Colorado

2018 MIDTERM ELECTION

Time: D H M S

Just 3 days ago, Colorado HealthOP was stunned by the announcement by the state insurance division that they were pulling the plug on the ACA-established CO-OP:

Dear Member,

It is with a heavy heart that I write to you today. This morning, the Colorado Division of Insurance (DOI)announced Colorado HealthOP will not be selling plans through the Connect for Health Colorado marketplace.

Please be assured that, as a Colorado HealthOP member, your coverage will remain in effect through December 31, 2015, so long as you continue to pay premiums. In two weeks, on November 1, 2015, the Connect for Health Colorado marketplace will open and you will have the opportunity to find another health insurance provider that will begin coverage for you on January 1, 2016.

Needless to say, we are astonished and disappointed by the DOI’s decision. We believe it is both irresponsible and premature.

As I noted in the update to my post on the "Transitional Policy" decision a few days ago, the ACA's CO-OP program had a lot going against it from the get-go:

The program has been under siege from the start, including from the insurance industry. Before the law’s passage, government grants to help them get going were switched to loans. None of that money could go for advertising — a wounding rule for new insurers that needed to attract customers. Moreover, the amount available was cut from $10 billion to $6 billion and then later, as part of the administration’s budget deals with congressional Republicans, to $2.4 billion. Federal health officials abandoned plans for a co-op in every state.

So, let's see here: You're trying to create start-ups to enter an existing, mature market which is already dominated by major, behemoth-sized competitors which have almost unlimited funds. Naturally it makes total sense to a) make the seed money a loan with a tight payback time table; b) prevent them from advertising in a saturated market; and c) slash their budget by 75%.

In spite of all of this, and even in spite of any impact from the decision to allow relatively healthy, low-risk enrollees to stay on transitional policies (which the CO-OPs had none of, since they were brand-new) through their competitors, 23 out of 24 of the CO-OPs did manage to survive the first full year (CoOportunity of Iowa/Nebraska didn't even make it that far), and a few of them (Community Health Options of Maine and New Hampshire, as well as (last I heard) Consumers' Choice Health Plan of South Carolina) actually do quite well the first year.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado is one of the few ACA exchanges issuing monthly reports during the off-season. Until now, these reports, while chock full of data, have made it rather confusing to separate out the key number which I'm looking for: The cumulative number of 2015 QHP selections and the currently effectuated QHPs, because of their tendency to mix SHOP and Dental policies into the mix.

In any event, CO's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

Louise Norris has provided some valuable information about 2016 individual market rate change requests in her home state of Colorado:

For 2015, Colorado HealthOP cut premiums aggressively, and ended up with the lowest-cost plans in eight of the state’s nine rating areas.  Unsurprisingly, that resulted in the CO-OP garnering the highest market share in the exchange during the 2015 open enrollment period, with nearly 40% of exchange enrollees selecting Colorado HealthOP coverage (among our own clients, Colorado HealthOP was even more popular, including among those who selected off-exchange coverage).

...In 2015, Colorado HealthOP got almost 40% of the exchange’s market share, and Kaiser was a close second with 35%; the two non-profits accounted for three-quarters of all the private plan enrollees in Connect for Health Colorado this year.

Colorado just released an updated enrollment report bringing things all the way up through April 30th...and as always, CO's report is both extremely comprehensive and extremely confusing at the same time.

Here's the relevant section:

The numbers, as I noted last time, need to be parsed quite a bit, since some of the numbers mix in SHOP (small business) enrollees while others mix in Dental coverage (which we all know is a big no-no!!)

If I'm reading/understanding this correctly, it looks like it breaks out to:

OK, this isn't a huge thing, but it's noteworthy.

Historically, Medicaid (and to a lesser extent, the CHIP program for children) has carried a certain stigma, since it's traditionally been reserved for the very poor. Many people enrolled the program have been embarrassed/ashamed to admit that they needed the assistance, and many who qualified for the program even under the pre-ACA rules never actually signed up based on the "shame" factor (still others didn't enroll because they simply didn't know that they qualified or didn't understand the procedure/paperwork for doing so).

With that Affordable Care Act, that all changed (well, in the states which expanded Medicaid, anyway). Yes, it's still limited to the poor, but there's a difference between being "dirt poor" and "working poor" (and yes, I understand that many "dirt poor" people work their butts off...I'm talking about general societal perception here). Suddenly, millions of people who considered themselves "lower middle class" (or otherwise "not poor", anyway) found themselves being able to enroll in Medicaid alongside the "dirt poor".

