2018 MIDTERM ELECTION

Time: D H M S

Rhode Island ends OE4 w/29.4K QHPs (way down from 2016 w/reasons listed)

Oof. Regular readers know that I've compiled plenty of evidence showing that while the 39 states run through the federal exchange (HC.gov) showed a ~5% enrollment drop this year, the state exchanges have been showing an overall net increase of roughly 2% over 2016. Rhode Island, however, is the odd man out on this front, as shown in this email I just received (not up on their website yet):

Despite facing a unique set of challenges this open enrollment, 29,420 individuals selected 2017 coverage through HealthSource RI during open enrollment period (November 1, 2016 – January 31, 2017). As of January 31, 27,395 of those individuals paid, and are therefore confirmed, in 2017 coverage. We do anticipate these number will change as payments are made through the February 23 payment deadline and also as HealthSource RI remedies account issues incurred during the open enrollment period. It is difficult to point to one clear cause for this year-over-year drop in enrollment, but we believe several factors might have played a role:

1. System and service issues

Just before the start of open enrollment, Rhode Island launched a new integrated eligibility system to improve the way it delivers health and human services programs. In the long run, the new system will make it easier for Rhode Islanders to get the benefits they need, but in the short term, this new technology presented challenges. System issues have prevented customers from enrolling during the Open Enrollment period. HealthSource RI is continuing to help customers enroll if they experienced a technical or access issue due to this new system. It is expected that when those issues are resolved there will be a rise in HealthSource RI’s total enrollment numbers.

I admit that this blindsided me. I was under the impression that of the 12 remaining state exchange tech platforms, only Vermont was still experiencing significant technical problems; I had no idea that Rhode Island was as well. Huh.

UPDATE: I reveived the following clarification form the RI exchange:

HealthSource RI was impacted by a new system that the State of Rhode Island launched in September to support the way all health and human service benefits are offered to our residents. This includes services unrelated to HSRI such as SNAP and child care benefits offered from the state’s Department of Health and Human Services. The platform HSRI has been using since our 2013 launch is not the system causing issues/impacting enrollment.

In other words, the state exchange itself is fine, it was some unrelated system being used by the state's main HHS department. Fair enough; sorry about the confusion.

2. Lower than anticipated renewal rates due to changes in eligibility, customers moving to Medicaid and United leaving HSRI

UnitedHealthcare chose not to offer products through HealthSource RI this open enrollment. Since they did not offer 2017 coverage options, customers who had UnitedHealthcare in 2016 did not qualify to be automatically enrolled into coverage for 2017.  That meant that these customers had to actively return to HealthSource RI and enroll in 2017 coverage. This process might have prevented some UnitedHealthcare customers from re-enrolling in coverage through HealthSource RI due to the noted system issues.

On the one hand, UnitedHealthcare dropping out obviously had a negative impact. On the other hand, ironically, this weakens the other conventional wisdom theory (higher premiums = lower enrollment)...because Rhode Island actually had the lowest average rate hikes of any state in the country this year...a mere 1.3% on average. That's lower than the rate of inflation, for heaven's sake. There's still more going on in RI, however:

HealthSource RI helps all Rhode Islanders enroll in coverage, whether they qualify for coverage through Medicaid or commercial health insurance. HealthSource RI enrollment numbers have dropped in part as some customers qualified for Medicaid for 2017.  Medicaid recipients are still enrolled in coverage, but are not included in HealthSource RI’s enrollment numbers.

They don't specify just how many 2016 QHP enrollees changed status to qualify for Medicaid instead, but Rhode Island's population and enrollment numbers are so low to being with that even a shift of a few hundred makes a huge difference.

3. Lower Uninsured Rate

HealthSource RI has played a key role in decreasing the rate of uninsured Rhode Islanders. In 2016, only 4.2% of residents lacked health coverage. As the number of uninsured Rhode Islanders has gone down, so has the pool of potential customers for HealthSource RI. For this reason, we expected fewer new customers to enroll during open enrollment for 2017 than for 2016.