Massachusetts

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

I just received another official update from the MA Health Connector...

On enrollment, as of today, we have 261,619 enrolled members for January. We have an additional 14,368 plan selections made (but unpaid) for a total of 275,994 under the CMS definitions. New enrollments for 2019 continue to trend slightly ahead of last year.

A week or so ago I noted that Massachusetts had enrolled just over 264,000 people (10,000 of whom hadn't actually paid their January premium yet...MA's exchange is one of the only states which is able to actually track payment data live, since they handle it themselves). They were up 10K over the same date in 2017, or up around 4% year over year.

I don't have a hard "thru 12/05" number for 2017 this week, but they did confirm the 276K number is still "slightly ahead", which is good.

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

I just received an official 2019 ACA Open Enrollment Period report from the Massachusetts Health Connector...

As of today, we have 254,177 enrolled for January 1. That is up about 10,000 from last year's 244,308 at the same date. When you include people with plans selected but not paid, we are at 264,118.

The high number is again explained by the fact that Massachusetts, like several other state-based exchanges, front-loads their auto-renewals. 254K / 244K = around a 4% increase year over year, which is solid and right in line with other state-based exchanges to date...while the federal exchange (HC.gov) continues to lag around 11% behind last year. On the other hand, HC.gov doesn't front-load auto-renewals, so it's a bit of an apples to oranges comparison.

As I just noted earlier this afternoon, Massachusetts is NOT expecting the repeal of the ACA's individual mandate to impact their 2019 individual market enrollment or premiums for a simple reason: The Bay State never formally repealed their own, pre-ACA mandate penalty. They basically mothballed it once the ACA's version went into effect, and are simply dusting it off for 2019 and beyond now that the federal mandate has been formally repealed.

However, the two mandate penalties don't work quite the same way. For the federal mandate, unless you qualify for an exemption (and there's a whole bunch of those), the penalty for not having ACA-compliant healthcare coverage is (or has been up until now) as follows:

This Just In...

Ready for Open Enrollment, Health Connector sets 2019 plans with lower premium increases, selects community organizations to provide in-person support to residents

Boston – September 13, 2018 – The Massachusetts Health Connector Board of Directors today approved 57 Qualified Health Plans from nine carriers for individuals and families, with new plan designs that create better value for members and premium increases that average under 5 percent from 2018.

Unfortunately, the press release doesn't specify what "under 5%" means, nor does it break that out by carrier/market share. I've put in a request for those details and will update this as soon as I hear back from them. They sent me the following chart, but this only includes enrollees earning between 300-400% of the Federal Poverty Level, which means the marketshare across the entire individual market is likely somewhat different. I'm assuming the 4.4% overall average applies to the entire market but could be wrong about that as well:

NOTE: The good news is that I don't have to worry about any sabotage impact for Massachusetts in 2019 (thanks to the state still having their pre-ACA individual mandate penalty in place and banning #ShortAssPlans outright). This obviously makes that part of my analysis very easy--I can just enter "0%" across the board in the "2018 sabotage factor" columns.

The bad news is that determining the market share for each carrier in Massachusetts is a royal pain in the ass. only two of the twelve carriers offering individual market plans actually state what their enrollment numbers are, and this is further confused by the fact that several of them (Fallon, Harvard Pilgrim and Tufts) have two or three different listings for different divisions of the company.

In addition, Massachusetts is one of just two states where the individual and small group market risk pools are merged, making it even more difficult to separate out the two for market share purposes.

A couple of years ago, UnitedHealthcare decided to pull out of the ACA individual market in dozens of states. They stuck around in a handful for 2017, but dropped out of all but two of those this year as well.

Well, next year they're adding one state...but they're making it very clear that they're doing so against their will:

UnitedHealthcare is returning to one of the government-run health exchanges that the nation's largest insurer largely abandoned in 2017.

Minnetonka-based UnitedHealthcare must sell coverage next year on the health exchange for Massachusetts because it now covers more than 5,000 people in the state via small-employer health plans.

The individual and small-group markets are merged in Massachusetts, where state law requires insurers of a certain size to sell on the exchange.

*(OK, it's possible that "no one" actually means "everyone except for me.")

