California: Updated Enrollment Figures Coming This Afternoon: How far off will I be? (UPDATED)

Regular readers know that given the HHS Dept's going radio silent on the total ACA enrollment figures since the last official report was released back in May (which only ran through April 19th), I've been patching together bits and pieces of enrollment data from a handful of state exchanges, plus the occasional snippet of info from other states which has managed to find daylight from time to time.

Based on this, I've been projecting roughly 9,000 QHP enrollments being added per day during the off-season, translating into around 270,000 per month, of which about 90% eventually pay their first months premium. That translates to around 240K paid enrollees being added per month, which in turn is being roughly cancelled out by people dropping their policies after the first few months as they move on to other types of coverage (Medicare, ESI, Medicaid and so forth). Based on these estimates, there should now be a gross total of around 9.6 million enrollments, of which around 8.3 million have paid their first premium, and around 7.4 million who are currently enrolled as of October.

Now, HHS Secretary Sylvai Burwell did finally let one key number out last month: The number currently enrolled nationally was 7.3 million as of August 15th. That's not quite the same thing as giving the gross total or paid total to date, but it's close enough to what I had projected for me to be comfortable with my other numbers above.

In any event, in addition to the HHS Dept. keeping mum about Healthcare.Gov enrollments (covering 36 states), there's also been bupkes to date from the 2 largest state-run exchanges: New York and California...until now.

New York is still keeping their mouths shut, but Covered California head Peter Lee recently mentioned the state's own "currently enrolled" figure: 1.3 million, compared with the 1.4 million total enrollment figure as of 4/19.

Now, I've done a simple reverse calculation with my projection chart to estimate that California should be enrolling around 1,500 - 1,600 additional people per day. How do I get this?

• CA had 1.405 million enrollees from 10/1/13 - 4/19/14 (200 days)
• That's around 7,000 per day
• All of the other data I have suggests that on average, the national off-season daily rate is running between 19% - 25% of the enrollment period rate, or 22% as a midline
• If CA is hitting that rate, that's 1,500 - 1,600 per day being added.
• Therefore, the total number for CA should be around 1.68 million people, of whom around 1.47 million have paid for at least their first month to date, and 1.3 million of whom have already been confirmed to be currently enrolled.

I bring all this up because in a few hours, Peter Lee will be discussing CoveredCA with the media. While most of the info will no doubt be about the 2nd open enrollment period coming up in less than a month, he'll supposedly also be giving out "updated enrollment numbers".

In other words, I wanted to publish this now so that I'll be on the record later this afternoon; let's see how close or far off the mark I end up being!

UPDATE: 3:05pm: Here's the official press release, and the main number...doesn't make much sense to me based on earlier data provided:

FOR IMMEDIATE RELEASE

Media Line: (916) 205-8403

Oct. 16, 2014

COVERED CALIFORNIA LAUNCHES RENEWAL FOR ​MORE THAN 1.1 MILLION ENROLLEES AND ANNOUNCES NEW INITIATIVES FOR NEXT OPEN-ENROLLMENT PERIOD

Lessons Learned from Initial Open Enrollment Applied to Major Changes for Upcoming Open Enrollment Nov. 15 to Feb. 15

SACRAMENTO, Calif. — Covered California announced it has begun the renewal process for 1.12 million individuals who enrolled in plans in the exchange last year and unveiled substantial new improvements to facilitate enrollment in coverage for 2015.

“Last year, we succeeded in signing up millions of Californians in health coverage through Covered California and Medi-Cal,” Covered California Executive Director Peter V. Lee said. “We learned a great deal in the process, and in this second open enrollment we are building on those lessons using effective and concrete changes.”

The first wave of renewal notices was sent to consumers on Wednesday. Consumers who complete the renewal process will hear from their insurance plans in December. Their selected health plan will send a statement reflecting coverage starting Jan. 1, 2015. Consumers who take no action will be renewed into their existing plan.

Individuals who have health coverage through Medi-Cal renew their coverage throughout the year, on a rolling monthly schedule. Medi-Cal will contact them directly if they need to take action. Unless they are contacted by Medi-Cal, these individuals do not need to go to the Covered California website to renew or apply. 

Covered California also provided updated enrollment numbers for 2014 on Thursday. Of the Californians who selected a plan during the initial open enrollment, 1,140,000 (or 81 percent) had their coverage take effect by paying their first month’s premium. 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.

