Charles Gaba's blog

UPDATE 3/16/21: Health Source Rhode Island just released their 2021 OEP report as well; they ended up down around 8% y/y. With that, I now have either the final official enrollment numbers or at least close approximations for all 50 states + DC. The table, graph and text below have been updated accordingly.

With New York State of Health releasing their 2021 Open Enrollment Report data (w/some caveats), I now have official (or semi-official) enrollment data for 49 states and the District of Columbia. The odd man out is Rhode Island...which also happens to be one of the smallest states with the smallest number of ACA enrollments; last year they enrolled around 34,600 people.

There's a few caveats:

  • New York's QHP tally included enrollments through 2/28; the official CMS report will likely cut them off as of 1/31.
  • The numbers for DC, Idaho, Rhode Island and Vermont are estimates...it's possible that the official numbers for each will be slightly lower.
  • Minnesota's total could be a few thousand lower than I have it listed below...there's always a difference of a few thousand between MNsure's reports and CMS's; I'm not sure why.

At the very worst, the official CMS 2021 OEP report will come in at something like 11.98 million or so.

UPDATE 3/16/21: With Rhode Island added, the semi-official tally comes in at just over 12.0 million (12,005,270 QHP selections total). Again, it could drop slightly below that if my estimates for a handful of states are off, but it should be damned close to it.

A picture is worth 1,000 words and all that.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle. For cases per capita, the most obvious point is that New York and New Jersey, which towered over every other state last spring, are now dwarfed by North & South Dakota, although things are pretty horrible nearly everywhere now.

1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.

1 out of every 9 residents of Utah, Iowa, Tennessee and Arizona have tested positive.

1 out of 10 in Oklahoma Arkansas, Nebraska, South Carolina, Alabama, Kansas, Mississippi, Indiana and Idaho.

1 out of 20 in every state except Washington, Oregon, Maine, Vermont and Hawaii.

HealthSource RI becomes the latest state-based exchange to jump onboard the August 15th train...

Governor McKee and HealthSource RI Announce New Enrollment Period Extended Through August 15

  • Historic level of financial assistance is now available through HealthSource RI.
  • New Enrollment Period has been extended through August 15, 2021, adding three months to the previous May 15, 2021 deadline.
  • Starting April 1, most HSRI customers will have a lower monthly bill.
  • Beginning in summer 2021, HSRI will make more financial assistance available to people who previously did not qualify to receive it based on their income.
  • Individuals and families who have received unemployment payments in 2021 will be newly eligible for additional financial help for this year or may qualify for health coverage at no cost.
  • Rhode Islanders should enroll in coverage as soon as possible to take full advantage of these new benefits. 
  • The deadline to enroll is August 15, 2021.

A few weeks ago, Pennie (Pennsylvania's ACA exchange), like several other state-based exchanges, put out a simple statement celebrating the passage of the American Rescue Plan (ARP) and the dramatic improvement in ACA affordability that it brings for the next two years. Like most of the other exchanges, Pennie's initial press release was pretty bare-bones, as the bill had just been signed into law and there were a ton of logistical details to be worked out.

Today, at their monthly board meeting, Pennie provided some further info on how they plan to proceed:

Pennie’s American Rescue Plan Policy Goals

  • Implement ARP provisions as soon as possible, and as broadly as possible, to maximize savings for Pennie customers
  • Automate these provisions, to the extent possible, to ensure that the benefits under the new law reach Pennie customers without requiring customer action
  • Ensure that customers who need to take an action are given specific instructions on what they need to do to maximize their benefits
  • Use this unique opportunity to connect more Pennsylvanians to comprehensive coverage and reduce the number of uninsured throughout the Commonwealth

Last week the Maryland Health Benefit Exchange issued a press release touting impressive enrollment numbers over the past year via their year-long COVID-19 Special Enrollment Period (SEP). The topline number was that they enrolled over 140,000 Maryland residents in either ACA exchange policies or Medicaid.

