California: 99.4% accurate on TOTAL enrollments, 93.2% on PAID, 86% on CURRENT...due to misinformation from CoveredCA

2018 MIDTERM ELECTION

Time: D H M S

OK, I've started a new entry since the last one was getting pretty long.

I still have to sort through a bunch of data, but the main takeaway is this:

  • I projected the total California QHP enrollment figure to be around 1.68 million. The actual number is 1,414,668 (as of 4/15...see update at bottom of this page) plus 200,000 off-season enrollments from 6/1 - 9/30 plus an unknown number from the 46 days between 4/16 - 5/31.
  • I have no idea why they left those 46 days out of the press conference. Very odd.
  • There were 200,000 people who enrolled from June 1st - September 30th (122 days), or 1,639 people per day.
  • Assuming the missing 46 days saw a similar rate to the rest of the off-season period, that would be 1,639 x 46 = 75,394 additional enrollees.
  • Assuming this is correct, that's 1,614,668 + 75,394 = 1,690,062
  • That would make my projection 99.4% accurate.

Of course, it's theoretically possible that not a single person enrolled during those 46 days (which is, to put it mildly, unlikely). If so, that would make me off by 3.9%. Somehow I don't think that's very likely.

As an aside, as a reminder: 200K / 122 days = 1,639/day...almost precisely the same 1,600/day that I was projecting 2 weeks ago.

On the other hand, on the paid enrollment side, I was off by quite a bit in California...for a simple reason:

Needless to say, it was pretty reasonable for me to assume that, you know, 85% of CoveredCA QHP enrollees had paid their first month's premium. If that was true, that would have meant that 1.19 million out of those 1.405 million had paid.

However, today Lee reported that the actual number turned out to be a bit lower...81%, or around 1.14 million people, roughly a 50,000 person difference.

However, it's actually a bit better than that, because there's a 10,000 difference in the 3/31 payment rate and the 4/19 rate:

For Covered California’s initial open enrollment period — from October 2013 through March 2014 — how many consumers actually began their coverage?

At the end of the first open enrollment period, which ran from October 1, 2013 to March 31, 2014, Covered California reported 1,395,929 individuals who selected a health insurance plan. Of those who selected a plan, about 1,140,000 had their coverage take effect (an effectuation rate of about 81%). As outlined in the May 2014 Enrollment Forecast Brief, Covered California anticipated having 1,190,000 individuals with coverage by the end of the first open enrollment period and the open enrollment effectuation rate was slightly less than originally estimated but in the range that Covered California has consistently reported.

1.14M / 1.396M = 81.7%, so closer to 82% than 81%, but whatever.

Assuming that the off-season enrollments held at the same 81.7%, that's 1.37 million paid instead of my estimate of 1.47 million, meaning I'm off by 6.8%. Again, I'm not exactly pouty about this since 5 official sources in a row reported it as being 85% last spring.

Now, here's where things get interesting. The press release and corresponding press conference today stated that around 1.3 million Californians are "currently enrolled". Where did that number come from?

Well, if you take 1.405 million and add 200K, that's 1.605 million. Take 81% of that and you have 1.3 million on the nose.

However, they also reported a couple of other key points:

Today, a total of 1.12 million individuals have effectuated coverage and will be part of the renewal process. Covered California expects this number to increase as special enrollment continues and as recent enrollees effectuate their coverage, with about 1.3 million Californians participating in the renewal process through the end of the year.

In other words, that 1.3 million figure doesn't just include those whose coverage started as of October 1st, but also includes anyone who enrolled/will enroll from Sept. 16 - Oct. 15 (policies starting on 11/01) and Oct. 16 - Nov. 14 (policies starting on 12/01).

So, how to account for these 2 "missing" months? Easy:

How many consumers did not continue their coverage after starting payments?

Of the 1,140,000 who enrolled in the open enrollment period and effectuated coverage, 150,000 subsequently disenrolled from their coverage. This is an average monthly disenrollment rate of 1.6% (or a retention rate of 98.4%). In addition to the monthly disenrollment rate, we forecast that an additional 15% will not renew during the upcoming open enrollment period.

