told, this is a long-winded way of saying that Mary Taylor’s monomaniacal focus on premiums for 3% of Ohioans has had a deleterious effect on the insurance accessibility for 37% of Ohioans.


1 There may be a psychological effect on potential entrepreneurs: should you decide to strike out on your own, having access to quality, affordable health care will make it much easier to succeed.

Let’s say a diabetic 61-year-old wants to leave his large firm to create a LLC that services his sector. Currently, he can’t get insurance and would pay thousands of dollars a month for treatment; on the Exchange he can get a Platinum plan for $737 a month with no out-of-pocket costs. That’s not peanuts, but if he isn’t immediately successful then that cost will be much lower.

This is the kind of efficient macroeconomic policy that conservatives claim to want (even at the expense of short-term growth). The fact that a bill which improves labor market elasticity and efficiency across all sectors has resulted in a 4-year conniption is strong evidence that the contemporary GOP are no more than kleptocratic nihilists.

2 I’m only looking at the 19-64 demographic. It’s very hard to predict how minors will get coverage, so I won’t try. Suffice to say that between subsidies and CHIP they should all get coverage. And Medicare is unchanged.

3 This is supposed to change with the Employer Mandate, so that 2% more people will get employer-based insurance. The Mandate that became law was designed by Pres. Snowe, who wound up voting against the bill anyway, and has been delayed for a year.

Basically, your employer must subsidize your insurance by the amount that you’d receive on the Exchange. To do this, your employer must know your household income. Nobody has figured out how to make that happen, or even why an employee would want that to happen.

That also means that it would less for Walmart to employ a teenager than to employ a head-of-household.