Now the Good News: 85%+ of Feb enrollees likely to be previously uninsured

Over the weekend, I threw some cold water on the ACA enrollment momentum theme with a one-two punch: First, I pointed out that the February report will only include 4 weeks of data (2/02 - 3/01) vs. January's 5 weeks (12/29 - 2/01); then I looked into the actual data to see if this story from Yahoo Finance was correct in suggesting that enrollments have dropped off even on a daily-average basis since January.

The bad news is that unfortunately, from the (very limited) data I have so far, this does appear to be the case. At the moment--based on only 12 states' worth of data, and only for about 1/3 of February for those states--I'm estimating that the average enrollments per day in February may be perhaps 2/3 of the January average (around 22,000/day vs. 32,744, give or take). Combining these two factors suggests that total February Private QHP enrollment may be as low as 600,000 people, though I'm guessing it'll end up closer to 700,000. Oh, yes...there's also the fact that the HC.gov exchange has been partially offline for the past 2-3 days for scheduled maintenance, cutting the total "enrollable" days on the Federal exchange down from 28 to 25 for the month.

Here's a repost of the final version of the chart that I posted yesterday...as you can see, among these 12 states, the Feb. drop-off so far ranges between 5% - 80% depending on the state, and averages around a 43% overall (again, the NY number is a bit skewed due to the dates, but I've tried to adjust for that):

In any event, hitting 4 million by the end of February looks like it's gonna be tight at this point. Again, this is limited data, and good news out of a couple of large states such as California or Florida could completely change this scenario. I should also reiterate that the odds are still strong for a March "surge" similar to December's which still makes hitting 6 million total a reasonable goal...though 6.5M is probably unlikely at this point.

HOWEVER, here's the silver lining, and it's a major one: 

In New York State, at least (it's the only state which has provided this information so far), over 90% of all NEW private QHP enrollments (ie, those in the past week) are people who were previously uninsured.

How do I know this? Well, setting aside the January HHS Report (which I've already shown has a major discrepancy with the NY Exchange's own data...HHS has NY down at only 211K as of 2/01 when the NY Exchange has them with 222K 12 days earlier), let's look at the other part of the NY press releases:

On February 10th, the NY State of Health said that, of the combined Private & Medicaid enrollments, 66% were previously uninsured:

"412,221 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. Sixty-six percent of New Yorkers who have enrolled to date were uninsured at the time of application...."

66% of 412,221 = about 272,066 people.

Yesterday (February 17) the announcement was:

Another 44,000 people enrolled in a health insurance plan through the state's exchange over the past week, pushing the total to 456,042, according to the state Department of Health.

Of the total enrollees, 69 percent did not have insurance at the time of their application. A total of 266,177 enrolled in private plans through the exchange, while 189,865 were placed on a Medicaid plan, according to the exchange.

69% of 456,042 = around 314,669 people.

This means that an additional 42,603 previously uninsured people have enrolled in the past 7 days...out of 43,821 new enrollees total, or over 97% of them.

Now, there's a minor catch here...both the 2/10 and 2/17 numbers include both private and Medicaid enrollees...but we can solve for that as well. The 2/10 breakdown was 251,306 private / 160,915 Medicaid. The 2/17 breakdown is 266,177 private / 189,865 Medicaid.

This means that the 43,821 new enrollments over the past week break out to 14,871 Private QHPs and 28,950 Medicaid enrollments.

In other words, even if every single one of those Medicaid enrollments is new, that still means that 13,653 of the 14,871 new private QHP enrollments...92%...were previously uninsured as well.

(Conversely, it's theoretically concievable that 100% of the new private QHP's were previously uninsured, and only 96% of the new Medicaid enrollees, though this is unlikely).

So, assuming that the New York data is fairly representative nationally, the two major takeaways to look for from February are likely to be:

  • Yes, private QHP enrollment is likely to be down around 35-40% from January;
  • HOWEVER, of those who are enrolling, 85% or more of them are likely to have been previously uninsured.

Basically, a big chunk (perhaps half or so?) of the 3.3 million or so who enrolled through the end of January were the low-hanging fruit...people like myself who already had insurance and were simply replacing it with a new, ACA exchange-based policy. These are also people who are naturally more likely to take private health insurance coverage in stride--they've been paying for it up until now and include it as part of their normal monthly expenses, like the electric or cable bill. With what I assume are pretty much most of those folks squared away, the remaining (February & March) enrollments should be almost exclusively the ones for whom major portions of the ACA were intended in the first place: Those who don't currently have any sort of health coverage whatsoever, and who may not be used to the process or the monthy expense involved (even with subsidies). This is a tougher nut to crack, and the numbers are likely to reflect that.

This last part is speculation, however; I'll post further updates as new data comes in.