END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

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Charles Gaba's blog

 

(h/t to former CCIIO Director Gary Cohen for the reminder)

You've probably never heard of the Center for Consumer Information & Insurance Oversight (CCIIO)...

The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), part of the Department of Health & Human Services (DHHS), provides national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure that affordable, quality health coverage is available to all Americans. The center also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.

...but among other things, they're the folks who actually implement the ACA, including, among other things, HealthCare.Gov (I'm not sure if it's the same team that operates HC.gov or not...probably a lot of overlap between the two?).

Consumer Information and Insurance Oversight

Ensuring the Affordable Care Act Serves the American People

As I keep noting, early enrollment numbers can be extremely misleading, especially given the half-length Open Enrollment Period this year. Yes, enrollments via the federal exchange are up around 38% year over year so far, as well as being up 40% in Massachusetts, 3% (including auto-renewals) in Maryland, 33% in Colorado and so forth...but the shorter period could simply mean that more enrollments are being "front-loaded" this year. It's still all about how big the 12/15 surge is, along with how many NEW enrollees are added.

On the one hand, I nailed the Week Three HC.gov number almost perfectly (I projected 2.3 million, the actual number is 2,277,079). Yay, me! Only off by 1%! On the other hand, I seriously underestimated the first two weeks, so I'm not patting myself on the back too much. It's an insane year with too many unknowns for me to do much more than throw darts at the board. Still, I'll take credit where I can.

In addition, CMS has also started breaking the numbers out by state, which helps analysts look for trends and cause/effect relationships, so let's jump in!

First, the main numbers:

I used to track the monthly Medicaid/CHIP enrollment reports issued by CMS, watching as the numbers rose dramatically thanks to ACA Medicaid expansion.

I pretty much stopped doing that about a year ago, however, since the expansion numbers have mostly petered out. ACA Medicaid expansion actually has continued to climb a bit more since January, and is likely somewhere around 16 million people as of now, but it's also been partly cancelled out by a slight drop in standard Medicaid enrollment as the economy has continued to improve in general. In short, there's little reason to keep writing the same update every month.

 

(h/t to nmbrmnstr via Twitter for the heads up)

As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").

It's my understanding that if they can't keep it below that threshold, the bill won't go through for some obscure Senate rule reason or another (although apparently White House budget director Mick Mulvaney also stated that they really don't give a crap whether the mandate is repealed or not as long as the larger bill gets passed, so perhaps I'm mistaken about this? Need clarification on this point...)

Press release from the Massachusetts Health Connector...

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

Not much of an update, but good to see a hard number officially posted at AccessHealthCT (I assume they'll be updating this regularly from the looks of it):

 

via the Maryland Health Connection:

MARYLAND ACA EXCHANGE ENROLLMENTS AS OF 11/17/17:

  • Total Enrollments (active renewal, passive renewal, new): 130,556 (up 3% vs. last year)
  • Active Enrollments (renewals + new): 29,478 (up 98% over last year)
  • New Enrollments: 10,900 (up 10% over last year)
  • Applications: 275,790 (up 13% over last year)
  • Mobile App Visitors: 74,744 (up 110% over last year)

OK, the MD exchange breaks out their numbers slightly differently than I do, but they've provided the numbers necessary to reformat. Like a few other states, they're "front-loading" their auto-renewals, giving the following:

  • 18,578 Active Renewals
  • 101,078 Auto-Renewals
  • 10,900 NEW Enrollees
  • 130,556 TOTAL Enrollments

For clarification: When the MD exchange says that 130,556 is "3% higher than last year", they're talking about at this point in time. Subtract 3% and you get roughly 126.7K as of 11/17/16. Maryland's total enrollment by the end of the 2017 Open Enrollment Period was 157,832.

Remember this from a few weeks back?

Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November

An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshedeven though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.

There's been a lot of buzz the past couple of days over this analysis of the impact of repealing the ACA's individual mandate from Standard & Poors, which is significantly different from the Congressional Budget Office's projections:

Repeal Of The Health Insurance Mandate Won't Save As Much As Expected, Says Report

CENTENNIAL (S&P Global Ratings) Nov. 16, 2017--As the tax-reform debate heats up, the U.S. Senate tax bill may include a provision to repeal the individual mandate penalty. Repealing the penalty associated with the individual mandate will increase the uninsured rate. Subsequently, it will reduce government expenditure because there will be less federal funding needed for health insurance costs. However, the change won't be as financially meaningful as some expect, said a report released by S&P Global Ratings today titled, "U.S. Tax Reform: Repeal Of The Health Insurance Mandate Will Save Less Than Expected, And Will Not Support The Current Insurance Market."

