Massachusetts

Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has ten different carriers participating in the individual market. MA (along with Vermont and the District of Columbia) has merged their Individual and Small Group risk pools for premium setting purposes, so I'm not bothering breaking out the small group market in this case.

Getting a weighted average was a bit tricky. On the one hand, only one or two of the rate filings included actual enrollment data. On the other hand, the Massachusetts Health Connector puts out monthly enrollment reports which do break out the on-exchange numbers by carrier. This allowed me to run a rough breakout of on-exchange MA enrollment. I don't know whether the off-exchange portion has a similar ratio, but I have to assume it does for the moment.

This press release is mostly of interest because it came from the Governor's office, not the MA Health Connector itself:

Baker-Polito Administration Announces Health Connector Completes Successful Open Enrollment with Highest-Ever Membership, Covering 282,000 People with Health Insurance

Governor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.

Heh. "13-year history" took a moment to register...but of course Massachusetts has had a health insurance exchange website since 2006, when "RomneyCare" went into effect.

via Covered California:

New Analysis Finds Leading State-Based Marketplaces Have Performed Well, and Highlights the Impact of the Federal Mandate Penalty Removal

  • The report examines the impact that federal and state actions have had on state-based marketplaces and the federally facilitated marketplace (FFM).
  • Cumulative premium increases in California, Massachusetts and Washington are less than half of the increases seen in FFM states, but 2019 premium increases spiked in California and Washington compared to Massachusetts, which continued its state-based penalty.

WASHINGTON D.C. — A new report highlights the benefits of state-based exchanges, particularly in the areas of controlling premium costs and attracting new enrollment. The report, which was produced by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange, found that premiums in these states were less than half of what consumers saw in the 39 states that relied on the federally facilitated marketplace (FFM) between 2014 and 2019.

So, a couple of hours ago, CMS Administrator Seema Verma tweeted out the following:

.@coveredca blames subpar enrollment on no federal mandate penalty, but NJ kept penalty and saw much, much bigger drop. Forcing Americans to buy insurance they can’t afford isn’t the answer.

— Administrator Seema Verma (@SeemaCMS) January 31, 2019

Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.

This is a very quick post as I’m in the middle of the Families USA healthcare conference, but it’s a significant one: The Massachusetts Health Connector, which wrapped up their 2019 ACA Open Enrollment Period last night, just reported the following:

Here is an update as of today, with Open Enrollment having ended last night.

Note: These numbers below should be considered something of a high-water mark. There will be fluctuations as plan-selecteds lose their window, members terminate, but also some applicants end up enrolling in March coverage.

Total enrollments (Including all January, February and March enrollments to date): 292,006

Plan selected/unenrolled: 8,079

2019 enrollment as defined by CMS: 300,085

Our new enrollment (people who did not have Health Connector coverage as of Nov. 1) is 60,361. This is a 23 percent increase from last year’s 49,034 at the same point in time.

Our retention rate is currently 89.7 percent, up about 2.6 percent from last year.

Holy smokes.

I've noted several times before that the Massachusetts Health Connector (MA's ACA exchange) is one of only a handful of states which has managed to break their Open Enrollment record for five straight years:

  • 2014: 31,695 (major technical problems)
  • 2015: 140,540 (complete platform overhaul)
  • 2016: 213,883
  • 2017: 266,664
  • 2018: 267,260
  • 2019: 284,969 and counting...

What's most remarkable about the current total is that the 2019 Open Enrollment Period hasn't ended yet in Massachusetts. Residents still have until midnight Wednesday, January 23rd to enroll.

Oh, yeah...and don't forget: Unlike most states, Massachusetts still has a healthcare coverage mandate law which imposes a financial penalty on MA residents who don't have adequate healthcare coverage (unless they qualify for a hardship or other special exemption):

This just in from the MA Health Connector:

Update from us, as of last Friday:

  • 277,029 paid enrollments
  • 7,615 plans selected/unpaid
  • 284,969 total, per CMS enrollment definition
  • We have 47,573 new enrollees.

Once again: Massachusetts has managed to outperform their ACA enrollment numbers every year for five years running:

  • 2014: 31,695 (major technical problems)
  • 2015: 140,540 (complete platform overhaul)
  • 2016: 213,883
  • 2017: 266,664
  • 2018: 267,260
  • 2019: 284,969 and counting...

