Charles Gaba's blog

Not much of an update, but good to see a hard number officially posted at AccessHealthCT (I assume they'll be updating this regularly from the looks of it):

 

via the Maryland Health Connection:

MARYLAND ACA EXCHANGE ENROLLMENTS AS OF 11/17/17:

  • Total Enrollments (active renewal, passive renewal, new): 130,556 (up 3% vs. last year)
  • Active Enrollments (renewals + new): 29,478 (up 98% over last year)
  • New Enrollments: 10,900 (up 10% over last year)
  • Applications: 275,790 (up 13% over last year)
  • Mobile App Visitors: 74,744 (up 110% over last year)

OK, the MD exchange breaks out their numbers slightly differently than I do, but they've provided the numbers necessary to reformat. Like a few other states, they're "front-loading" their auto-renewals, giving the following:

  • 18,578 Active Renewals
  • 101,078 Auto-Renewals
  • 10,900 NEW Enrollees
  • 130,556 TOTAL Enrollments

For clarification: When the MD exchange says that 130,556 is "3% higher than last year", they're talking about at this point in time. Subtract 3% and you get roughly 126.7K as of 11/17/16. Maryland's total enrollment by the end of the 2017 Open Enrollment Period was 157,832.

Remember this from a few weeks back?

Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November

An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshedeven though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.

There's been a lot of buzz the past couple of days over this analysis of the impact of repealing the ACA's individual mandate from Standard & Poors, which is significantly different from the Congressional Budget Office's projections:

Repeal Of The Health Insurance Mandate Won't Save As Much As Expected, Says Report

CENTENNIAL (S&P Global Ratings) Nov. 16, 2017--As the tax-reform debate heats up, the U.S. Senate tax bill may include a provision to repeal the individual mandate penalty. Repealing the penalty associated with the individual mandate will increase the uninsured rate. Subsequently, it will reduce government expenditure because there will be less federal funding needed for health insurance costs. However, the change won't be as financially meaningful as some expect, said a report released by S&P Global Ratings today titled, "U.S. Tax Reform: Repeal Of The Health Insurance Mandate Will Save Less Than Expected, And Will Not Support The Current Insurance Market."

A few days ago I noted that I had seriously misunderstood the Congressional Budget Office's individual market premium projections in the event the ACA's individual mandate is repealed: Yes, it'd be ugly, but not nearly as bad as I thought, although they still expect up to 13 million people to lose coverage as a result.

Yesterday, the Center for American Progress did an analysis which broke out those 13 million by state...along with the impact on individual market premiums and the 25 billion in immediate Medicare cuts which the GOP's tax bill would implement.

While I have my own doubts about some of the CBO's assumptions, there can be no doubt that premiums would increase substantailly, millions of people would end up without healthcare coverage, and the $25 billion in Medicare cuts do appear to be locked in if the GOP's bill were to become law:

I know there’s a lot going on in The Graph (see below), so lemme break it down:

  • The pale blue lines show the enrollment trend for the 2016 ACA Open Enrollment Period via the 38 HealthCare.Gov states (the lower line) and all 50 states + DC (the higher line). This was the all-time record for the ACA: 9.7 million via HC.gov, 12.7 million nationally.
  • The pale red lines show the enrollment trend for the 2017 Open Enrollment Period via 39 HC.gov states & all 50 +DC (Kentucky moved from their own exchange to the federal exchange last year). This was down a bit from 2016: 9.2 million / 12.2 million.
  • The dotted black lines are my “official” projections for the 2018 Open Enrollment Period: 7.5 million and 10.0 million respectively, both way down from both of the prior years.
  • The filled-in green/blue sections are the actual, confirmed 2018 enrollment numbers to date. Note that there are still enrollments missing: HC.gov only runs through 11/11, while other states range from no data at all all the way through 11/15. I’ve confirmed 1.71M to date, but suspect the total is actually closer to 3.0 million as of today.
  • The little blue dots are my current projections through this Saturday the 18th: 2.3M and 4.0M respectively.

Connect for Health Colorado® Reports Increase in 2018 Medical Plan Selections

DENVER — Between Nov.1 and Nov. 15, more than 22,000 Coloradans selected health coverage for 2018 through the state health insurance Marketplace, according to new data released today by Connect for Health Colorado®.

“I am glad to see the number of initial sign-ups during the first two weeks of Open Enrollment,” said Connect for Health Colorado® CEO Kevin Patterson.  “There has been some confusion about healthcare coverage this year. I want everyone to know that the financial help to buy health insurance is still available for next year. I urge everybody buying their own health insurance to take a minute on our site, ConnectforhealthCO.com, to check to see if they qualify and then review their options and complete their enrollment before the last-minute rush.”

Covered California’s Open-Enrollment Period off to a Solid Start

  • More than 48,000 new consumers selected a plan during the first two weeks of open enrollment, which is slightly ahead of last year’s pace.
  • New subsidized enrollees are using increased tax credit money to purchase coverage that is more comprehensive.
  • The majority of consumers signing up will be able to pay lower prices in 2018 than they would have for the same plans last year.

SACRAMENTO, Calif. — Covered California issued its first enrollment snapshot for the first two weeks of the current open-enrollment period. From Nov. 1 through Nov. 14, more than 48,000 new consumers signed up for coverage through Covered California, which is slightly ahead of last year’s pace when more than 39,000 consumers selected a plan during the first two weeks of November 2016.

No precise numbers yet, but this tweet from Access Health CT gives the key numbers:

To date, over 17K CT residents have enrolled in a plan for 2018 - with 6K new to #AHCT. #shopshopshop #AHCTBoDMeeting #GetCoveredCT

— Access Health CT (@AccessHealthCT) November 16, 2017

Assuming "to date" includes yesterday (11/15), this gives us a perfect year over year comparison; last year AccessHealthCT had 16,085 people enroll in Qualified Health Plans in the first 15 days (9,455 renewals + 6,630 new), so they appear to be up about 6% year over year so far.

Now that we have a couple of weeks worth of hard enrollment data under our belt, it's time to start trying to break the numbers out by state and category (that is, Active Renewals, Auto-Renewals and most importantly new Enrollees). This is trickier than it sounds for several reasons:

  • HealthCare.Gov hasn't started breaking out their numbers across the 39 states which utilize their platform yet. For them, I had to base my estimates on what portion of the 39-state total each state had in the first 12 days last year (via CMS's Public Use File). I'm assuming the ratios within HC.gov are roughly the same this year.
  • Five of the state-based exchanges haven't released any enrollment data yet (CO, DC, ID, NY and VT)
  • The other seven state-based exchanges have released some hard data, but none of their thru-dates match up with the federal exchange (11/11).
  • Even then, some state exchanges have only released the number of new enrollees, not renewals (CA, WA and--I think--MD), while others have already baked in passive/auto-renewals (MN, RI), which means their renewal numbers may actually decrease over time as some who were auto-renewed already change their minds.
  • In addition, in those states which included auto-renewals (MN, RI), I don't know the breakout between active and passive renewal, so I had to take a guess.

With all that in mind, here's where things stand to the best of my calculations. Again, while the subsets within each category are estimates, the totals include confirmed QHP selections only. I suspect the actual total to date is well over 3 million as of 11/15/17:

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