In other words, they added around 275K (200K confirmed, 75K likely), of which around 225K have paid up...but have also lost about 150K.

That makes the currently enrolled figure: 1.14M - 150K = 990K, plus 225K = 1.215 million, minus 150K = 1.065 million. Notice that there's around a 55,000 person difference between this and the 1.12 million "effectuated coverage" number noted above (aka "currently enrolled"). This suggests that the payment rate went up for off-season enrollments, but is a bit tricky to figure out so I"m not gonna worry about it that much.

How many individuals currently have coverage in Covered California?
Today, 1,120,000 individuals have coverage in a Covered California qualified health plan.

The bottom line is that the "1.12 Million effectuated" number is what I referred to as "currently enrolled" which I thought was 1.3 million. Off by 14% on that one, ouch.

Again, given that CoveredCA has been tossing the 1.3 million figure around for a couple of weeks now as "currently enrolled", it was natural for me to assume that there really were 1.3 million people, you know, currently enrolled instead of 1.12 million.

How many individuals will be participating in the renewal process for the upcoming open enrollment period?
All individuals who currently have coverage as well as those who recently selected or will select a health plan for the duration of the coverage year will be eligible to renew their coverage. Up to 1,300,000 individuals will be able to renew for 2015 health insurance coverage.

Huh. Yeah, that "up to" is a new one to me.

Here's what I find interesting: You'll note that of the 4 major projections/estimates on my part, the two that I was dead-on target with were the ones where I wasn't basing them on official numbers from CoveredCA...whereas the two that I was off by a significant amount were based on official statements by the exchange. Take that for what you will.

There's a couple of additional important data points:

Updated data shows that 1,414,668 individuals selected a health plan during the first open enrollment period for coverage starting January to May. Many individuals finished their open enrollment application by April 15th, which resulted in May coverage.

In other words:

  • 3/31 Total: 1,395,929
  • 4/15 Total: 1,414,668
  • 4/19 Total: 1,405,102

You begin to see what a headache this is. CoveredCA added another 19,000 people during the "extension" period...but then "lost" 9,500 of them over the next 4 days. Clerical errors? Cancellations? Double entries? Who the hell knows, but each time this stuff changes, it can bump my accuracy rate up or down by a tenth of a percent or two.

And finally, fantastic news on the "retention/attrition" front, which helps mitigate my disappointment in the "paid" and "currently enrolled" areas:

How many consumers did not continue their coverage after starting payments?

Of the 1,140,000 who enrolled in the open enrollment period and effectuated coverage, 150,000 subsequently disenrolled from their coverage. This is an average monthly disenrollment rate of 1.6% (or a retention rate of 98.4%). In addition to the monthly disenrollment rate, we forecast that an additional 15% will not renew during the upcoming open enrollment period.

The 15% forecast may or may not prove to be correct, although of course if the reason they don't renew is because they got a job with ESI, aged into Medicare and so on, it's not a bad thing. As for the 1.6%/month attrition rate, that's not quite how I'd word it. I find the net attrition rate (after additions and subtractions) to be more significant than the gross rate, although both are important for different reasons.

The net attrition since April is 1.12 million currently enrolled/paying out of 1.14 million enrolled/paying as of April, or a net reduction of less than 2% over 6 months.

What does this really mean, then?

It means that, for the most part, the number of people enrolling during the off-season is more or less cancelling out the number of people dropping their coverage during the off-season. This is also seen nationally, with around 7.2 million out of the on-season 8 million paying...and 7.3 million still enrolled as of mid-August. Perhaps that number has gone down a bit (though I suspect it's the same or slightly higher), but it should still be roughly around what it was last spring...around 7.2 million or so.

In the end, this strongly suggests that whatever number are enrolled and paid up by about a month after a given enrollment period ends is likely to stay at that number throughout the rest of the year.