UPDATE: Vermont: Final OE5 Enrollment Total: 27,223 QHPs (w/important clarifiers)

2018 MIDTERM ELECTION

Time: D H M S

A huge shout-out to Ken Kelly for calling my attention to this press release which was apparently sent out way back on December 19th???

Vermont wraps up 2018 open enrollment for Vermont Health Connect

News Release — Department of Vermont Health Access
Dec. 19, 2017

Vermonters who Didn’t Complete Plan Selection Urged to Call this Week

WATERBURY, VT – State officials reported that nearly 23,000 Vermonters had confirmed a 2018 health plan and qualified for financial help to make the plan more affordable. Total enrollment in qualified health plans, which typically includes 46,000 small business employees and 11,000 individuals who don’t qualify for financial help, is expected to surpass 80,000. While enrollment will be similar to past years, this year’s earlier deadline means fewer members will experience gaps in coverage. In past years, nearly 2,000 members missed out on January coverage.

This is exasperating me for several reasons. First of all, I reload the VT Health Connect press release/enrollment update website every single day, yet the most recent update is from November 30th. This press release has never been added to it. I'm amazed that this is the first time anyone's given me a heads up about this press release (nearly 6 weeks later!).

In any event, there's no exact number provided, just "nearly 23,000" receiving APTC subsidies and "11,000" enrolling in individual market policies without subsidies, for a total of around 34,000 people. This compares nicely with the 29,440 who selected QHPs through the VT exchange in OE3 and 30,682 who did so in OE4. and if 34,000 is indeed the correct number, that'd put Vermont ahead of Kentucky in terms of their percentage increase over last year (up 10.8%).

HOWEVER, there's one potential caveat to this: Judging by the rest of the press release, it's possible that at least some of those 11,000 unsubsidized enrollees may have technically enrolled off-exchange. Vermont required all individual market enrollees to utilize their exchange for the first two years of Open Enrollment, but in 2016 they reversed that decision and started allowing off-exchange enrollments after all. The vast majority of ACA-compliant enrollees are still doing so via the exchange (86% in 2016), but the fuzzy wording here makes it difficult to know what the official "exchange-based" enrollment number reported by CMS will end up being. It's possible that, say, 4,000 of the 34K are off-exchange, which would bring Vermont's exchange tally in slightly lower than last year:

...“We came into this fall with three enrollment goals,” said Cory Gustafson, Commissioner of Department of Vermont Health Access. “First, we wanted as many Vermonters as possible to sign up for January coverage and the financial help to make it more affordable. Second, we wanted to encourage members who don’t qualify for financial help to sign up directly with their carrier and establish a single point of contact for managing their account. Third, we wanted everyone to do their homework and make sure they’re in the best plan for their needs and budget.”

Still, given the near-radio silence out of Vermont on this, until I hear otherwise, this is the best I can do: 34,000 2018 exchange-based QHP selections for the individual market. Of course, from an actuarial perspective, it doesn't really matter if they're on or off-exchange since all 34K are part of the same risk pool, but it's still important to know for marketing/PR purposes and to avoid confusion.

ASSUMING the 34K figure does indeed include on-exchange enrollees only, this makes Vermont the 17th state to EXCEED last year's numbers...and the 12th State-based exchange to do so (when you include FF-SBMs).

UPDATE: Thanks to Louise Norris for clearing this up for me; it turns out that I was correct to be suspicious of the number being on-exchange only:

I checked w/ @VTHealthConnect today about the numbers. Of those who are paying full price, 4,300 are on-exchange, and 6,900 are direct enrollments https://t.co/2cnAFwsS5a
Total pretty similar to last year & they're been pushing direct enrollment for non-subsidy-eligible enrollees

— Louise Norris (@LouiseNorris) January 30, 2018

The exact numbers, according to Norris:

Open enrollment for 2018 coverage in Vermont ended on December 15, 2017, lasting only half as long as open enrollment for previous years. A few days later, Vermont Health Connect reported that total enrollment in individual market qualified health plans for 2018 stood at about 34,000, with 23,000 people receiving premium subsidies, and 11,000 paying full price.

But those 11,000 people paying full price include on and off-exchange enrollees. Vermont used to require all individual market plans to be sold only through Vermont Health Connect, but they relaxed those rules in 2016, allowing direct-to-carrier enrollments for people who aren’t eligible for premium subsidies (there are more details below about how this works). Vermont Health Connect confirmed that effectuated enrollment as of late January 2018 stood at:

  • 22,923 people receiving premium subsidies
  • roughly 4,300 people paying full price on-exchange
  • roughly 6,900 people paying full price off-exchange (full-cost individual direct enrollment).

So enrollment in private plans through Vermont Health Connect for 2018 stood at roughly 27,223 as of January 2018, and an additional 6,900 people had full-cost individual direct enrollment coverage.

As of February 2017, enrollment in on-exchange plans stood at 28,775, in addition to 5,662 people enrolled in full-cost direct enrollment through the state’s two insurers. As noted above, Vermont Health Connect has been encouraging people who aren’t eligible for premium subsidies to use the full-cost direct enrollment pathway. So while enrollment in the exchange is slightly lower in 2018 than it was in 2017, enrollment in full-cost direct enrollment plans has grown. The result is that total enrollment in qualified health plans is very similar to where it was in 2017, despite the shorter enrollment period.

Put another way, Vermont's total ACA-compliant market is 34,123 at the moment vs. 34,437...1% shy of last year.

There's one more twist which makes reporting the "official" 2018 enrollment number even trickier: Norris states that the 27,223 on-exchange figure is effectuated enrollments only, not total QHP selections. Yes, ideally only effectuated enrollment numbers should be reported, but that doesn't change the fact that this is an apples to oranges comparison: The "official" number from last year was 30,682 QHP selections as of the end of January...which presumably was whittled down to 28,775 by the end of the month due to non-payments (about 7% net attrition). Assuming a similar ratio this year, that suggests that the actual number of QHP selections as of 12/15 was around 29,300.

So, which number should I plug in? Well, for the moment I'll stick with 27,223, which is only a few hundred higher than what they reported as of 12/02. This means that for the time being, at least, Vermont will appear to be down around 11.3% year over year...moving up just one notch from where it already was relative to last year's total. However, since Vermont has been actively pushing unsubsidized enrollees to go off-exchange, it's a special case; if you go with the larger number, they're only down 1% year over year. I'll have to include a special note explaining the confusion.