2018 MIDTERM ELECTION

Time: D H M S

California: Appx. 40K covered lives via SHOP exchange; suggests up to 330K nationally?

Long-time followers of this site know that I attempt to track every person who gets enrolled in healthcare coverage through the Affordable Care Act, whether it's via individual/family exchanges, Medicaid expansion, off-exchange QHP enrollments...or the SHOP (Small Business) exchanges. They'll also recall that last year, due to the massive technical problems which most of the exchange websites faced, only a handful of SHOP exchanges were even usable, much less actually signing people up. The exchanges were, for the most part, so busy scrambling to get the individual enrollment side working properly that they pretty much put the SHOP exchanges on the back burner. Only about a half-dozen states had theirs running at all, and the total enrollment topped out at only around 83,000 people nationally.

This year, as far as I know, all of the SHOP exchanges were all systems go...but enrollment has still been pretty anemic, to the point that the HHS Dept. hasn't bothered mentioning SHOP enrollment in either their weekly "snapshot" reports or even in the official monthly ASPE enrollment reports.

In fact, even though the SHOP exchanges are operational in every state this year, only a handful, again, have reported their enrollment numbers so far:

  • Connecticut: 1,100 covered lives
  • District of Columbia: 15,763 covered lives (the bulk of which are Congressional staffers...I'd guess around 12,000 of the total)
  • Minnesota: 1,419 covered lives
  • Rhode Island: 3,282 covered lives
  • Washington State: 290 covered lives

Yep, that's a grand total of less than 22,000 people enrolled in SHOP policies across 5 states (over half of which are Congressional staffers).

The total population of these 5 is around 17.7 million, or 5.5% of 319 million total. If you take account for the 12K or so Congressional staffers, these enrollees should extrapolate out to perhaps 200,000 people covered nationally. In my recent "Complete Graph" post, I tacked on another 10% for the heck of it to 220K (still barely even a rounding error, really). In essence, I estimated that SHOP enrollments are averaging around 2% as many as the individual/family QHP number at any given point.

That brings me to today's revelation that Covered California has enrolled around 40,000 people in SHOP plans this year.

So far, just under 2,000 businesses have enrolled, representing about 16,000 employees, according to Covered California's James Scullary. (Note: SHOP enrollment runs year-round, unlike the limited open-enrollment period for individuals and families.)

Remember, that's 16,000 employees. The reason I use "covered lives" in the list above is because many employees obviously have dependents covered by their policies as well.

According to the U.S. Census Bureau, the average household size nationally is around 2.63 people nationally, or 2.9 people in California specifically. If you knock that down to 2.5 to err on the side of caution, that should mean roughly 40,000 total SHOP-covered lives in California.

How does this match up with my earlier estimates? Well, California makes up around 12% of the total individual QHPs nationally; extrapolating 40K out would be around 330K. Interestingly, CA also makes up around 12% of the total population.

If anything, this makes it sound like total SHOP enrollments nationally may be about 50% higher than my 220K estimate...figure somewhere between 220 - 330K. Still a drop in the bucket, but a bigger drop (perhaps 3% of the QHP number instead of 2%?).

Who knows, some day the HHS Dept. might even decide to let us know SHOP enrollment on a state-by-state basis!