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.
As everyone who's been following the ACA over the past few years knows, the October 2013 launch of HealthCare.Gov and 16 state-based marketplace websites was not one of the prouder moments in the Obama administration's history. The federal exchange (which covered 35 states at the time) was a disaster out of the gate, as well about half of the state-based websites.
Over the past three Open Enrollment Periods, of course, most of the technical headaches have been worked out of most of the sites. HealthCare.Gov operates like a dream now (update: well, relatively speaking, anyway) and major improvements have been made in most of the state exchanges as well. In 5 cases, the solution was to either scrap the original platform and start over (Maryland and Massachusetts) or to say "to hell with it", drop their own platform completely and move home to the Mothership (Oregon and Nevada in 2015; Hawaii starting this year). Washington State kept their own platform but gave up trying to handle billing for their enrollees, joining just about every other state in letting the carriers handle payments directly.
During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Unlike most of the state exchanges (and HC.gov itself), MNsure has been dutifully continuing to update their data every month or so during the off season, providing an interesting glimpse into how the Special Enrollment Period (SEP) is going:
3/07/16 - 4/17/16: 90,696 QHPs Cumulative since 11/01/15 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid
Didja notice that? While the private QHP enrollment rate obviously dropped off tremendously after open enrollment closed (duh!), the SEP enrollment rate has dramatically increased since then, from 21/day in early February, to 55/day in late Feb/early March, to 91 per day over the past month. While it's still just 10% of the Open Enrollment rate, over 4x as many people are signing up for QHPs via MNsure now as were at the start of the off season.
During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Yesterday they held their March board meeting and updated their numbers through the first 5 weeks of the off season:
During Open Enrollment, MNsure averaged 928 QHP selections per day. During the off season, this has dropped down to 42 per day, or about 4.5% of the OE3 daily average.
If you extrapolate this nationally (and of course there's no way of knowing whether Minnesota is remotely representative), that would translate to around 6,200 people selecting exchange-based QHPs per day during the off season, which is lower than the past two years (7,000 - 9,000/day) but certainly within reason.
That's 300 more people who signed up for QHPs in the first 2 weeks of the off-season, plus another 6,500 added to MinnesotaCare and over 17,000 added to Medicaid (both of which are year round).
The QHP number (just 21 per day) is kind of interesting when compared to Rhode Island, which has has averaged 90 additional people per day in the first 2 weeks of February, yet has a population only 1/5th the size of Minnesota's. When adjusted for total population, Rhode Island's off-season rate is over 21x that of Minnesota.
The big difference, of course, is that Minnesota's BHP program (MinnesotaCare) cannibalizes the QHP market tremendously. When you add those 6,500 to the mix, MNsure has averaged 485 per day...or slightly higher than Rhode Island when adjusted for inflation (around 97/day when divided by 5).
85,390 Minnesotans Enroll in Private Coverage Through MNsure During the 2016 Open Enrollment Period
Enrollment goal exceeded, Minnesota leads the nation in new enrollees
February 01, 2016
ST. PAUL, Minn.—Today, MNsure announced 85,390 Minnesotans enrolled private health insurance coverage through the state exchange during the 2016 open enrollment period, November 1, 2015, through January 31, 2016. MNsure's goal was to enroll 83,000 in private coverage.
In addition, 33,333 Minnesotans newly enrolled in MinnesotaCare and 73,173 newly enrolled in Medical Assistance. MNsure also enrolled 7,144 Minnesotans in a dental-only plan. These numbers are preliminary and are not yet final.
At yesterday's MNsure Legislative Oversight Committee meeting, CEO Allison O'Toole reported that as of January 15, MNsure had enrolled 75,000 Minnesotans into private health insurance coverage since the beginning of open enrollment, November 1, 2015.
As of January 10, MNsure had enrolled 69,671 Minnesotans into private coverage. This means MNsure has seen an increase of 5,329 private plan enrollments in five days. In addition, about 45 percent of private plan enrollees are new to MNsure for 2016. This is the highest percentage of new enrollees nationwide.