Last summer, both houses of the Nevada state legislature quickly and surprisingly passed a full-blown Medicaid Public Option bill:

I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system. The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.

This post was inspired by a Twitter query by "Other Alex". He originally asked about the insanely expensive premiums for ACA policies in Charlottesville, Virginia, which I wrote about the other day. Anyway, after some back & forth between him, myself and Colin Baillio, Alex asked if I knew where the least-expensive ACA plans are.

I haven't looked it up by rating area yet (for instance, Virginia as a whole ranks 18th most expensive this year even though Charlottesville is the most expensive rating area in the country), but on a state-level basis, it appears that the least expensive state for ACA-compliant individual healthcare policies is actually...(drumroll please)...

Massachusetts.

I'm not really able to post a full analysis at the moment, but here's the final officlal OE5 enrollment numbers from Massachusetts:

Total enrollment:

  • 2018 – 263,026 enrolled + 7,662 plans selected = 270,688
  • 2017 – 253,146 enrolled + 10,863 plans selected = 264,009

New enrollments:

  • 2018 – 55,565
  • 2017 – 56, 977

Massachusetts is the 16th state to surpass last year's numbers, and the 11th state-based exchange (if you include Federally-facilitated SBMs).

UPDATE: Hmmm...according ot the official CMS report, Massachusetts actually enrolled 266,664 people into QHPs via their exchange last year, so they're only up 1.5% year over year, but it's still great news, espcially given how low their uninsured rate was to begin with.

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

I've confirmed with the Massachusetts Health Connector that their official QHP selection tally stood at exactly 262,534 as of Christmas Day (12/25).

This puts them a mere 232 higher than they were 6 days earlier (12/19), which seemed a little odd to me given that 12/23 was MA's deadline for January 1st coverage; normally I'd expect a last-minute enrollment surge in the final days ahead of a big deadline, although it's not nearly as big a deal in the states which still have later deadlines for February or March coverage. On the other hand, Christmas Eve and Day were included here, and no one enrolls in health insurance on Christmas, of course. I wouldn't expect much this week either with New Year's coming up; there's usualy a 9-day Dead Zone from 12/24 - 1/01 anyway.

This is a pretty minor update to my last Massachusetts post, but every enrollment counts: I've just received confirmation from the MA Health Connector that the Bay State has tallied up 262,302 plans selected or enrollments as of 12/19.

Their record to date was last year, when they had a total of 266,664 QHP selections through January 31st, 2017...and unlike most states, the deadline in MA is still a month away (residents have until 12/23 to enroll for January coverage and until 1/23/18 to enroll for February coverage).

This gives Massachusetts a full 5 weeks to add at least 4,400 more people to break that record. They've added 2,487 in the past 13 days; if they kept that pace they'd add 6,685 more between now and 1/23, so it's not unreasonable to think they can pull that off.

This is a really minor update, but every person counts; as of December 10th...

260,391 plans selected and enrollments (reminder, we did auto renewal last month, so this includes current members)

29,115 plans selected and enrollments by people who currently don’t have coverage through the Exchange (these are part of the 260,391)

This is a mere 576 higher than MA's tally from four days earlier, but considering auto-renewals are included, it makes sense: The odds are that a couple thousand of those auto-renewed went back in and cancelled their renewals, partly cancelling out some of the new enrollment numbers.

Anyway, the CMS Public Use File lists Massachusetts as officially enrolling 247,121 people as of December 10th last year, so they're still running 5.3% ahead of that. They need 6,300 more enrollees (net) to break last year's record...but keep in mind that MA is one of the states with an extended deadline: Baystaters can still enroll as late as January 23rd.

Excellent news out of Massachusetts! I haven't posted any updates from the Bay State since 11/15, when they reported enrollments were up 40% year over year, but today they've given me very comprehensive and up-to-date numbers:

As of Dec. 6, we had a total of 259,815 plan selections and enrollments. This includes auto renewal of existing members. Of that, 26,074 are people who are new for 2018.

For comparison sake, for Dec. 6, 2016, we were at 244,845, and 25,746 for the new. These numbers also includes auto renewal, of course.

Obviously when you throw auto-renewals into the mix, the percentage increase drops substantially, but they're still up 6% over last year (nearly 15,000 people), and new enrolles are up about 1%.

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