A few days ago I noted that I had seriously misunderstood the Congressional Budget Office's individual market premium projections in the event the ACA's individual mandate is repealed: Yes, it'd be ugly, but not nearly as bad as I thought, although they still expect up to 13 million people to lose coverage as a result.

Yesterday, the Center for American Progress did an analysis which broke out those 13 million by state...along with the impact on individual market premiums and the 25 billion in immediate Medicare cuts which the GOP's tax bill would implement.

While I have my own doubts about some of the CBO's assumptions, there can be no doubt that premiums would increase substantailly, millions of people would end up without healthcare coverage, and the $25 billion in Medicare cuts do appear to be locked in if the GOP's bill were to become law:

I know there’s a lot going on in The Graph (see below), so lemme break it down:

  • The pale blue lines show the enrollment trend for the 2016 ACA Open Enrollment Period via the 38 HealthCare.Gov states (the lower line) and all 50 states + DC (the higher line). This was the all-time record for the ACA: 9.7 million via HC.gov, 12.7 million nationally.
  • The pale red lines show the enrollment trend for the 2017 Open Enrollment Period via 39 HC.gov states & all 50 +DC (Kentucky moved from their own exchange to the federal exchange last year). This was down a bit from 2016: 9.2 million / 12.2 million.
  • The dotted black lines are my “official” projections for the 2018 Open Enrollment Period: 7.5 million and 10.0 million respectively, both way down from both of the prior years.
  • The filled-in green/blue sections are the actual, confirmed 2018 enrollment numbers to date. Note that there are still enrollments missing: HC.gov only runs through 11/11, while other states range from no data at all all the way through 11/15. I’ve confirmed 1.71M to date, but suspect the total is actually closer to 3.0 million as of today.
  • The little blue dots are my current projections through this Saturday the 18th: 2.3M and 4.0M respectively.

Connect for Health Colorado® Reports Increase in 2018 Medical Plan Selections

DENVER — Between Nov.1 and Nov. 15, more than 22,000 Coloradans selected health coverage for 2018 through the state health insurance Marketplace, according to new data released today by Connect for Health Colorado®.

“I am glad to see the number of initial sign-ups during the first two weeks of Open Enrollment,” said Connect for Health Colorado® CEO Kevin Patterson.  “There has been some confusion about healthcare coverage this year. I want everyone to know that the financial help to buy health insurance is still available for next year. I urge everybody buying their own health insurance to take a minute on our site, ConnectforhealthCO.com, to check to see if they qualify and then review their options and complete their enrollment before the last-minute rush.”

Covered California’s Open-Enrollment Period off to a Solid Start

  • More than 48,000 new consumers selected a plan during the first two weeks of open enrollment, which is slightly ahead of last year’s pace.
  • New subsidized enrollees are using increased tax credit money to purchase coverage that is more comprehensive.
  • The majority of consumers signing up will be able to pay lower prices in 2018 than they would have for the same plans last year.

SACRAMENTO, Calif. — Covered California issued its first enrollment snapshot for the first two weeks of the current open-enrollment period. From Nov. 1 through Nov. 14, more than 48,000 new consumers signed up for coverage through Covered California, which is slightly ahead of last year’s pace when more than 39,000 consumers selected a plan during the first two weeks of November 2016.

No precise numbers yet, but this tweet from Access Health CT gives the key numbers:

To date, over 17K CT residents have enrolled in a plan for 2018 - with 6K new to #AHCT. #shopshopshop #AHCTBoDMeeting #GetCoveredCT

— Access Health CT (@AccessHealthCT) November 16, 2017

Assuming "to date" includes yesterday (11/15), this gives us a perfect year over year comparison; last year AccessHealthCT had 16,085 people enroll in Qualified Health Plans in the first 15 days (9,455 renewals + 6,630 new), so they appear to be up about 6% year over year so far.

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