*(Yes, I know, the District of Columbia isn't actually a state, and Vermont's mandate is...well, read on...)
As the 2020 Open Enrollment Period rapidly approaches (it starts November 1st nationwide...except for California, where open enrollment is starting on October 15th), it's time to start getting the word out about some important things to keep in mind this fall.
One of the most critical things to remember for residents of California, the District of Columbia, Massachusetts, New Jersey, Rhode Island and Vermont is that each of these states* has reinstated an individual healthcare coverage mandate law/ordinance to replace the federal ACA mandate penalty which was zeroed out by Congressional Republicans back in December 2017. This means that if you live one one of them, unless you receive an affordability, hardship or other type of acceptable exemption, you'll be charged a financial penalty when you file your state/district taxes for 2020 in spring 2021 if you don't have qualifying healthcare coverage.
But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:
Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has ten different carriers participating in the individual market. MA (along with Vermont and the District of Columbia) has merged their Individual and Small Group risk pools for premium setting purposes, so I'm not bothering breaking out the small group market in this case.
Getting a weighted average was a bit tricky. On the one hand, only one or two of the rate filings included actual enrollment data. On the other hand, the Massachusetts Health Connector puts out monthly enrollment reports which do break out the on-exchange numbers by carrier. This allowed me to run a rough breakout of on-exchange MA enrollment. I don't know whether the off-exchange portion has a similar ratio, but I have to assume it does for the moment.
Baker-Polito Administration Announces Health Connector Completes Successful Open Enrollment with Highest-Ever Membership, Covering 282,000 People with Health Insurance
Governor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.
Heh. "13-year history" took a moment to register...but of course Massachusetts has had a health insurance exchange website since 2006, when "RomneyCare" went into effect.
New Analysis Finds Leading State-Based Marketplaces Have Performed Well, and Highlights the Impact of the Federal Mandate Penalty Removal
The report examines the impact that federal and state actions have had on state-based marketplaces and the federally facilitated marketplace (FFM).
Cumulative premium increases in California, Massachusetts and Washington are less than half of the increases seen in FFM states, but 2019 premium increases spiked in California and Washington compared to Massachusetts, which continued its state-based penalty.
WASHINGTON D.C. — A new report highlights the benefits of state-based exchanges, particularly in the areas of controlling premium costs and attracting new enrollment. The report, which was produced by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange, found that premiums in these states were less than half of what consumers saw in the 39 states that relied on the federally facilitated marketplace (FFM) between 2014 and 2019.
Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.
This is a very quick post as I’m in the middle of the Families USA healthcare conference, but it’s a significant one: The Massachusetts Health Connector, which wrapped up their 2019 ACA Open Enrollment Period last night, just reported the following:
Here is an update as of today, with Open Enrollment having ended last night.
Note: These numbers below should be considered something of a high-water mark. There will be fluctuations as plan-selecteds lose their window, members terminate, but also some applicants end up enrolling in March coverage.
Total enrollments (Including all January, February and March enrollments to date): 292,006
Plan selected/unenrolled: 8,079
Our new enrollment (people who did not have Health Connector coverage as of Nov. 1) is 60,361. This is a 23 percent increase from last year’s 49,034 at the same point in time.
Our retention rate is currently 89.7 percent, up about 2.6 percent from last year.
So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet. 2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!
In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st
Yeesh...when it rains, it pours! Right on top of updated and/or final 2019 Open Enrollment numbers 41 states (Idaho, Rhode Island and the 39 states hosted by HealthCare.Gov) comes yet another updated tally from Massachusetts:
As of today:
274,317 enrollments for January
2,997 enrollments for February or March
3,763 plans selected (1st premium not paid but not due yet)
Retention rate is 91 percent, up 2.6 percent from last year.
Massachusetts, home of the predecessor of Obamacare (Mitt Romney and other Republicans hate being reminded of this) doesn't reach their December deadline for January ACA coverage until Sunday, December 23rd.
As of today:
We have 262,459 enrollments for January 2019, compared to 238,631 as of a year ago.
For your CMS-definition math, we have an additional 18,345 plan selections, plus 21 effectuations for February and March, for a grand total of 280,825.
Holy smokes. Not only is the Bay State running a full 10% ahead of last year's paid effectuations as of the same point in time, when you include plan selections (which, for good or for bad, is the way that every other state's enrollments are officially counted during the Open Enrollment Period), they're already 5.1% ahead of last year's final tally.
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.
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.