Maryland

2018 MIDTERM ELECTION

Time: D H M S

A few days ago I noted that Maryland Governor Larry Hogan had signed a bipartisan bill into law which creates a $380 million reinsurance fund which should cancel out up to 21% of next year's looming individual market premium hikes.

However, I forgot to mention the other important thing that the same bill does: Evidently it would also head off Donald Trump's attempt to open the floodgates on the type of minimally-regulated "short-term" and "association" plans which would further damage the ACA-compliant individual market risk pool:

(C) THIS SUBTITLE APPLIES TO ANY HEALTH BENEFIT PLAN OFFERED BY AN ASSOCIATION, A PROFESSIONAL EMPLOYEE ORGANIZATION, OR ANY OTHER ENTITY, INCLUDING A PLAN ISSUED UNDER THE LAWS OF ANOTHER STATE, IF THE HEALTH BENEFIT PLAN COVERS ELIGIBLE EMPLOYEES OF ONE OR MORE SMALL EMPLOYERS AND MEETS THE REQUIREMENTS OF SUBSECTION (A) OF THIS SECTION.

Maryland Governor Larry Hogan signed a bipartisan bill on Thursday that state officials say will help keep healthcare premiums from spiking again next year.

The bill creates what’s known as a reinsurance program for the state’s health insurance marketplace, which was created as part of the Affordable Care Act.

...Without the fix or any action in Washington, Maryland officials predicted that healthcare premiums in 2019 could jump up to 50 percent, driving more of the 150,000 people to abandon the state’s marketplace — possibly leading to its collapse.

I just did a light analysis of how many people would be helped or hurt by CSR funding in 2019 in Rhode Island, and concluded that at least 28% of exchange enrollees would see their premiums increase if CSR funding was restored, while only perhaps 2-3% would see their premiums drop.

It turns out that over the weekend, my colleague Xpostfactoid did a much deeper analysis of the same situation in Maryland:

So there you have the enrollment results of full-bore on-exchange silver-loading of CSR costs in one state. In all, 49,993 on-exchange enrollees with incomes up to 400% FPL chose plans other than silver. About 48,000 of them were subsidized. That's 31.2% of all enrollees, within striking distance of Aron-Dine's upper bound of 36% for all marketplace enrollees.

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

Maryland was originally one of 3 state-based exchanges which stuck to the "official" half-length, December 15th Open Enrollment Period deadline this time around. However, with just 2 days to go before the original deadline, the MD Health Connection announced that they had decided to bump out their deadline by an extra week after all, through December 22nd.

When the dust settled, 153,571 Marylanders had signed up for 2018 coverage, down about 2.7% from 2017. This made MD one of only three fully state-based exchanges to come in short year over year...and the only one to do so with an extended deadline (both Idaho and Vermont stuck with the 12/15 cut-off). Even so, achieving over 97% of their prior-year numbers is still pretty impressive, all things considered.

This just in...

NEARLY 154,000 MARYLANDERS ENROLLED IN MARKETPLACE HEALTH COVERAGE FOR 2018

BALTIMORE (JAN. 4, 2018) – A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, the state-based health insurance marketplace.

In an open enrollment period that was about half as long as a year ago, average daily enrollment in qualified health plans was up 69 percent compared to the prior open enrollment. There were an average of 2,953 enrollments each day during the recent 52-day period, compared to 1,752 average daily enrollments during a 90-day enrollment period a year ago.

“We are thrilled by the robust turnout for 2018 coverage,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which administers Maryland Health Connection. “Our hats are off to our call center, consumer assisters and brokers who helped process roughly as many enrollments as last year during a much shorter open enrollment period. We believe the result will be better access and better health outcomes for Maryland families.”

I've been expecting the first and third of these developments:

MARYLAND Open enrollment extended by one week:

OPEN ENROLLMENT EXTENDED UNTIL DEC. 22
ONE WEEK ADDED TO ENROLL IN 2018 HEALTH, DENTAL COVERAGE

BALTIMORE (DEC. 13, 2017) – Open enrollment through Maryland Health Connection has been extended until Friday, Dec. 22 to choose a plan for health coverage to begin Jan. 1, 2018, with expanded call center hours through next week.

