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Does tiny Rhode Island have big implications re SEPs & Rate Hikes?

Last week I noted that the Rhode Island ACA exchange has become my newest BFF: They've decided to continue posting weekly enrollment reports even during the off-season!

Better yet, they're also making sure to include both the gross enrollment and net effectuated enrollment numbers. If every state exchange (and especially HealthCare.Gov, of course) were to do this, I'd be a very happy man indeed. In the meantime, I'll have to settle for RI's regular updates, although extrapolating anything nationally from a single state with just over 1 million people is a bit tricky.

Anyway, last week they reported (thru 2/06):

  • 35,428 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
  • The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
  • 8,103 of the 35,428 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
  • 33,148* of the 35,428 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

Today, they report the latest numbers as:

INDIVIDUAL AND FAMILY ENROLLMENT • As of February 13, 2016:

  • 35,813 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
  • The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
  • 8,448 of the 35,813 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
  • 33,473 of the 35,813 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

OK, so that's a net increase of 385 people week over week, or 55 per day. This is a drop from the 126 per day they averaged the first off-season week, but is still 67% of RI's open enrollment daily average.

Again, that would be the equivalent of 39,000 new people enrolling every day nationally during the off season, which I find very hard to believe (based on 2014 and 2015, the national off-season number is likely to be more like 7,000 per day).

In response to much hand-wringing and complaints from various insurance carriers, CMS recently announced that they'd be cracking down on off-season Special Enrollment Periods, eliminating some of them while putting tighter restrictions on the rest. However, that only applies to HealthCare.Gov, not the state-based exchanges. I have no idea what sort of rules/restrictions Rhode Island has in place for their off-season SEPs, but they seem to be still adding people at around 5.5x the national off-season average.

Whether this is a good or bad thing remains to be seen, but it's worth noting that RI's average rates only went up 4.5% in 2015 and only 6.5% more for 2016, well below the national average for both years...so perhaps the off-season SEP "gaming" issue isn't quite the problem some are making it out to be after all?

Also noteworthy:

  • A 93.5% payment rate, which is excellent.
  • Only 345 of the 385 are new enrollees...which means that 40 people in Rhode Island were already enrolled in 2015 exchange policies right up through the end of December, yet managed to find an excuse to re-eroll last week. Huh.

SHOP ENROLLMENT • As of February 13, 2016:

  • Small employer accounts created: 2,243
  • Small employer applications completed: 803
  • Small employer enrollment (paid): 553
  • These employers represent 4,029 covered lives
  • 86% of small employers are enrolled in the Full Choice Model.
  • 93% SHOP renewal rate (2016 to date).