Health exchanges utilized in rich and poor counties

Sept. 23--The Affordable Care Act has been characterized by some as a government handout for the poor, but recently released enrollment data for southwest Ohio shows residents of some of the region's most affluent counties signed up for coverage at about the same rate as those in poorer, urban areas.

The U.S. Department of Health and Human Services on Monday released figures showing total enrollment in Ohio's health insurance marketplace -- the online portal for enrollment in private health plans under the ACA -- was highest in Montgomery and Hamilton counties, where most poor and minority communities are concentrated in the cities of Dayton and Cincinnati.

But about the same percentage of residents in Warren and Butler counties -- two of the wealthiest and most homogeneous counties in the area -- signed up for health insurance through the online exchange.

Total marketplace enrollment in MontgomeryHamilton counties combined was 18,985, representing 1.41 percent of the counties' total population of 1.34 million.

By comparison, total enrollment for Butler and Warren counties -- which include some of the highest-income ZIP codes in the area in West Chester Twp. and Mason -- was 7,926, or 1.34 percent of the 590,441 people who live in both counties.

The numbers likely reflect the continued impact of the Great Recession, which hit middle-class households hard with job losses and declining wages, said John Bowblis, an economics professor and health industry expert at Miami University in Oxford.

"There are certain counties in the area, like Butler, Warren and Greene, which are thought to be more affluent and do have pockets of affluence," Bowblis said. "But when we look at the (marketplace) enrollment numbers for people with low-to-moderate incomes, we see the same level of need across the entire area."

About 85 percent of the 154,000 Ohioans who signed up for marketplace coverage this year qualified for tax credit subsidies available to low and middle income households to offset the cost of premiums and deductibles.

Those numbers are not surprising, Bowblis said, when you consider that the Dayton area, like much of Ohio, is still struggling to bounce back from the loss of well-paying jobs in the manufacturing industry, which was the state's leading employer before the recession hit in December 2007.

More than 166,000 Ohioans lost manufacturing jobs, and their health benefits, during the Great Recession of 2007-2009, according to the state's Department of Jobs and Family Services.

While the state has regained about 50,000 of those jobs over the past four years, most of the new jobs pay a fraction of the wages they used to pay, reducing the incomes of those previously living solidly middle-class lifestyles.

"You have these counties that are affluent overall, but there are large areas inside these counties that are not as affluent and those areas are growing," Bowblis said.

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