Just as impressive, if not more so: 97.2% of Massachusetts ACA enrollees have already paid their first monthly premium, which is well above the ~90% national average.

So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

  • In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

ALSO...

Yeesh...when it rains, it pours! Right on top of updated and/or final 2019 Open Enrollment numbers 41 states (Idaho, Rhode Island and the 39 states hosted by HealthCare.Gov) comes yet another updated tally from Massachusetts:

As of today:

  • 274,317 enrollments for January
  • 2,997 enrollments for February or March
  • 3,763 plans selected (1st premium not paid but not due yet)
  • 281,077 total

Retention rate is 91 percent, up 2.6 percent from last year.

The total is only 252 higher than their last update as of December 17th, but that's not surprising considering that we had both Christmas and New Year's in between. Again, MA has managed to improve their enrollment number every year for 5 years straight, an impressive feat indeed!

Again, Massachusetts' total from last year was 267,260 QHP selections, which means they're now 5.2% ahead of last year's final number...with 3 weeks left to go!

 

Massachusetts, home of the predecessor of Obamacare (Mitt Romney and other Republicans hate being reminded of this) doesn't reach their December deadline for January ACA coverage until Sunday, December 23rd.

As of today:

We have 262,459 enrollments for January 2019, compared to 238,631 as of a year ago.

For your CMS-definition math, we have an additional 18,345 plan selections, plus 21 effectuations for February and March, for a grand total of 280,825.

Holy smokes. Not only is the Bay State running a full 10% ahead of last year's paid effectuations as of the same point in time, when you include plan selections (which, for good or for bad, is the way that every other state's enrollments are officially counted during the Open Enrollment Period), they're already 5.1% ahead of last year's final tally.

I just received another official update from the MA Health Connector...

On enrollment, as of today, we have 261,619 enrolled members for January. We have an additional 14,368 plan selections made (but unpaid) for a total of 275,994 under the CMS definitions. New enrollments for 2019 continue to trend slightly ahead of last year.

A week or so ago I noted that Massachusetts had enrolled just over 264,000 people (10,000 of whom hadn't actually paid their January premium yet...MA's exchange is one of the only states which is able to actually track payment data live, since they handle it themselves). They were up 10K over the same date in 2017, or up around 4% year over year.

I don't have a hard "thru 12/05" number for 2017 this week, but they did confirm the 276K number is still "slightly ahead", which is good.

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

I just received an official 2019 ACA Open Enrollment Period report from the Massachusetts Health Connector...

As of today, we have 254,177 enrolled for January 1. That is up about 10,000 from last year's 244,308 at the same date. When you include people with plans selected but not paid, we are at 264,118.

The high number is again explained by the fact that Massachusetts, like several other state-based exchanges, front-loads their auto-renewals. 254K / 244K = around a 4% increase year over year, which is solid and right in line with other state-based exchanges to date...while the federal exchange (HC.gov) continues to lag around 11% behind last year. On the other hand, HC.gov doesn't front-load auto-renewals, so it's a bit of an apples to oranges comparison.

As I just noted earlier this afternoon, Massachusetts is NOT expecting the repeal of the ACA's individual mandate to impact their 2019 individual market enrollment or premiums for a simple reason: The Bay State never formally repealed their own, pre-ACA mandate penalty. They basically mothballed it once the ACA's version went into effect, and are simply dusting it off for 2019 and beyond now that the federal mandate has been formally repealed.

However, the two mandate penalties don't work quite the same way. For the federal mandate, unless you qualify for an exemption (and there's a whole bunch of those), the penalty for not having ACA-compliant healthcare coverage is (or has been up until now) as follows:

This Just In...

Ready for Open Enrollment, Health Connector sets 2019 plans with lower premium increases, selects community organizations to provide in-person support to residents

Boston – September 13, 2018 – The Massachusetts Health Connector Board of Directors today approved 57 Qualified Health Plans from nine carriers for individuals and families, with new plan designs that create better value for members and premium increases that average under 5 percent from 2018.

Unfortunately, the press release doesn't specify what "under 5%" means, nor does it break that out by carrier/market share. I've put in a request for those details and will update this as soon as I hear back from them. They sent me the following chart, but this only includes enrollees earning between 300-400% of the Federal Poverty Level, which means the marketshare across the entire individual market is likely somewhat different. I'm assuming the 4.4% overall average applies to the entire market but could be wrong about that as well:

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