Massachusetts

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

As I've noted the past few months, unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fullly Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day. Presumably they didn't have 17,000 people enroll in a mad rush on February 1st, so there's an odd discrepancy here, but whatever.

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.

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:

I noted last month that the Massachusetts Health Connector had increased their effectuated QHP enrollee total by around 12,000 people in the first month of the off season, which goes against the expected net attition expected once Open Enrollment ends.

However, I also noted that MA is unusual in that most of their exchange QHPs are in the form of "ConnectorCare" plans, which are availble for enrollment year round, just like Medicaid and SHOP enrollment. As a result, this increase, while legitimate, can not be used to extrapolate anything nationally.

The Massachusetts ACA exchange reported exactly 196,554 QHP selections (including the still-qualifying "ConnectorCare" plans) as of January 31st, the final day of the 2016 Open Enrollment Period.

They just held their March board meeting, which always include highly detailed powerpoint charts & graphs running through the end of the prior month...so here's where things stand after the first month of the off season. The main number: The official effectuated enrollment number is up to 208,374 (remember, Massachusetts doesn't even report QHP enrollees until they've actually paid their premium. It'd be awesome if every other exchange was able to do so as well, as that would finally kill off the "But how many have PAID??" talking point once and for all.

Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.

And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.

In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.

As of this morning, there were still 4 states with some 2016 Open Enrollment data missing: Idaho, Massachusetts, New York and Vermont. The Massachusetts exchange board held their monthly meeting today, so I can cross one more state off the list:

By early February, approximately 201,000 individuals were enrolled in 2016 health coverage.

  • Over 36,000 new members are enrolled in QHPs. For a frame of reference, our new members amount to about 15% of the size of last year’s estimated uninsured population*
    • Of the approximately 27,000 new members who indicated a race or ethnicity in their application, about 12% are of Hispanic, Latino or Spanish origin, 8% are African American and 4% are Chinese
  • We continue to see a high retention rate for our 2015 membership at about 94%
  • Individuals who selected a plan between January 24th and January 31st still have time to pay for coverage effective March 1, so new membership tied to Open Enrollment may continue to grow

(sigh) After the huge "live purge" piece I just posted, I really didn't need this addtional confusion...

With 17 days left of #OpenEnrollment:~189k individuals are enrolled in 2016 health coverage; including ~28k new members. #OE3

— MA Health Connector (@HealthConnector) January 14, 2016

That's an excellent number, and it's actually around 9,000 higher than the last formal update from the MA exchange...

...Unfortunately, it's also 7,600 lower than the 196,647 figure reported in the official federal ASPE report as of 12/28.

In 2014, Massachusetts' ACA exchange website was one of the biggest disasters of the site rollouts, managing to enroll fewer than 32,000 people while flushing tens of millions of dollars down the drain. The biggest problem was that the system couldn't accurately determine whether enrollees were eligibile for federal tax credits or not...which was kind of important since around 85% of enrollees nationally qualify for them.

This was especially embarrassing given that not only is Massachusetts considered a major technology base (hey, it's right there in the name: Massachusetts Institute of Technology...), it was also, of course, the home of the precursor to the Affordable Care Act, aka "RomneyCare". You can read the entire ugly story in vivid detail thanks to Ed Lyon's amasingly detailed Health Connector Autopsy Report.

Massachusetts' #OE3 enrollment numbers have to be handled a little carefully. Unlike most exchanges which mainly report the number of Qualified Health Plan (QHP) selections (ie, placed in cart & checked out), the Massachusetts Health Connector is very careful to specify how many of those are actually entered into the system and have paid their first monthly premium.

With that in mind, their first 2016 Open Enrollment update report states the following:

In the first week of Open Enrollment (November 1st through 7th)*, new member activity in the system included:

When I updated my #OE3 state-level enrollment projections yesterday, I came across this official projection for #OE3 from Your Health Idaho's Sept. 18th board meeting minutes:

Rep. Rusche asked what our target enrollment is for this cycle and what barriers we see in making those targets. Mr. Kelly said the team is focused on the 80% goal of 92,000 as our enrollment target.Premium increases are a potential barrier. Net premium is a relatively small increase for most consumers, and each consumer will experience something different depending Page 5 of 14 on their plan, their location, their carrier, etc. We feel that while the premiums are increasing the relatively small net premium increase will mitigate this barrier to a large degree.

When I asked for clarification, they informed me that:

We currently have 86,659 effectuated enrollments with Your Health Idaho, as of September 15. The 92,000 would also refer to effectuated enrollments.

The Massachusetts Health Connector held their monthly board meeting last week and have released their September dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.

I've pasted screen shots of every page of the report below, but here's the main takeaways:

  • Effectuated QHPs have reached 179,470 enrollees...a whopping 38.930 higher (28%) than at the end of Open Enrollment.

While the national effectuation number is likely around 3% lower today than it was in March (9.9 million vs. 10.2 million), in Massachusetts it's 45% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.

  • In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 17,246 people drop their QHP policies, meaning a total of 196,716 people have selected a plan and paid at least their first monthly premium.
  • Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 218,000 people to date, which is only significant to me and The Graph.

But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,562 lives covered as of October 1st) and even Dental Plans!

Data nerds, go nuts!!

The Massachusetts Health Connector just held their monthly board meeting this morning, and have released the August dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.

I've pasted screen shots of every page of the report below, but here's the main takeaways:

  • Effectuated QHPs have reached 175,605 enrollees...a whopping 35,065 higher (25%) than at the end of Open Enrollment.

While the national effectuation number is 2.3% lower or so today than it was in March (9.95 million vs. 10.19 million), in Massachusetts it's 42% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.

  • In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 16,874 people drop their QHP policies, meaning a total of 192,479 people have selected a plan and paid at least their first monthly premium.
  • Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 213,000 people to date, which is only significant to me and The Graph.

But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,486 lives covered as of September 1st) and even Dental Plans!

Data nerds, go nuts!!

For Massachusetts, I'm not bothering with an actual spreadsheet, as this Boston Globe article has summed up the key numbers:

The new rates will affect about 300,000 people who buy health insurance on their own or work for small businesses with 50 or fewer employees and will renew plans in January.

...The rate hikes approved by the state mean that premiums for individuals and small businesses will rise 6.3 percent next year, on average, but the costs for some plans will rise more, and others less. This year, rates for individuals and small employers rose an average of 3.1 percent in January, after increasing 1.9 percent in 2014.

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