I was actually off by quite a bit on the paid number...not due to any poor calculations on my part, but due to erroneous information provided earlier this year by CoveredCA.

• Way back in April, Peter Lee stated, on several occasions, that 85% of total policies had been paid for out of the 1.4 million total. That would be around 1.19 million paid. It was reasonable to assume that this percentage would eventually go up a few percent more, to the same 90% that has been reported in other states. He said today that they overestimated this by about 50,000 people, knocking it down to 1.14 million who actually paid out of the original 1.405 million.
• Then, a couple of weeks ago, Lee stated the number of people currently enrolled as being 1.3 million. It now appears that this number included those who are are still enrolling right now and over the next month, including those who enrolled after September 16 and therefore haven't had their policies kick in yet (ie, those starting on November 1st or December 1st).
• June - Sept: 200,000 more added. That's 1,630 per day, which is actually slightly higher than I had projected.
• Assuming the same 81% payment rate is holding true during the off-season, that's about 162,000 additional paid enrollees through the end of September.
• OK, so that means the 1.3 million figure = 1.14 million paid (open enrollment folks) + 162K paid enrollments from 6/1 - 9/30.
• I have no idea why he didn't include late April and all of May in this figure. Weird. Assuming those enrolled at the same rate as the rest of the summer, that's another 68,000 people.
• Hoping to enroll 500K more people on top of the 1.3M expected to renew (1.7 million total assuming 100K non-payments/etc)
• Retention Rate: Out of 1,140,000 paid during open enrollment, 1.6% attrition/month rate (150,000 total; 98.4% of prior month); less than 2.5% estimate
• They'll be adding the option to pay the first month's premium as part of the enrollment process, but it doesn't look like it will be required or even available on every policy.
• So, this means that you have 1.40 million + 200,000 + perhaps 68,000 = 1.67 million total...versus my 1.68 million estimate. The only unknown is that 68,000 from 4/20 - 5/31.
• As for the payment rate, as I noted above, I was obviously way off on that...because the 85% figure that Lee stated (repeatedly) last spring was, quite simply, wrong. Assuming that 81% rate continues to hold true through today, that means the total paid number for CA should be around 1.35 million, versus my 1.47 million.
• 3.4 million prevously uninsured Californians now have insurance thanks to the ACA specifically (QHPs + Medicaid etc)
• 2.5M eligible for subsidies; enrolled about 1/2 of them.

For more information about the enrollment numbers, see the October 2014 “Individual Market Enrollment Report” online at http://news.CoveredCA.com/p/covered-california-individual-market.html.

“This is our very first experience with renewal, and we will learn things during this process just as we learned a great deal about open enrollment during 2013-2014. We do believe many significant improvements have been made that will assist our consumers during both renewal and open enrollment this year,” Lee said. 

In the meantime, Covered California continues to gear up for open enrollment, which will begin Nov. 15 and continue through Feb. 15. Open enrollment is the next opportunity for all Californians to benefit from new insurance rules, including the requirement that insurance be offered regardless of health status. In addition, this is the window of time when Californians can buy subsidized coverage starting in 2015.

Covered California has adopted changes, guided by a newly released report titled “Covered California Open Enrollment 2013-2014: Lessons Learned,” to improve consumers’ experience. The report commissioned by Covered California offers an in-depth look at Covered California’s work during the first open-enrollment period. It is available online at www.CoveredCA.com/resources/PDFs/10-14-2014-Lessons-Learned-final.pdf.

“We know this open-enrollment period will be more challenging in some ways. Consumers will only have three months to enroll, compared with the six months they had last time. This is complicated by our knowledge that many who are uninsured have adapted to a culture of coping and have become accustomed to living without health insurance,” Lee said.

With less than one month before open enrollment begins, consumers can begin the process of shopping for 2015 coverage. They can find out if they are eligible for financial assistance and find out how much a health plan will cost them, by using Covered California’s Shop and Compare Tool (on CoveredCA.com at www.CoveredCA.com/shopandcompare/#calculator). Covered California also offers a full listing of the plans and their rates in the booklet “Health Insurance Companies and Plan Rates for 2015” (online at www.CoveredCA.com/PDFs/CC-health-plans-booklet-2015.pdf)

Following are the top lessons learned and the ways that Covered California is improving its work for the coming open-enrollment period.

