Rhode Island

2018 MIDTERM ELECTION

Time: D H M S

Rhode Island is the 5th state (to my knowledge) to officially post their preliminary 2019 individual market rate change requests.

As shown below, things are pretty cut & dry in Rhode Island; they only have 2 carriers participating in the individual market (Blue Cross Blue Shield and Neighborhood Health Plan). BCBSRI is asking for a 10.7% average increase, while Neighborhood is requesting 8.7% overall.

The estimated market share ratios are based on this press release from HealthSourceRI, the state ACA exchange. That doesn't include the final numbers or the off-exchange enrollment, but it should be pretty close, as there are only 2 carriers and their requested increases are so close to begin with it wouldn't make much difference. The weighted average is 9.3%.

HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and there's a lot going on here:

HealthSource RI sees 5% enrollment increase and nation leading lowest benchmark plan cost
State-based marketplace sees rise in enrollment of “young invincibles”

I don't write much about Rhode Island outside of the actual Open Enrollment Period each year, and I almost never write about the ACA's "SHOP" (Small Business Health Options Program...which should really be labelled SB-HOP) these days (the program has never enrolled more than perhaps 200,000 people nationally at most)...but both the state and the program could use a little love, so what the heck:

HealthSource RI for Employers enrolls its 700th small business

RUMFORD, RI (March 6, 2018) – HealthSource RI for Employers today announced it has hit a major milestone. The health insurance marketplace for small employers has now enrolled its 700th small business. These 700 local businesses reflect over 5,200 Rhode Islanders.

This just in from HealthSourceRI:

Between November 1 and December 31, 2017, 33,021 individuals selected a plan through HealthSource RI. Though Open Enrollment has ended, customers who began, but did not complete, the enrollment process by December 31 will be able to finalize their 2018 enrollment process between January 1 and January 23. HealthSource RI is communicating directly with customers who are eligible for this opportunity. For this reason, final 2018 Open Enrollment figures will not be available until later in the month.

At HealthCare.Gov, around 66,000 stragglers/special case enrollments were added to the total between 12/16 - 12/23, which would translate into around 250 more people in Rhode Island, give or take. Of course, HC.gov also lost 145,000 enrollees due to people dropping their renewals/etc, but RI's exchange is structured a bit differently, with auto-renewals being added on day one, so most of those folks likely already dropped out before the 12/31 tally anyway. My guess is the final total will end up around 33.2K.

via U.S. News & World Report:

PROVIDENCE, R.I. (AP) — Rhode Island's health insurance exchange says time is almost up to purchase coverage for 2018.

HealthSource RI says Sunday is the last day to choose and pay for a 2018 health plan through the exchange for residents who don't receive affordable health coverage through an employer.

HealthSource RI said Friday that more than 32,000 people have signed up and many new enrollees are 18 to 34 years old.

Last year, about 30,000 people enrolled.

HealthSource RI says it wants to remind people they need to purchase insurance for 2018 to avoid a tax penalty.

Rhode Island has now officially beaten last year's total of 29,456 QHP selections, though they're still way down from the 34,670 they achieved two years ago. Of course they still have until tomorrow (New Year's Eve deadline), so they might be able to come close. At a minimum, RI is now at least 8.6% ahead of last year.

via the Providence Journal:

HealthSource RI enrollment far exceeds projections

Updated Dec 22, 2017 at 7:48 PM

More than 30,700 have already signed up, and hours at the walk-in and call centers have been extended in anticipation of a surge in enrollments leading up to the Dec. 31 deadline.

PROVIDENCE — Rhode Island has outpaced projected sign-ups for Obamacare next year with more than 30,700 residents now enrolled in health insurance through the state-based health insurance exchange.

HealthSource RI officials expected to see around 30,000 people in total enrolled by the end of December. With a little more than a week to go and the last days of open enrollment typically the busiest, numbers are sure to increase.

via email from HealthSourceRI:

At week six of Open Enrollment nearly 29,000 Rhode Islanders have enrolled in coverage, which is about five percent more than last year. HealthSource RI continues to see an increase in new customers. We have more than three times the number of new enrollees this Open Enrollment period compared to the previous. HealthSource RI is pleased to see an increase in customers age 18-34, often known as “young invincibles.” While 25 percent of our renewing customers are age 18-34, 34 percent of our new customers fall into this age group.

Rhode Island is a tiny state, of course, so this doesn't necessarily mean much nationally, but it's great news across the board nonetheless.

