Maryland

2018 MIDTERM ELECTION

Time: D H M S

Interesting. When I last checked in on the Maryland exchange, their effectuated QHP enrollment was down about 14% since the end of open enrollment (from 162,177 QHP selections to 139,379 effectuated enrllees as of the end of April).

However, they just posted the following market share breakdown, which shows that they currently have 148,403 Marylanders enrolled in exchange policies, a net drop of just 8.5%. Apparently they've added more people during the off season via SEPs than they've lost due to attrition since April.

Last year, Maryland's individual market saw rate hike requests average roughly 20% overall. For 2017, it doesn't look quite as bad on a percentage basis (although obviously the actual dollar increase is still on top of last year's):

Health insurers seek rate increases in Maryland as United Healthcare quits market

...United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.

Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market.

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

Maryland's ACA exchange saw a dramatic 35% year over year enrollment increase during the 2016 Open Enrollment Period, totalling 162,177 QHP selections.

I was just informed by the MD Health Benefit Exchange that as of April, their effectuated individual enrollments are down to 139,379 people. That's a drop of just over 14%. This is completely in line with my numbers for 8 other states.

A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.

In the past few days, this has become increasingly clear, as Centene's news from yesterday shows.

As Kevin Drum at Mother Jones notes (quoting Richard Mayhew of Balloon Juice):

As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.

In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.

Investor's Business Daily's Jed Graham picked up on some of my work for his post today, including the enrollment data for both Minnesota and Connecticut...but in addition to that extra data point (which I'll come back to in a moment), he also nabbed the latest number out of a third state, Oklahoma, from one of Adam Cancryn's updates on what I'm calling the UnitedHealthcare Disenrollment Odometer:

A couple of weeks ago, the Maryland ACA exchange provided me with their semi-official OE3 enrollment tally:

As of 2/1, total QHPs are 165,123 (49,377 new + 115,746 renewal-active and passive).

However, this number didn't include a few "overtime" days of enrollees, which padded the number a bit more...nor did it include the subtraction of unpaid QHP enrollees (ie, cancellations/purging of enrollees who didn't pay their January premiums in time, were transferred to Medicaid due to income changes and so forth).

A few days ago they issued a formal press release with the official final tally, which is, as expected, slightly lower than 165K...but not by much:

MORE THAN 162,000 MARYLANDERS ENROLLED IN HEALTH COVERAGE FOR 2016 THROUGH THE STATE MARKETPLACE

AMONG FASTEST GROWTH RATES IN U.S. SINCE 2015

I just received an update out of the Maryland Health Connection:

As of 2/1, total QHPs are 165,123 (49,377 new + 115,746 renewal-active and passive).

It's important to note that Maryland is still taking OE3 enrollees through Friday via their "In Line by Midnight" extension due to the lingering impact of the snowstorm a couple of weeks back, so MD's final official number will actually be slightly higher than this.

Even without the stragglers, however, Maryland kicked butt again this year, enrolling over 10% more people than the 150K that both they and I were expecting (and even more than my preliminary projection of 163K)...and a whopping 37% higher than 2015's total.

Hmmm...this was unexpected:

ALERT! If you started enrolling by 1/31 deadline but unable to finish due to recent snowstorm, you may finish by 2/5 pic.twitter.com/U9X3QhTIT9

— MD Health Connection (@MarylandConnect) January 29, 2016

I'm surprised by this for several reasons. The snowstorm was nearly a week ago, and there's still 3 days left for people to enroll as it is; are there still a lot of areas of Maryland coping with power outages/other disruptions which are making it unreasonable to expect people to get in under the wire?

Second, because CMS just stated pretty unequivocally that HealthCare.Gov will not be offering any official deadline extension (although, like the MD exchange, they did say that they'll have an "in line by midnight" exception). I assumed that if HC.gov was taking a "hard line stance" that the state exchanges would as well.

Maryland already exceeded my (and their) OE3 target of 150K QHPs a few weeks ago, so anything more is just gravy, but every bit helps counter the shortages I'm seeing in other states. Last week they reported 155,701 QHP selections as of 1/20/16.

Just now, they confirmed the latest numbers ahead of Sunday's final deadline:

As of 1/26, 156,695 QHP / 304,667 Medicaid / 25,784 Dental.

I've never really tracked dental plans, and I'll be writing about the latest Medicaid numbers later, but that's 156,695 QHPs as of 1/26, or 994 more in the past 6 days, or 166 per day.

This is actually a slowdown from MD's average from 12/28 - 1/20, when they reported a net gain of 5,408 over 23 days (235 per day). On the other hand, given how much Maryland has been kicking butt this year, perhaps they're just running out of people to, you know, enroll.

Anyway, MD is on track to add at least another 1,000, potentially up to 3,000 more for a final number close to 160K.

The final 2016 deadline to enroll in a qualifying healthcare plan for policies starting coverage as of March 1st officially ended as of MIDNIGHT on January 31st.

As usual however, there are a few caveats to this...but not as many as the past two years:

No official press release, but this was just posted on Twitter a few minutes ago:

We have 155,000 already enrolled this year, up 60% from last year! @MarylandConnect @BMore_Healthy @HCAMaryland pic.twitter.com/oyqtiA3ccW

— Leana Wen, M.D. (@DrLeanaWen) January 21, 2016

Maryland had previously reported just over 150,000 QHPs as of 12/28/15, so this sounds about right: Around 5,000 more people in the first 3 weeks of January, with 10 days left to go (I'm not sure what date the 155K figure is through, I'll assume that's as of last night). That's roughly 220 per day.

Assuming no final week surge of any sort, Maryland should add roughly 2,200 more people by the 31st, but I'm guessing it'll be closer to another 5K, for perhaps 160K in the end.

Back on December 17, I noted that the Maryland ACA exchange had managed (with the help of automatic renewals) to achieve just under 150,000 QHP selections as of 12/15...which happened to be both their and my projected target for the full 2016 Open Enrollment Period. This was excellent for two reasons: They had effectively hit the target (well, 149,765, anyway)...and had done so with nearly 7 weeks to go.

Today they've updated their numbers and the performance since 12/15 has been, well, quieter:

1) More than 382,000 Marylanders have gotten coverage since Open Enrollment started.

As of Dec. 28, 362,520 Marylanders enrolled in health coverage for 2016, including 71,055 Marylanders who chose a new Qualified Health Plan, and 79,238 people already enrolled who renewed their plan for next year. This also includes 212,227 Marylanders who enrolled in Medicaid coverage through the state marketplace since Nov. 1.

Wow!! Impressive!!

Enrollments thru 12/15: 28,270 new + 121,495 active & passive renewals = 149,765. + Medicaid since 11/1 = #QuarterMillionMarylanders Covered

— MD Health Connection (@MarylandConnect) December 17, 2015

As I noted last month, according to the Maryland Health Benefit Exchange's October board meeting slideshow, their official projection for OE3 QHP enrollment is...150,000 people.

In other words, like Massachusetts, Maryland has already hit the target for the 2016 Open Enrollment just halfway through the period. The difference is that Massachusetts never really issued their own formal target (well, OK, technically Maryland needs 235 more people...)

Sometime this week I'm expecting CMS to release a 2015 Q3 Effectuated QHP report showing how many people were still enrolled in (and paying for) ACA exchange policies as of September 30, 2015.

As you'll recall, for 2014 the flow was:

For 2015, the flow so far has been:

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