The volume of consumer interest and interactions exceeded expectations and challenged all systems and service channels. As a result:

• Covered California will start open enrollment with more than double the number of Service Center representatives — state employed and contractors — to dramatically reduce wait times and help consumers enroll. More than 1,300 representatives will help consumers over the phone, by chat or by processing their paper applications or documents. The majority of these representatives are state employees working in Rancho Cordova and Fresno, but two private vendors — Faneuil and Maximus — will operate call centers to boost capacity during this period. Last year, Covered California began open enrollment with 381 Service Center representatives and ended with 709.
• While the vast majority of consumers are served in their own languages by Covered California staff, the capacity of the Service Center will be expanded more in order to serve callers in Spanish, Chinese and other languages without the use of interpreters. This year Covered California will have 254 Service Center representatives able to serve consumers in languages other than English, compared with 55 during open enrollment in 2013.
• Service Center hours — including phone service and online chat — have been expanded to accommodate consumers after hours, with representatives now available from 8 a.m. to 8 p.m. Monday through Friday and from 8 a.m. to 6 p.m. Saturday. In addition, the Service Center will be open on many Sundays during open enrollment, including every Sunday from Nov. 16 through Dec. 15.
• Covered California is working with health plans to make it possible for consumers to make their first premium payment online as soon as they have selected a plan. This will give consumers peace of mind that they have evidence that their payment has been received and that they will have coverage in place.
• To meet high consumer demand, Covered California spent $22.6 million to upgrade the enrollment portal infrastructure to allow for greater user capacity and speedier page loads so that consumers do not have to return later to complete an application.
• For self-service, Covered California is redesigning its interactive voice response (IVR) system to handle more consumer calls while decreasing wait times and updating consumers on wait times when they are placed on hold.
• Covered California is continuing to make significant improvements so that notices consumers receive are clearer, explanations on the website are better — in both English and Spanish — and the consumer experience is more seamless.

Many consumers are new to insurance and need extensive education about health insurance terminology, how to enroll in coverage and how to use insurance. As a result:

• Advertising this year features real Californians speaking to the ways that coverage has benefited them as a result of the Affordable Care Act, including testimonials from people who were able to get vital care as a result of their coverage. The volume of advertising will taper down in the coming two weeks and then ramp up significantly before open enrollment starts on Nov. 15.
• Realizing that Certified Enrollment Counselors and Certified Insurance Agents are some of the agency’s strongest connections to consumers, Covered California is giving these valued partners enhanced and expanded tools to educate enrollees, including biweekly webinars, training from subject matter experts, a bimonthly newsletter to highlight best practices and modifications to the enrollment process, and an updated glossary of terminology.
• This year, Covered California will expand dedicated call lines to help Certified Insurance Agents and Certified Enrollment Counselors help consumers during the application process.

Most consumers relied on a variety of touch points, including in-person assistance, to successfully complete enrollment. As a result:

• Covered California’s partners will open more than 200 storefronts in retail locations, such as malls, to help serve consumers on a drop-in basis that meets their scheduling needs. Consumers can get help at these sites to enroll, renew and learn more about health coverage options.
• Covered California will begin the open-enrollment period with more than 12,000 Certified Insurance Agents, 10,000 county eligibility workers, and 6,400 Certified Enrollment Counselors to help educate and enroll consumers. To get free, confidential, in-person assistance, consumers should visit CoveredCA.com and click “Find Help Near You.”
• Enrollment of African-Americans, Latinos and Asian-Americans will be emphasized and broadened through targeted advertising in relevant media outlets, through Navigator grants supporting in-person enrollment guidance from expert communicators specializing in outreach to underserviced communities, and through engagement of African-American churches to host community-wide enrollment events.

“We are extremely excited about the changes we have put in place, and we look forward to building on the enthusiasm around open enrollment this year as we did last year,” Lee said, noting that more than 70 events are scheduled in the Los Angeles area alone between now and Nov. 15. “The Affordable Care Act is working, and it is changing the lives of people for the better.

“At the same time, we know we have more work to do. We want Covered California to deliver best-in-class customer service, and we know we’re not there yet,” Lee said. “But we’re getting better every week, and we will continue to learn and improve.”

Covered California offers a range of choices of private health insurance plans. Consumers can choose the health plan and level of coverage (Bronze, Silver, Gold or Platinum) that best meets their health needs and budget.