Healthcare.Gov

A week or so ago I  noted that several of the 13 state-based exchanges (remember, Nevada split off of HC.gov this year) had opened up their ACA exchange websites for prospective enrollees to window shop for 2020 coverage. One of them, Covered California, actually started allowing people to enroll already; the rest were for comparison shopping only.

Well, as of today, residents of every state can window shop for 2020 healthcare policies, because HealthCare.Gov has followed suit and is now letting you plug in your household & income info to see what plans are available next year, what the unsubsidized premiums are, and (most importantly for a lot of people) what sort of financial assistance you may be eligible for.

There have been some interesting modifications to the interface and workflow of HC.gov this year:

FEDERAL HEALTH INSURANCE EXCHANGE 2020 OPEN ENROLLMENT 

HealthCare.gov incorrectly sent out open enrollment notices

LAS VEGAS (KLAS) — In a statement issued by Nevada Health Link, the organization announced that it had become aware that the Federal Health Insurance Marketplace, known as HealthCare.gov had incorrectly sent notices to Nevada consumers regarding the upcoming open enrollment period.

The incorrect notices were sent to Nevada consumers via mail, email and through notices on the HealthCare.gov portal.

"These notices from the Marketplace were sent in error. Nevadans who received these notices from the Marketplace should be aware that NevadaHealthLink.com is the only place to get enrolled in a qualified health plan during the next open enrollment period beginning on November 1, 2019," said Heather Korbulic, Executive Director for the Silver State Health Insurance Exchange.

Nevada consumers are asked to reach out to the Nevada Health Link consumer assistance center for further questions by calling 1-800-547-2927.

Not much to add here.

Some Guy, June 25, 2015 (right after the Supreme Court ruling in King vs. Burwell):

It's even conceivable--unlikely, but conceivable--that a few years from now, after 1) The ACA has become even more firmly entrenched nationally; 2) the software/technology for running a state exchange has become even more streamlined, simplified, faster, easier to use, cheaper, etc etc; and 3) (hopefully) some changed attitudes/changed administration officials (ahem), a few states on HC.gov now may even decide to go ahead and move onto their own "full" exchange/website after all...completely of their own volition.

February 2018:

Nevada wants out of federal health exchange

Nevada's Silver State Health Insurance Exchange took the first step on Thursday to getting out of the federal healthcare.gov system and build its own exchange.

UPDATE 3/26/19: In light of last night's bombshell announcement that the Trump DOJ is now officially calling for the entire ACA to be repealed in the #TexasFoldEm lawsuit, the wording of yesterday's press release from Trump's CMS division is straight out of 1984 territory:

CMS Issues the 2019 Exchange Open Enrollment Period Final Report
Agency also extends the policy allowing issuers to continue “grandmothered” plans

The Centers for Medicare & Medicaid Services (CMS) today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirms another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases. Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the Exchanges began operations in 2014.

So I was reading this thread on Twitter...

When people say “oh the shutdown only affects government workers,” remind them that IT requires maintenance. GOV websites that help businesses are going offline by the dozens per week https://t.co/1wGeTgsCyy pic.twitter.com/sYmBwTYFSq

— Ned Pyle (@NerdPyle) January 17, 2019

How many government servers were not patched in the past month? How many applications and website frameworks were not updated? How many pentests were postponed? How many logs were not examined for intruders?

— Ned Pyle (@NerdPyle) January 17, 2019

Imagine if your private company simply stopped having employees show up for a month. The government is no different and the impact is larger than all but the most massive private sector orgs

— Ned Pyle (@NerdPyle) January 17, 2019

ACASignups.net, February 11, 2018:

That should mean that the average HC.gov premium is around $600 or so per month in 2018. The 3.5% surcharge hasn't changed for 2018, which means the federal exchange should take in something like $252/year per enrollee. Total enrollment in HC.gov plans was down 5% this year, so I'll assume average effectuated enrollment will be as well...somewhere around7.13 million per month. That means ~$1.8 billion in HC.gov revenue directly from the premium surcharge.

All of this brings me to my question:

As I warned back on December 19th when CMS released the Week 7 HealthCare.Gov Enrollment Snapshot Report, the final, official enrollment tally for the 2019 Open Enrollment Period was almost certain to end up slightly lower than the Week 7 cumulative numbers indicated. There are several reasons for this: Some people who were auto-renewed contact HC.gov to cancel their 2019 renewals, while others had their enrollments involuntarily denied or otherwise cancelled due to problems with verifying their identity, address or legal residency status.

Last year around 79,000 QHP selections were dropped in the final report; I expected this to be slightly lower, at around 75,000. I'm pleased to report, however, that according to CMS, only around 43,000 people were scrubbed from the 39 states hosted by HealthCare.Gov this year:

Final Weekly Enrollment Snapshot for the 2019 Enrollment Period

So, how likely is HC.gov to reach last year's total in the final week? Well...not very likely, but let's do the math anyway. Again, this is for the 39 states hosted by HC.gov only; it does NOT include the 12 state-based exchanges, which are mostly AHEAD of last year so far.

  • Last year, 8,743,642 people selected QHPs via HC.gov total:
    •  4,580,782 actively re-enrolled
    • 1,702,429 were auto-reenrolled
    • 2,460,431 were new enrollees
  • Of those 8.74 million total, there are likely around 6.16 million currently enrolled as of December
  • Last year, 97% of those still enrolled as of December re-enrolled (actively or passively). If that holds true this year, that'll be around 5.97 million total renewals
  • That means HC.gov would need 2.77 million new enrollees total

So, where did things stand as of 12/08?

Right alongside the 2019 Public Use Files being posted, HealthCare.Gov is now open for people to window shop for 2019 ACA individual market healthcare policies.

Remember, HC.gov only hosts the ACA marketplace for 39 states; 12 states operate their own marketplace websites, and most of those have been open for window shopping for several weeks now. In fact, Covered California has allowed people to actually sign up for 2019 since October 15th.

Fire up the Wayback Machine, Peabody, and take us to September 2015:

AP's NEW "HC.gov Security Flaws" story attacks problems FIXED UP TO A YEAR AGO.

Last night I posted what seemed, at first, to be a merely-amusing (if a bit depressing) story about a Florida news station website accidentally (?) reposting a year-old AP newswire story about potential security vulnerabilities at Healthcare.Gov:

"Critical" flaw found in HealthCare.gov security

WASHINGTON -- The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.

Those are among the conclusions of a report released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.

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