GIVING THIS ANOTHER SHOT: How many are still enrolled in grandfathered/transitional plans by state?

2018 MIDTERM ELECTION

Time: D H M S

The total individual/family policy health insurance market was roughly 10.6 million people in 2013. This included people enrolled in either "grandfathered" policies (i.e., policies enrolled in prior to the ACA being signed into law in 2010) or in "transitional" policies (those enrolled in between 2010 and late 2013, just before the ACA required all new individual market policies to be fully compliant with the new healthcare law.

How many of those 10.6 million people are still enrolled in grandfathered (GR) or transitional (TR) policies today? Unfortunately, there seems to be very little available data about just how many people are still in these policies. The Kaiser Family Foundation gave a rough estimate of around 2.1 million people last year, which sounded about right to me. However...Kaiser didn't include a state-level breakout of their estimates, and of course it's a year later so that number, if accurate, has probably shrunk a bit more.

I've tried to crunch the numbers on this several times in the past with limited success, but I'm tackling it again today. Note that due to their closed-off nature, both of these numbers have shrunk every year since 2013 as current enrollees either die off, age onto Medicare, transition to Medicaid, switch to employer-based coverage or make the leap into an ACA-compliant policy. However, exact numbers have been very difficult to come by for a variety of reasons.

In some cases I have hard data...but most of those are as of several years ago. There was an extremely high attrition/churn rate in these policies, ranging from 40-67% per year according to the Congressional Budget Office prior to 2014 (when both types of plans were "locked in" and accepting no further new enrollees). IF this rate had remained steady since 2013, then the 10.6 million people enrolled in GR/TR plans would have dwindled to somewhere between 110K - 1.43 million nationally as of today.

Since 2014, however, the attrition rate has dropped off considerably as the remaining enrollees tend to cling to those plans as long as possible before either switching to a new, ACA-compliant policy, aging into Medicare, seeing their income drop to the point that they move to Medicaid or (in some cases) die off (hey, it happens). As shown below, I've done my best to track down hard data for as many states as possible, but in most states the numbers I have are vague at best. Therefore, in cases where I don't have anything better to work with, and in the interest of erring on the side of caution, I'm going to assume roughly a 25% average net attrition rate per year for 2014, 2015, 2016, 2017 and 2018. I fully recognize how rough this is but it's the best I can do for now. If that rate was consistent, there'd still be around 2.5 million still enrolled in GF/TR plans today.

HOWEVER, there's one more twist: While most states took the Obama Administration up on their "If you like your plan you can keep it" transitional plan offer, 17 states did not allow transitional policies to continue. 15 of them cut things off on 12/31/13, while two more (Colorado and Oregon) only allowed a 2-year extension. Given the 40-67% annual attrition rate prior to 2014 (I'm gonna split the difference and assume around 50% on average), that suggests that perhaps 1/3 of those enrolled in 2013 were in grandfathered plans, with the rest transitional. For those states, again in cases where I don't have better data, I'm going to start with the assumption that only 1/3 of the 2013 enrollees were grandfathered in and work from there.

With all of this in mind, here's what I've come up with:

ALABAMA:

  • I recently estimated there's likely around 27,000 enrolled in GR/TR policies today.
  • However, Louise Norris pointed me towards this article from 2015 in which Humana announced that they were cutting about 40,000 people off of grandfathered policies across 11 states. Unfortunately, the article doesn't break out the number in each state, so I'm assuming it's proportional to each state's 2013 market share (best I could think of). Based on that, around 2,200 of them would've been in Alabama, leaving ~25,000.

ALASKA:

ARIZONA:

  • Kaiser estimated Arizona had 266,000 GF/TR enrollees in 2013. That should be down to around 63,000 today...minus another ~3,500 via the Humana cut-off, for ~59,500 left.

ARKANSAS:

  • Kaiser estimated 133,000 GF/TR enrollees in 2013. That should be down to around 32,000 today.

CALIFORNIA:

COLORADO:

  • Kaiser estimated Colorado had around 282,000 GF/TR enrollees in 2013. They did allow transitional policies for two years but discontinued them at the end of 2015, at which point I estimate they were down to around 159,000 GF/TR combined. Assuming around 53,000 were allowed to continue on, CO should be down to around 23,000 still in grandfathered policies today...minus around 3,600 from Humana, leaving perhaps 19,400.

CONNECTICUT:

DELAWARE:

  • Kaiser estimated Delaware had around 21,500 GF/TR enrollees in 2013, but didn't allow transitional enrollees, leaving around 7,200. That should be down to around 1,800 today.

DISTRICT OF COLUMBIA:

  • Kaiser estimated around 19,200 GF/TR enrollees in 2013, but didn't allow transitional enrollees, leaving around 6,400. That should be down to around 1,600 today.

FLORIDA:

GEORGIA:

  • Kaiser estimated around 420,000 GF/TR enrollees in 2013. That should be down to around 101,000 today...minus another 5400 from Humana or around ~95,600.

