Oregon: OFF-exchange QHPs now make up 50% of total

A few days ago, I posted an article over at healthinsurance.org which delved into the mysterious world of OFF-exchange QHPs...ie, people who just enroll in a private, individual/family healthcare policy the old-fashioned way, by contacting Blue Cross, Aetna, UnitedHealthCare or whoever directly instead of going through one of the ACA exchange websites.

I also posted an accompanying piece here which noted how hard it is to lock down these enrollment numbers, since the carriers aren't generally required to provide that information publicly except in a general sort of way (and even then, usually only once a year or so). Only Oregon and Washington State really post off-exchange data with any sort of frequency, and only Oregon is doing so weekly.

My larger point in both stories is that off-exchange QHPs made up as many, if not more, of the individual insurance market as the exchange-based enrollments did last year: Up to 8 million, vs. the 7 million or so via the exchanges. This is important for a number of reasons, especially two: The total number of ACA-compliant policies and the actuarial risk pools, which off-exchange QHPs share with exchange-based ones in most cases.

Anyway, at the time, Oregon's data showed that off-exchange QHPs made up around 44% of the total.

This week, the latest numbers show that this ratio has shifted more towards the off-exchange numbers:

Members enrolled, Nov. 15-Jan. 18

  • On Healthcare.gov 85,706
  • Outside of Healthcare.gov 90,223
  • Total 175,929​

A few weeks back, I noted an odd discrepancy between the exchange-based number posted on the Oregon.gov site and the corresponding number posted by HHS; even accounting for the thru-dates differing slightly, the Oregon.gov number has been averaging about 5% lower for some reason. For instance, the number above, thorugh 1/18, is 85,706, versus the 90,345 (through 1/16) listed on the latest HHS weekly report.

I discussed this with Lisa Morawski of the Oregon Insurance Division; she did some investigation and thinks she's figured out what's accounting for the discrepancy:

We continue to see our healthcare.gov numbers lag the numbers reported by HHS. We have identified a couple things potentially driving this difference:

  • The Insurance Division receives data directly from carriers, and each carrier has its own process and IT system for capturing enrollment through healthcare.gov. There may be a lag between when a consumer selects a plan on healthcare.gov and when that same consumer appears in the carrier’s system.
  • It appears at least one carrier is showing someone as enrolled only if the first month’s premium is paid. The HHS numbers reflect consumers who have chosen a plan through healthcare.gov. This would result in lower numbers reported from the carriers at this point in time.

Both of these make perfect sense, especially given the fairly small difference (about 5-6% each week). As such, since HHS has started breaking out the weekly reports by state anyway, I'm going to use the HHS numbers for consistency (besides, I already list the paid estimate in a separate column).

Anyway, the OFF-exchange number (90,223) is either 50-51% of the total depending on whether you use the state's number or HHS's for the exchange-based enrollments...which just adds more evidence to my original point: 

Not impressed yet by enrollment in ACA's exchanges? Take heart: off-exchange sign-ups could roughly double the QHP 'big picture'