MNsure's goal is to enroll 83,000 Minnesotans by the end of open enrollment.
This will be the final enrollment update until preliminary end of open enrollment numbers are released on Monday, February 1.
As a reminder, the 2016 open enrollment period ends on Sunday, January 31. The MNsure Contact Center will be open extended hours on Saturday, January 30, from 8 a.m. - 8 p.m., and on Sunday, January 31, from 8 a.m. - midnight.
Minnesota held their monthly board meeting. At first glance, it looks like they've managed to add 1,991 QHPs since December 28th, which would be impressive...except that, as a later slide shows, 1,871 of these are due to including their SHOP (small business) enrollees in today's number versus these folks not being included in the news article a week or so ago.
Nothing wrong with this, actually, but it does mean that the net gain of individual market QHPs is far less impressive (just 120), for a total of 67,800:
UPDATE/CORRECTION: I've been informed by the MNsure exchange that, in fact, they did add 1,991 individual QHP enrollments since 12/28/15 after all; apparently the 67,680 figure from a couple of weeks back also included SHOP QHPs, so the net increase really is nearly 2,000 people, which is indeed very impressive.
Adding 1,991 in just 13 days represents a 3.0% increase during the slowest part of the enrollment period. By comparison, as I noted earlier today, HC.gov added just 157,536 people from 12/27 - 1/09...or only 1.8% in 14 days. Minnesota has basically been doubling the enrollment rate of the federal exchange since Christmas, which is interesting even if the raw numbers are still small.
In addition, as MNsure noted in their correction: "45% of our QHP enrollments are NEW to MNsure in 2016. That's the highest percentage nationwide according to the data HHS released about a week and a half ago now."
My apologies for the error, and mazel tov on the improved numbers!
A subcommittee of a state task force recommended Monday continuing with a state-run health insurance exchange like MNsure for now, rather than transferring Minnesotans to the national exchange called HealthCare.gov
Moving to the federal website would be costly and wouldn't work with the state's MinnesotaCare insurance program, said a report endorsed by the 11-person subcommittee of the state task force on health care finance.
Plus, by moving to HealthCare.gov, the state would lose control over its network of health insurance navigators that help people enroll in coverage, according to the report.
I've been getting a little worried about the Minnesota exchange of late. Their first two years were pretty rough, and their most recent update prior to today had them at only 26.5K QHPs as of 12/13. Of course, that didn't include the critical final few days before the January enrollment deadline...nor did it include the extended deadline for Minnesota, which was pushed all the way out to 12/28.
Not an official data update, but a nice catch from Louise Norris (the article is mainly about MNsure bumping out their enrollment deadline from 12/15 until 12/28):
As of Sunday, MNsure reported 26,532 sign-ups in private insurance policies through the exchange, including 18,595 new enrollees. The overall sign-up tally is up by more than 8,800 people in a five-day period, and the new enrollee figure is up by 6,415 people.
OK, that's 6,864 QHP selections in 17 days, or 404 per day so far.
Minnesota only accounted for 0.5% of total QHP selections for 2015; extrapolated nationally at the same ratio, this would suggest around 1.37 million QHPs nationally through yesterday...which is a little lower than I'm currently estimating, but in the right ballpark.
The federal exchange, HealthCare.gov, opened for business Sunday and will serve 38 states that rely on the marketplace. California’s state-run exchange is launching a 38-stop bus tour to get the word out about signing up and re-enrolling for coverage. Minnesota’s exchange had a couple hundred people sign up in the first hour after opening in the morning with no signs of any technology problems.
“We’re not expecting a whole lot of enrollment because it’s a 60 degree day on a Sunday, but so far so good,” said Shane Delaney, a spokesman for MNsure. The state exchange has hundreds of brokers and navigators geared up to assist consumers.
OK, that's a bare minimum of 200 QHP selections as of 10am (I'm guessing) on Nov. 1st in Minnesota. Duly noted.