HAWAII:

  • Kaiser estimated around 27,000 GF/TR enrollees in 2013, but didn't allow transitional enrollees, leaving around 9,000. That should be down to around 2,200 today.

IDAHO:

  • According to the Kaiser Family Foundation, in 2013, Blue Cross Blue Shield of Idaho held 50% of the total individual market (around 47,500 out of 95,700 total enrollees).
  • According to BCBSID themselves, in 2013, around 15% of their indy market enrollees were in grandfathered policies, while the other 85% were in transitional policies.
  • Assuming similar ratios among the other 2013 carriers, that suggests around 14,300 grandfathered & 81,400 transitional enrollees as of 2013...but BCBSID's same report says that they had 15,000 grandfathered enrollees alone, so there's some type of discrepancy here. I'm going to split the difference and assume roughly 22,000 were grandfathered state-wide vs. 74,000 transitional.
  • According to Mark Farrah Associates, in March 2017, Idaho's total individual market was around 134,000 people.
  • Idaho enrolled 94,500 people in exchange-based plans this year, leaving ~39,500 off-exchange enrollees.
  • Assuming a ~25% annual net reduction in grandfathered & transitional enrollment, they should be down to around 23,000 combined today

ILLINOIS:

INDIANA:

  • Kaiser estimated around 171,000 GF/TR enrollees in 2013. That should be down to around 41,000 today. However, Mark Farrah Associates put the entire off-exchange indy market at just 37,000 people a year ago (including off-exchange ACA enrollees), so either Farrah's estimates were off or my 25% attrition rate is too low. I'll call it 30,000 for now.

IOWA:

  • I seem to have misplaced the link, but Iowa should have around 77,000 people still enrolled in grandfathered or transitional policies as of today.

KANSAS:

  • Kaiser estimated around 124,000 GF/TR enrollees in 2013. That should be down to around 30,000 today.

KENTUCKY:

  • Kaiser estimated around 131,000 GF/TR enrollees in 2013. That should be down to around 31,000 today.

LOUISIANA:

  • Kaiser estimated around 175,000 GF/TR enrollees in 2013. That should be down to around 42,000 today.

MAINE:

  • Kaiser estimated around 32,000 GF/TR enrollees in 2013. They allowed transitional plans, but Norris informs me that none of those plans are still available this year which amounts to the same thing as cutting them off for my purposes. That should mean a fraction of grandfathered plans only, which would bring them down to around 2,600 today.

MARYLAND:

MASSACHUSETTS:

  • Kaiser estimated around 79,000 GF/TR enrollees in 2013, but didn't allow transitional enrollees, so I'm assuming GF was around 26,000 people. That should be down to around 6,200 today.

MICHIGAN:

  • Kaiser estimated around 344,000 GF/TR enrollees in 2013. I'm assuming that's down to around 82,000 today.

MINNESOTA:

MISSISSIPPI:

  • Kaiser estimated around 85,000 GF/TR enrollees in 2013. I'm assuming that's down to around 21,000 today. Subtract 1,100 via Humana and you're down to 19,900.

MISSOURI:

Kaiser estimated around 260,000 GF/TR enrollees in 2013. I'm assuming that's down to around 62,000 today.

MONTANA:

Kaiser estimated around 45,000 GF/TR enrollees in 2013. Montana allowed transitional plans but according to Louise Norris, the state "encouraged" carriers to cut them off, and all of the carriers did so which amounts to the same thing. I'm therefore assuming it was around 15,000 GF enrollees, which should be down to around 3,600 today.

NEBRASKA:

Kaiser estimated around 124,000 GF/TR enrollees in 2013. I'm assuming that's down to around 30,000 today.

NEVADA:

Kaiser estimated around 96,000 GF/TR enrollees in 2013, but didn't allow transitional plans, so I'm assuming around 32,000 GF only, which should be down to around 7,700 today.

NEW HAMPSHIRE:

Kaiser estimated around 35,000 GF/TR enrollees in 2013. I'm assuming that's down to around 8,400 today.

NEW JERSEY:

Kaiser estimated around 155,000 GF/TR enrollees in 2013. I'm assuming that's down to around 37,000 today.

NEW MEXICO:

Kaiser estimated around 57,000 GF/TR enrollees in 2013, but didn't allow transitional plans, so I'm assuming it was around 19,000 GF only. This should be down to around around 4,600 today.

NEW YORK:

Kaiser estimated around 170,000 GF/TR enrollees in 2013, but didn't allow transitional plans, so I'm assuming it was around 57,000 GF only. This should be down to around 13,700 today.