Individuals can apply at MarylandHealthConnection.gov or through the “Enroll MHC” mobile app available free in the App Store (iOS) and the Google Play Store (Android).

Also, hundreds of insurance brokers and navigators around the state can help Marylanders apply for financial help and enroll in a plan. Their locations and contact information are available at MarylandHealthConnection.gov or through a GPS-enabled locator tool on the app.

The last update out of Maryland had 2018 QHP selections breaking 130K total, with new enrollments up 10% and overall enrollments up 3% year over year through Nov. 17th.

Just now, the MD Health Connection posted an update through this week:

Incoming exec director Michele Eberle of @MarylandConnect urges Marylanders to enroll in health coverage with 10 days left. New enrollments up 14% this year. Mobile app visitors up 140% Overall enrollment up 4% Keep it going! pic.twitter.com/75g2qu5PbC

— MD Health Connection (@MarylandConnect) December 5, 2017

I'm assuming these stats are as of December 4th. Last year MD's official QHP selection tally as of December 3rd was around 129,000; if they're 4% ahead of that as of the same date, that means they should have a little over 134,000 to date this year.

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.

The article is behind a firewall so I can only post the opening line, but it includes the key number:

Maryland health exchange enrollment is up 104% through first week 

Enrollment numbers totaled 16,198 as of Nov. 9. This time last year, that total was 7,941.

Crisp & clean and no caffeine: That's up almost 6,000 more in just a couple of days.

This is just an update to an existing Washington Post story, but it looks like the Maryland exchange is issuing near-daily updates (which is awesome in my view):

...Statewide, in fact, growth is up 100 percent since last year, according to Betsy Plunkett, a deputy director for the Maryland Health Benefit Exchange. First-time enrollment is up 15 percent, with changes to existing plans up 270 percent. Overall, 10,420 people enrolled in the first week compared to 5,212 in 2016, she said.

As I noted a few days ago, Maryland was the first state to issue Day One numbers, and they were pretty impressive, a 70% increase year over year.

Well, apparently they've increased the pace since then:

"We realize it's a shorter period so we have to get people in the door quicker," said Andrew Ratner, chief marketing officer for Maryland Health Benefit Exchange, which runs the marketplace.

Sign-ups have been brisk so far, with more than 5,000 people picking plans in the first two days, nearly twice as many as last year. The Maryland Health Connection website, which usually closes at 11 p.m., had to stay open an hour later on Wednesday because 300 people were still online. Maryland currently has about 120,000 Obamacare enrollees.

...and again in Day Three:

Believe it or not, the original core focus of ACASignups.net was...wait for it...to track how many people are Signing Up for the ACA. Hard to believe, I realize.

Anyway, I have my first hard data point of the batcrap insane 2018 Open Enrollment Period, and it's a surprisingly positive one:

Enrollments in health insurance through the state’s health exchange was robust on the first day of open enrollment Wednesday, with more people signing up for insurance than last year, officials said Thursday.

Advocates and others had expressed concern that consumers would be confused by political wrangling and policy changes to the Affordable Care Act from the administration of Pres. Donald Trump that led to last-minute rate increases and a severe decrease in marketing dollars for the program.

But exchange officials reported that enrollments under the law, known as Obamacare, were up 70 percent to more than 1,800 compared with 1,055 on the first day a year ago. About 150,000 people signed up for private insurance on the exchange in the state last year and more enrolled directly through insurers.

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

The Maryland Health Connection is now allowing residents to comparison shop for 2018:

View 2018 health insurance plans and prices now!

MarylandHealthConnection.gov has already been loaded with plans and prices for 2018, one month before open enrollment begins. The upcoming open enrollment period will run November 1 - December 15. Health coverage will start on January 1, 2018.

  • How do I get an estimate for 2018 health insurance plans?

You can compare plans and prices through a desktop computer browser or by downloading our mobile app, Enroll MHC, on your iPhone or Android.

Click on “Get Started”- this will take you to the application portal. Next, click “Get an Estimate” on the application site. Finally, enter basic information like your county, age and income to see what coverage and financial help you may qualify for. If you choose to get an estimate, the site will take you through a scenario of what plans and pricing you could receive for 2018. You won’t actually be applying for coverage.

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