According to the CMS Public Use File, Rhode Island's official tally as of 12/10/16 was 27,555 enrollees; 29,000 is indeed 5.2% higher. In fact, they only need 500 more people to beat their OE4 numbers, though they'd have to add another 5,700 to reach the all-time Rhode Island record of 34,670 set in OE3.

OK, that headline is a bit of clickbait, I admit.

Rhode Island is a tiny state, so any number change is gonna look pretty outsized, but this is still an eye-opener:

In Rhode Island, enrollment this year is five times higher in the first week than it was last year, said Zach Sherman, the director of HealthSource R.I. An early outreach campaign by the state seems to have paid off with more than 500 people enrolling, compared to 109 people in the first week last year.

I've received a hard number direct from the exchange: It's actually 604 new enrollees through 11/07, versus 126 new enrollees in the first 7 days last year.

I first looked at Rhode Island's proposed rate hikes back in early July. At the time, the average increase for the two carriers participating in RI's individual market was 10.5% assuming CSR reimbursement payments are guaranteed for 2018. If they weren't guaranteed, however, I estimated at the time that an additional 19 percentage points would be added into the mix, based on an estimate by the Kaiser Family Foundation.

However, I realized a little later on that I was misinterpreting KFF's analysis; they were referring to how much they estimated silver plans would go up due to the lost CSR funds, not all metal levels. Furthermore, for Medicaid expansion states (which includes Rhode Island) they estimated the average was only 15%.. Based on these factors, the impact across the board on Rhode Island should have only been around 10.3%.

Rhode Island just released their 2018 Individual and Small Group market rate hike requests, and they're pretty straightforward. For the small group market, I don't have the weighted market share for each carrier, but overall it ranges from 5.8 - 12.8%, with an unweighted average of 8.8%.

On the individual market, as with 2017, there's only two carriers participating in 2018: BCBS of RI and Neighborhood Health Plan. They're asking for a 13.8% and 5.0% increase respectively, with a weighted average of 10.5%.

BCBS gave their enrollment as around 27,000; for Neighborhood, I estimated theirs based on dividing their projected total member months by 12 to get 16,345. RI's on-exchange enrolment was 29,456 during Open Enrollment this year, so that would leave roughly 12,800 off-exhange enrollees, for roughly a 2:1 on/off-exchange ratio, which sounds about right.

Oof. Regular readers know that I've compiled plenty of evidence showing that while the 39 states run through the federal exchange (HC.gov) showed a ~5% enrollment drop this year, the state exchanges have been showing an overall net increase of roughly 2% over 2016. Rhode Island, however, is the odd man out on this front, as shown in this email I just received (not up on their website yet):

Despite facing a unique set of challenges this open enrollment, 29,420 individuals selected 2017 coverage through HealthSource RI during open enrollment period (November 1, 2016 – January 31, 2017). As of January 31, 27,395 of those individuals paid, and are therefore confirmed, in 2017 coverage. We do anticipate these number will change as payments are made through the February 23 payment deadline and also as HealthSource RI remedies account issues incurred during the open enrollment period. It is difficult to point to one clear cause for this year-over-year drop in enrollment, but we believe several factors might have played a role:

1. System and service issues

As i noted last week, with all renewing enrollees accounted for, Rhode Island's ACA exchange is likely to come up short not only of my pre-election projection (40,000 enrollees), but will likely see a drop from last year's 34,670 QHP selections. They had only hit 29,312 QHPs as of Christmas Eve, and have only tacked on another 580 people since then:

INDIVIDUAL AND FAMILY ENROLLMENT • As of December 31, 2016

Rhode Island is one of three states (along with Washington and Massachusetts) which allowed people to enroll for January coverage as late as December 23rd. RI's numbers have also included auto-renewals for some time now, so today's report includes everyone whose 2017 policies will kick off effective this Sunday, January 1st:

INDIVIDUAL AND FAMILY ENROLLMENT  •  As of December 24, 2016

Last week, the Rhode Island exchange reported 27,555 QHP enrollees as of 12/10, a tiny increase over the prior week mainly due to auto-renewed enrollees dropping out, cancelling out most of the increase.

Rhode Island is one of 3 states which are still taking enrollments for January, but they've released another report (thorugh 12/17) which brings the tally up to 

INDIVIDUAL AND FAMILY ENROLLMENT As of December 17, 2016

Huh. Rhode Island didn't post any updates at all for the first 5 weeks of OE4, but has now posted weekly updates back to back:

INDIVIDUAL AND FAMILY ENROLLMENT As of December 10, 2016

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