In my post about today's official ASPE ACA Enrollment Report, there weren't too many surprises....but there were a few notable items. As I noted:

  • HAWAII: I was assured 8 ways from Sunday that Hawaii's23,000 enrollee figure was specifically for 2015 enrollment. This made no sense to me given their tiny enrollment last year, but I was assured of it. Well, apparently my original instincts were correct, because they're showing up with only 12,625 in the end.
  • IDAHO: This is the only state which hasn't given their own enrollment update in forever. According to the prior ASPE report, they were at around 90.5K as of January 17th...yet somehow they only managed to rack up another 6,500 enrollees over the entire final month of Open Enrollment?? I was expecting upwards of 30K or so. This makes zero sense to me...am I missing something here?

In addition, there are a few states where their most recent official enrollment reports had some confusing data, which the ASPE report pretty much trumps regardless of anything else (at least, this is the official number which will be tossed around no matter what anyway):

The Colorado ACA exchange has just released their latest official enrollment report, and while it's chock full of useful data, it's also bit hard to read (physically...it's a low-res version, will swap it out with a higher-res PDF once they post it), and the numbers also require a bit of parsing...and are a bit confusing.

UPDATE: OK, I've found the actual high-res Dashboard report and have swapped out the low-res one below.

the grand total of "submitted enrollments" is just shy of 154,000. However, that appears to include 3,716 SHOP enrollees (the precise SHOP number is a bit fuzzy due to the footnote regarding this being "currently covered lives, regardless of date of enrollment").

So, separate SHOP out and you have 150,229 QHP selections.

OK, strike that...Colorado has released their newest data as well as DC and Vermont, leaving just 3 states to go (Connecticut (data since 2/13), Kentucky (data since 2/12) and Idaho, which hasn't posted any updates since way back on January 17th...over a month ago.

Anyway, here's Colorado:

DENVER, CO – Between Nov. 15 and Feb. 15, nearly 220,000 Coloradans enrolled in healthcare coverage for 2015, either in private plans purchased through the health insurance Marketplace, or with Medicaid or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.

During the three-month open enrollment period, 139,652 people enrolled in private coverage through Connect for Health Colorado; another 76,194 in Medicaid and 3,720 in CHP+.  Connect for Health Colorado also enrolled 24,884 individuals in dental plans.

There's one very interesting tidbit, however:

I've confirmed that Rhode Island's weather-induced enrollment extension is indeed state-wide and is of the "full" variety (ie, people can start the application process, not just finish it), through February 23rd. This is exactly the same policy that the Massachusetts exchange announced the other day.

Also, a late-breaking extension announced from Maryland.

11:45pm: OK, add the DC exchange to the pile.

9:00am 2/16/15: OK, HHS/CMS has clarified the specifics for the 37 Healthcare.Gov states.

11:50am 2/16/15: Idaho's policy took some work to decipher...

2:24pm 2/16/15: ...and Minnesota...

The last official update out of Connect for Health Colorado had the QHP tally at 125,378 as of 1/31.

Yesterday (Friday, 2/13), CBS Denver reported:

As of last Monday, Colorado reported 128,000 enrollments in 2015. About three-fourths of those are returning customers , with about a fourth being new customers.

OK, so that's an increase of around 2,622. However, the "...as of last Monday" bit is confusing. To me, saying "last Monday" on a Friday refers to the prior Monday (ie, 2/02 in this case). However, that would suggest that CO enrolled over 1,300 per day for 2 days in a row. The state was only averaging 233/day over the prior couple of weeks, which means they'd have to have ramped up over 5.5x, which is possible (a few other states have pulled this off).

Connect for Health Colorado has released their end-of-month enrollment update. Since the 1/15 deadline for February coverage, they've added another 3,728 QHP enrollees, or 233/day. At that rate they'd only add another 3,500 by 2/15, or less than 130K total (vs. their target of 194K or mine of 208K). Of course, that's an extremely unfair comparison, as 1/16 - 1/31 covers the slowest portion of the open enrollment period (immediately after a monthly deadline).

Even so, there's no realistic way that CO can hit their target at this point--they'd have to average 4,600/day just to hit theirs (and over 5,500 to hit mine). For comparison, last year Colorado averaged 627 enrollees per day throughout the entire open enrollment period (and that included the huge surges in December and March). This year they've averaged 1,607/day, and that includes all of the renewals from 2014. Even with a massive final surge, I just don't see any way of CO hitting more than 160,000 QHPs at this point, although I'll obviously be happy to be proven wrong.

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