NORTH CAROLINA:

  • Kaiser estimated around 467,000 GF/TR enrollees in 2013. I'd normally assume that's dropped to around 111,000 today...except that BCBSNC announced last fall that they had voluntarily decided to cut all 50,000 of their remaining grandfathered enrollees loose. That brings the likely GF/TR total down to around 61,000.
  • UPDATE: I've confirmed with BCBSNC that they still have 43,000 people enrolled in their transitional plans. BCBS holds over 95% of the ACA-compliant market in NC, I've also dug through the 2018 filings for the other half-dozen or so carriers offering grandfathered/transitional policies in NC (including American National, Brighthouse, Colonial Penn, Globe Life, Mutual of Omaha, New York Life, Nippon Life and Western & Southern) and they collectively only add up to 217 more. That means a grand total of just 43,217 state-wide.

NORTH DAKOTA:

  • Kaiser estimated around 44,000 GF/TR enrollees in 2013. I'm assuming that's down to around 10,600 today.
  • However, Norris says that BCBSND cut off TR plans by 2015, and had 3/4 of the individual market back in 2013 anyway, so I figure they're down to around 4,200 today.

OHIO:

Kaiser estimated around 330,000 GF/TR enrollees in 2013. I'm assuming that's down to around 79,000 today. Subtract 4,300 via Humana and it's down to 74,700.

OKLAHOMA:

Kaiser estimated around 122,000 GF/TR enrollees in 2013. I'm assuming that's down to around 29,200 today. Subtract 1,600 via Humana and it's down to 27,600.

OREGON:

Kaiser estimated around 160,000 GF/TR enrollees in 2013. They did allow transitional plans, but only through the end of 2015, at which point I'm estimating they had around 90,000 GF/TR combined, of which 30,000 should've been GF only. That would mean roughly 13,000 today.

PENNSYLVANIA:

Remarkably, Pennsylvania appears to only have around 13,000 people still enrolled in grandfathered OR transitional policies as of today.

RHODE ISLAND:

Kaiser estimated around 18,000 GF/TR enrollees in 2013, but didn't allow transitional plans, so I'm estimating 6,000 GF only. That should be down to around 1,500 today.

SOUTH CAROLINA:

Kaiser estimated around 134,000 GF/TR enrollees in 2013. I'm assuming that's down to around 32,100 today. Around 1,700 of those were dropped by Humana, leaving just 30,400.

SOUTH DAKOTA:

Kaiser estimated around 66,000 GF/TR enrollees in 2013. I'm assuming that's down to around 15,800 today.

TENNESSEE:

Kaiser estimated around 243,000 GF/TR enrollees in 2013. They allowed transitional plans, but Norris informs me that none of those plans are still available this year which amounts to the same thing as cutting them off for my purposes. That should mean a fraction of grandfathered plans only, which would bring them down to around 20,000 today...minus 3,100 via Humana for 16,900.

TEXAS:

Kaiser estimated around 745,000 GF/TR enrollees in 2013 (they originally weren't gonna allow transitional plans but reversed course). I'm assuming that's down to around 179,000 today.

UTAH:

Kaiser estimated around 140,000 GF/TR enrollees in 2013. I'm assuming that's down to around 33,600 today.

VERMONT:

Kaiser estimated around 21,000 GF/TR enrollees in 2013, but didn't allow transitional plans, leaving perhaps 7,000 GF only. I'm assuming that's down to around 1,700 today.

VIRGINIA:

WASHINGTON STATE:

At the end of 2013, more than 248,000 were enrolled in health plans in Washington state’s individual market. Some 238,000 people received discontinuation notices from their insurers and had to find new coverage by Jan. 1, 2014. The Insurance Commissioner’s Office estimated earlier this year that 113,000 of those who received notices would qualify for subsidies and 30,000 would qualify for the state’s newly expanded Medicaid program, Apple Health.

...which means there were only 10,000 people still enrolled in grandfathered policies as of 1/1/14. However, I've been informed that LifeWise is the only carrier still offering GF plans in Washington State, and they still had 8,436 people enrolled in them as of one year ago, so I'm guessing they still have a good 6,300 or so enrolled today.

WEST VIRGINIA:

Kaiser estimated around 24,000 GF/TR enrollees in 2013. They allowed transitional plans, but Norris informs me that none of those plans are still available this year which amounts to the same thing as cutting them off for my purposes. That should mean a fraction of grandfathered plans only, which would bring them down to around 2,000 today.

WISCONSIN:

Kaiser estimated around 177,000 GF/TR enrollees in 2013. I'm assuming that's down to around 42,500 today. Subtract another 2,300 via Humana and you're left with 40,200.

WYOMING:

Kaiser estimated around 21,000 GF/TR enrollees in 2013. I'm assuming that's down to around 5,000 today.

Add them all up and it comes to somewhere around 1.73 million people as of today...which, as it happens, is around 17% lower than Kaiser's estimate for last year, which gives me some amount of confidence in the total number if not the specific states.

I'll be happy to correct/update any of the state numbers if people can provide me with hard evidence one way or the other, thanks!