GRAHAM-CASSIDY REPEAL BILL DEADLINE:

Time: D H M S

Rhode Island: 6K down, 6K up; new additions cancel out non-renewals to date

A few days ago, Rhode Island issued their latest numbers through 12/27. However, like Vermont, Minnesota and Hawaii, they bumped their January-start deadline out to New Year's Eve, making it tricky to get a bead on their "post deadline" enrollment pattern, which is where things are for every state now.

Thankfully, they've rectified this today by bringing the data up to date through January 3rd:

PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Saturday, January 3, 2015, for Open Enrollment.

Individual Enrollment data (November 7, 2014 through January 3, 2015)
As of January 3, 2015, 78% of Year One customers have renewed (selected a plan) for 2015 (59% of renewing customers paid their first month’s premium).
Total New Customers: 6,067
Total Renewed Customers: 20,313
Total HealthSource RI enrollments for 2015 coverage (including those who have not yet paid): 26,380

SHOP Enrollment data (cumulative as of January 3, 2015)
Small employer applications completed: 531
Total paid small employer enrollments:  422 (representing 3,078 covered lives, based on their submitted census).
As of January 3, 2015, 30% of employer enrollments represent new or renewing customers for coverage effective January 1, 2015.
Small employers enrolling in Full Choice Model: 76%

Hmmm...78% manually renewing out of around 26,000 even (20,313 = 78% of 26K) is a bit low, although the remaining 5,700 can still enroll in time for February or March coverage; they'll just have a 1 or 2-month gap in their policies. Interestingly, this was almost exactly cancelled out by the 6,067 new additions, bringing the total to 26,380 as of 1/03.

On the other hand, Rhode Island doesn't have any autorenewal policy; it's an unusual case, because it's the only state which voluntarily required current enrollees to manually log in and renew/re-enroll in their policies for the new year. Other states such as Massachusetts, Maryland, Oregon and Nevada did this as well, but in their cases they had no choice but to do so.

Rhode Island is the only state following my advice on this from way back in June; given all the changes in the policy options, premiums, companies participating and so on, it seemed like a better idea to require everyone to log into their account and at the very least have a big checkbox saying "I understand that there may be changes in my options for 2015 but I choose to renew my current policy" or words to that effect. That way the policy enrollees would be better informed and couldn't complain about sticker shock/etc. later on.

The argument against this, of course, is that people are basically lazy and don't want to have to go through the "hassle" of logging into the exchange website again, even if it's only once a year. That made sense given the technical headaches last year, but most of the exchanges are vastly improved this time around, and it only takes a few minutes to log in, look around a bit and then check out again. Then again, I'm a website developer by trade; not everyone is as comfortable with that sort of thing.

Anyway, Rhode Island was the test case for this policy: 78% actively logged in and either renewed their current policy or switched to a different one. 22% failed to do so--either deliberately (because they moved to some other form of coverage) or accidentally (which is where the downside comes in). In that context, 78% sounds pretty good to me, but I don't know if that's high enough to recommend it in other states (plus, RI might have a more tech-savvy populace than, say, Alabama...).

So, can Rhode Island enroll an additional 11K by 2/15 to meet the HHS Dept's target (37K) or 21K more to meet my own (47K)? We'll have to see...

Meanwhile, SHOP (small business exchange) enrollment in RI is also down a bit from last week (from 3,157 to 3,078). I assume this will bounce around a bit more as employees join or leave companies, etc.

UPDATE 01/08/15: I've reposted Betsy's comment from below this entry; her first point gives some insight into the seemingly low payment rate in RI so far (59%); the second point (in bold) is exactly what I was concerned about back in June:

RI also changed its policy on payment half-way through. When I renewed, I was reassured that of course they'd just keep taking my premiums out of my bank account as they had for the past year. That's what showed on the website as well. But fortunately I double-checked, and no, they had reset everything and eliminated the auto-pay. When I called in again, it then took another four days before they managed to process the payment. (I still don't have my new card.) They did not send a bill either paper or email. So I wonder how many people think they've paid but haven't. The payment deadline for Jan. 1 coverage is Jan. 15, so there's still time.

My impression is that the RI exchange did not run as well on the back-office stuff as they did last year.

And given the number of news reports (including AP stories that the local media duly reprinted or linked on their websites) saying "Don't worry, you're automatically renewed," I suspect some people won't realize this until they try to access services in the new year. There have been quite a few reminder mailings from Blue Cross, but those may be perceived as just marketing and tossed. I don't know if the exchange will do something like the auto insurers have to, sending out a "last chance!!!" mailing.

I didn't even understand the tax credit changes at the time, but I did understand the confusion factor:

As an aside, I also question the wisdom of not requiring everyone to re-enroll each year. Obviously HHS is trying to minimize the inconvenience/hassle factor, but it seems to me that this is just going to cause even greater confusion than it would if they simply issued a blanket statement: If you enrolled via an ACA exchange, you have to renew once a year even if nothing else has changed.

Meanwhile, as usual, RI also provides a plethora of data-nerd demographic stuff as well:

Demographic Data
In addition, HealthSource RI has released the following demographic data regarding new enrollees and renewals to date (not including SHOP enrollees):

Gender
Male:  47%
Female: 53%

Age
Under 18: 5%
18-25: 9%
26-34: 16%
35-44: 17%
45-54: 22%
55 and older: 30%
 
Plan type selected
Gold-level plan: 14%
Silver-level plan: 63%
Bronze-level plan: 23%
Catastrophic: 1%

Carrier selected
Blue Cross & Blue Shield of RI: 54%
Neighborhood Health Plan of RI: 43%
UnitedHealthcare: 3%

Financial assistance
No financial assistance: 13%
Advanced premium tax credits (APTC): 34%
APTC and cost-sharing reductions (CSR): 53%

Rhode Islanders using HSRI
Inbound Phone Calls Received: 165,671
Walk Ins Received (Providence): 9,124
Walk Ins Received (Warwick): 2,364
Total Walk Ins Received: 11,488
Website Unique Visitors: 107,864
Website Visits: 210,647
Website Page Views: 414,866

Upcoming Deadlines:

New and renewing customers who enroll and pay for their first month’s premium by January 23, 2015, will have coverage that begins on February 1, 2015.

New and renewing customers who enroll by February 15 and pay for their first month’s premium by February 23 will have coverage that begins on March 1, 2015.

The open enrollment period for individuals ends on February 15, 2015.

Small employers may enroll at their renewal date, regardless of where that date falls in the calendar year.

Medicaid-eligible individuals may enroll throughout the year.