2018 MIDTERM ELECTION

Time: D H M S

Congrats, Trumpublicans: Your ACA sabotage efforts "worked" beautifully: HCgov peters out at 9.2 million.

Before the election, I was assuming the 2017 Open Enrollment Period would rack up between 13.5 - 14.0 million QHP selections...between 6% - 10% more than last year. The HHS Dept. agreed with me, projecting around 13.8 million (an 8.6% increase).

Last year the federal exchange included around 76% of the total enrollments (around 9.6 million). This year, HC.gov added Kentucky, which should have bumped the ratio up to around 77% this year. Assuming 13.8 million total, that would mean roughly 10.6 million enrolling via the federal exchange.

After Trump won and the GOP immediately started the actual legislative process to repeal the Affordable Care Act with preliminary votes in both the House and Senate, I downgraded my projections to around 13.3 million nationally (10.2 million via HC.gov).

Then, Donald Trump actually took office...and in a one-two punch, not only signed an executive order which specifically instructed the HHS Dept. to do everything in their power to sabotage the implementation of the ACA, but also attempted to pull the plug on the critical last-minute advertising blitz which is so vital to reminding procrastinators (particularly young ones...you know, the ones who help the risk pool?) to get off their duffs and actually sign up.

The good news is that they were only partially successful in their efforts: After a massive backlash, they supposedly decided to keep some of the outreach/marketing in place (automated email reminders and some of the TV ads), although it's more likely that these were already locked in anyway and couldn't be pulled so close to the finish line. The bad news is that they were still able to kill off millions of dollars worth of advertisements anyway.

As a result, I downgraded my final projection to a wide range: As low as 12.4 million, as high as perhaps 13.0 million nationally...with anywhere from 9.5 - 10.0 million of that coming via the federal exchange.

Well, it looks like even that was optimistic. CMS just released the final "snapshot" report, and it's not pretty:

Biweekly Enrollment Snapshot • WEEKS 12 through 14, JAN 15 – JAN 31, 2017

On January 31, 2017, Open Enrollment for 2017 coverage ended with more than 9.2 million plan selections in states that use the HealthCare.gov eligibility and enrollment platform. Those selections were made from a market that experienced a 25 percent increase over the previous year in the average premium for the benchmark second-lowest cost silver plan as well as a 28 percent decline in the number of issuers participating over the past year.[1]

You can tell that it's a Trumpster who wrote up the press release itself from the "25% hike / 28% decline" dig. This is also a good point to remind everyone that I simply cannot guarantee that any of the data from HHS going forward is accurate. I'll keep posting as if it is until further notice, but I'll be including disclaimers to that effect for any data which uses the HHS Dept. as it's source.

This Open Enrollment Snapshot covers the period from January 15, 2017 through January 31, 2017.

This snapshot does not include plan selections from State-based Marketplaces. CMS will release a detailed final enrollment report in March, including final plan selection data from State-based Marketplaces.

Of the more than 9.2 million consumers who selected a plan through the HealthCare.gov platform, about 3 million are new consumers, which means 33 percent of all plan selections were from new consumers. In addition to the approximately 3 million new HealthCare.gov consumers, about 6.2 million were returning Marketplace consumers.

This year’s plan selection totals take into account any consumer initiated or insurer initiated cancellations that occurred during Open Enrollment.

These snapshots provide point-in-time estimates of biweekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity during a reporting period may change as plan modifications or cancellations due to life changes like starting a new job or getting married occur. In addition, as in previous years, the biweekly snapshot does not report the number of consumers who have paid premiums to effectuate their enrollment.

A more detailed report that looks at plan selections across all states for the entire Open Enrollment period will be released in March.

Definitions and details on the data are included in the glossary.

Yep, 376,000 new QHP selections across 39 states. For comparison sake, last year's final week racked up 687,000 people.

Again, there's no way of proving the extent of the impact, but I'd be willing to bet that the final 2-week tally would have been at least 250K higher if the Trump administration hadn't done everything they could to suppress enrollments (I suppose actually taking the website offline might've been too obvious).

I'm actually being pretty conservative here; Joshua Peck, who was the chief marketing officer for HealthCare.Gov up until 2 weeks ago was far more pointed:

Ex-Obama official: Trump 'sabotage' slowed healthcare enrollment

A former Obama administration official estimates that nearly 500,000 people missed out on ObamaCare enrollment this year because of moves by the Trump administration.

Joshua Peck, former chief marketing officer for healthcare.gov, said "there should be no doubt" that the Trump administration's efforts to "sabotage" enrollment were successful.

"The Administration’s actions may have blocked nearly half a million people from getting covered," Peck said.

"About 480,000 real people, with lives and families didn’t get health coverage."

He estimated the pulling the TV ads likely caused enrollment to drop by 350,000 people.

An executive order signed by President Trump related to ObamaCare could have discouraged another 130,000 people from signing up, he said.

Peck said he reached his estimate by looking at historical deadline performance and the measured impact of outreach so far this year.

In addition to HC.gov, final numbers have also been released from 3 of the 12 state-based exchanges (New York, Maryland and Washington State). Including today's HC.gov report, I've confirmed exactly 12,220,364 QHP selections across the 42 states which have reported in so far.

By comparison, officially, the final HC.gov number is "only" 4.4% lower than last year...but again, you have to take Kentucky into account; if you remove the 81,155 QHPs from KY, this year's total comes in at 9,120,650...5.2% lower.

For the record, Kentucky itself racked up 13.3% fewer enrollees than last year. I'm sure that had nothing whatsoever to do with Matt Bevin shutting down the highly-regarded perfectly-operating kynect exchange for no particular reason last winter.

The other 9 states haven't released their numbers yet (California and Colorado are still in the middle of their "overtime periods" and Minnesotans still have until Feb. 8th to sign up due to a unique Special Enrollment Period); my guess is that once they do, the grand total will increase by another 100K - 200K (Minnesota's final number could potentially be up to 100K higher than expected all by itself). My guess is that when the dust settles (including Minnesota's SEP), the final tally nationally will come in at around 12.3 - 12.4 million in the end.

There is one saving grace here: If you include the over 700K Basic Health Plan (BHP) enrollments from New York and Minnesota, the combined QHP + BHP tally will likely come in at around 13.0 - 13.1 million people, but each of those states run their own exchanges and marketing; neither would be impacted by the HC.gov advertising anyway.

And remember, it's not just that several hundred thousand fewer people enrolled due to the marketing campaign being crippled...it's also about who those lost enrollees were: 37% of those who sign up in the final week are the "Young Invincible" crowd (18-34 year olds) who help balance out the overall risk pool.

Last year, 18-34 year olds made up 26% of the exchange enrollees as of mid-December...but this increased to 28% when the final surge (which included 37% young adults) was added into the mix. This year, the mid-December mix was identical (26%)...but very likely won't have that 37% to bump it up. In risk pools, every percentage point of young, healthy enrollees counts for a lot.

(sigh) Anyway, here's the final state-by-state breakout of the 39 HC.gov states: