Massachusetts

Massachusetts' total individual market was only around 72,000 people in 2014, but their ACA exchange had disastrous technical problems during the first ACA open enrollment period, causing tens of thousands of Baystaters to enter a sort of "limbo" status healthcare coverage-wise (the first version of the exchange couldn't properly confirm which enrollees qualified for APTC assistance, so only those paying full price were actually enrolled in exchange QHPs; those claiming APTC status were temporarily transferred over to state-based coverage until it could be sorted out, which took nearly a year in most cases). Fortunately, in 2015, the state got their act together and enrolled nearly 214,000 people in exchange-based policies this year.

I just posted some key specs from the MA Health Connector's monthly enrollment report, but they also posted a bunch of other interesting stuff from their board meeting as well. In no particular order...

  • I already knew that Massachusetts was among the 30-odd states that UnitedHealthcare was dropping out of. However, it turns out that United is currently covering fewer than 500 of MA's exchange enrollees (considering that MA's entire individual market was only 72,000 people 2 years ago, and exchange enrollment alone is currently 224,000, I'd imagine that there aren't too many off-exchange United enrollees on top of those 500).
  • In addition, Guardian and MetLife are dropping off of MA's dental policy exchange, although according to their monthly report, neither one has any market share via the exchange this year anyway (Altus and Delta seem to make up 100% of the total). (correction: I was looking at the individual dental exchange; Guardian/MetLife are on the small group exchange this year)
  • The MA exchange reports an impressive 94% enrollment retention rate year over year:

The Massachusetts Health Connector has posted their latest monthly enrollment report, and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

As I've noted the past few months, unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fullly Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day. Presumably they didn't have 17,000 people enroll in a mad rush on February 1st, so there's an odd discrepancy here, but whatever.

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.

Investor's Business Daily's Jed Graham picked up on some of my work for his post today, including the enrollment data for both Minnesota and Connecticut...but in addition to that extra data point (which I'll come back to in a moment), he also nabbed the latest number out of a third state, Oklahoma, from one of Adam Cancryn's updates on what I'm calling the UnitedHealthcare Disenrollment Odometer:

I noted last month that the Massachusetts Health Connector had increased their effectuated QHP enrollee total by around 12,000 people in the first month of the off season, which goes against the expected net attition expected once Open Enrollment ends.

However, I also noted that MA is unusual in that most of their exchange QHPs are in the form of "ConnectorCare" plans, which are availble for enrollment year round, just like Medicaid and SHOP enrollment. As a result, this increase, while legitimate, can not be used to extrapolate anything nationally.

The Massachusetts ACA exchange reported exactly 196,554 QHP selections (including the still-qualifying "ConnectorCare" plans) as of January 31st, the final day of the 2016 Open Enrollment Period.

They just held their March board meeting, which always include highly detailed powerpoint charts & graphs running through the end of the prior month...so here's where things stand after the first month of the off season. The main number: The official effectuated enrollment number is up to 208,374 (remember, Massachusetts doesn't even report QHP enrollees until they've actually paid their premium. It'd be awesome if every other exchange was able to do so as well, as that would finally kill off the "But how many have PAID??" talking point once and for all.

Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.

And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.

In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.

As of this morning, there were still 4 states with some 2016 Open Enrollment data missing: Idaho, Massachusetts, New York and Vermont. The Massachusetts exchange board held their monthly meeting today, so I can cross one more state off the list:

By early February, approximately 201,000 individuals were enrolled in 2016 health coverage.

  • Over 36,000 new members are enrolled in QHPs. For a frame of reference, our new members amount to about 15% of the size of last year’s estimated uninsured population*
    • Of the approximately 27,000 new members who indicated a race or ethnicity in their application, about 12% are of Hispanic, Latino or Spanish origin, 8% are African American and 4% are Chinese
  • We continue to see a high retention rate for our 2015 membership at about 94%
  • Individuals who selected a plan between January 24th and January 31st still have time to pay for coverage effective March 1, so new membership tied to Open Enrollment may continue to grow

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