Since Medicaid enrollment is open year-round anyway, the number I'm obviously more interested in are the exchange plans, which most people can normally only enroll in during the official Open Enrollment Period each fall/winter. Since COVID has thrown that mostly into disarray, however, I've been keeping a close eye on SEP enrollment in 2020 and now in spring of 2021 as compared to the pre-COVID era, when the SEP rules were far more strictly adhered to.

The Kaiser Family Foundation has updated their ACA Exchange Subsidy Calculator tool, which lets you plug in your household information and calculate how much you're eligible for in subsidies, as well as telling you things like:

  • Your percent of the Federal Poverty Level (FPL)
  • The full-price benchmark Silver plan
  • Your net price for the benchmark Silver plan
  • The net price of theleast-expensive Bronze plan
  • The maximum you'd have to pay in out-of-pocket costs

It's been updated to reflect the newly-expanded & enhanced subsidies available under the American Rescue Plan for 2021 & 2022. The official ACA exchange websites will have this data available over the next few weeks depending on which state you live in (HealthCare.Gov is supposed to go live on April 1st; Covered California on April 12th; other states will vary):

via Connect for Health Colorado:

Connect for Health Colorado Extends Enrollment Period through at least August 15

DENVER — Yesterday afternoon, President Biden announced that the federal health insurance marketplace, HealthCare.gov, will extend the current enrollment period through August 15, 2021, to help as many people as possible get covered following the passage of the American Rescue Plan Act of 2021.

Connect for Heath Colorado® Chief Executive Officer, Kevin Patterson, released the following statement in response:

“We will follow the federal decision so that we can help as many Coloradans as possible get covered this year. Keeping our doors open through at least mid-August maximizes the number of people who can apply for financial help and enroll through our Marketplace, especially as our state recovers from the pandemic. We will share more details soon about how Coloradans who are newly eligible for benefits under the American Rescue Plan can get those additional savings.”

A lot has happened since I last ran some back-of-the-envelope math to get a feel for how many Americans are enrolling in ACA exchange policies durign the 2021 COVID Enrollment Period, which started in most states on February 15th.

At the time, HealthCare.Gov had reported 206,000 Qualified Health Plan (QHP) selections as of February 28th. I also had some partial COVID SEP data from a handful of the state-based ACA exchanges, as of various dates. I had 225,000 QHPs confirmed nationally.

At the time, I concluded that based on the enrollment pace of the first few weeks...

As noted above, Medicaid expansion states have only increased average SEP enrollment by around 2/3 as much as Non-expansion states. Since all 15 state-based exchanges have expanded Medicaid, this suggests that the 206K via HC.gov probably represents more like 80% of the total, meaning perhaps 258,000 nationally (~168,000 more than average).

 

A couple of weeks ago I went on a bit of a rant about some terribly irresponsible reporting about how much the American Rescue Plan is spending on subsidizing private health insurance and how many people that money is expected to provide insurance premium assistance for.

The bottom line is that a whole lot of people got both the numerator and denominator wrong: Instead of being ~$53 billion to cover ~1.3 million people (which would be an insane $40,000 per person for just six months), it's actually more like ~$61 billion to help cover ~18.6 million people (roughly $3,300 per person per year on average).

The main focus of the post was about how much/how many would be covered under COBRA (the Consolidated Omnibus Budet Reconciliation Act):

Thursday, March 18th:

Launching a new special-enrollment period – Covered California will open a new special-enrollment period – which will start on Monday, April 12 and run through the end of the year – to give uninsured and unsubsidized Californians time to sign up for coverage that starts as soon as May 1 and continue the outreach and enrollment effort to have marketing pay-off over time.

4:35pm this afternoon:

Today, President Biden announced that the Centers for Medicare & Medicaid Services (CMS) is extending access to the Special Enrollment Period (SEP) until August 15 – giving consumers additional time to take advantage of new savings through the American Rescue Plan. This action provides new and current enrollees an additional three months to enroll or re-evaluate their coverage needs with increased tax credits available to reduce premiums.

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