Minnesota

2018 MIDTERM ELECTION

Time: D H M S

Minnesota's "first-come-first-serve" enrollment cap system caused a massive surge in early QHP selections...so much so that they kicked things off by signing people up at a pace twelve times faster than last year in the first few days.

That pace has slowed down considerably since then, but they're still well ahead of last year. In the first 17 days of OE3, MNsure was enrolling 404 people per day. In the first 27 days of OE4, MNsure has enrolled 29,783 people...or 1,103 per day:

With more than four weeks of open enrollment in the books, more than 57 percent of Minnesotans enrolling in a private health insurance plan through MNsure are qualifying for financial help available only through the state-based health insurance marketplace. The average tax credit amount going to MNsure customers will be more than three times higher in 2017 than it was in 2016.

Minnesota continues to enroll people at a breakneck pace (fortunately, broken necks are covered by Obamacare). Things have slowed down somewhat from the first few days, but they're still signing people up at a rate 3.5x faster than they did last year's 404/day due mainly to their unique "enrollment cap" situation:

28,000 Minnesotans Enrolled in Individual Plans Through MNsure Since the Start of Open Enrollment
November 21, 2016

ST. PAUL, Minn.—Below is an update to MNsure's 2017 open enrollment period. Within the first three weeks of open enrollment, more than 28,000 Minnesotans have enrolled in health coverage.

Since the start of open enrollment, there have been:

A few days ago, I noted that MNsure had enrolled nearly 22,000 people in exchange policies in just 9 days, a rate 6x faster than last year.

Today, another update via Christopher Snowbeck of the StarTribune:

With 23,883 people signing up via MNsure for private coverage as of Nov. 13, the exchange is more than one-fourth of the way to its budget target of 83,000 enrollees at the beginning of next year.

That's 1,837 per day, vs. last year's 404 per day; while things are starting to slow down, they're still enrolling people at a rate 4.5x as fast for the moment. Again, this is mainly due to MNsure's unique first-come, first-serve enrollment cap on most of their carriers.

Some other tidbits:

Just yesterday I noted that Minnesota's ACA exchange is full bore ahead, especially due to their unique first-come, first-serve enrollment cap cut-off for 4 of the 5 individual market carriers. They're still moving at a breakneck pace:

From MNsure today:

ST. PAUL, Minn.—More Minnesotans have shopped early and enrolled in comprehensive health care coverage though MNsure than ever before. In just the first nine days, more than 20,000 Minnesotans enrolled through the state's health care exchange. It took about six weeks to achieve this milestone last year.

The results of this week's elections do not change MNsure's focus on providing high quality customer service to Minnesotans shopping for health care coverage and encouraging Minnesotans to take advantage of the financial assistance available only through MNsure.

From MNsure:

More than 15,000 Minnesotans have Enrolled in Health Coverage in Six Days

November 7, 2016

ST. PAUL, Minn.— MNsure is providing an update on the 2017 open enrollment period. Within six days, more than 15,000 Minnesotans have enrolled in health coverage. This milestone took about six weeks to achieve during last year's open enrollment period.

Since the start of open enrollment, we have seen:

Minnesota's ACA exchange, MNsure, continues to absolutely obliterate last year's open enrollment numbers during the first week:

The numbers as of Friday morning:

  • 13,040 people completed enrollment for health coverage
  • 187,683 visits to the MNsure website
  • 43,298 sessions or visits on the comparison shopping tool
  • 4,027 page views on the Assisters page
  • 12,121 accounts created
  • 13,701 applications completed

Assuming "Friday morning" means around 8am, that's 13,040 people actually enrolling in a healthcare policy in 3.3 days, or about 4,000 per day on average.

As I noted Thursday:

Last year, MNsure, Minnesota's technically (and actuarially) troubled ACA exchange enrolled "several hundred" people in Qualified Health Plans (QHPs) in the first day, and exactly 6,864 people in the first 17 days...which breaks out to an average of 404 per day for the first couple of weeks.

This year, just as I estimated last night, MNsure has already enrolled over 10,000 people...in just the first 2 days of operation:

With improvements at the call center and on the website, MNsure has enrolled a record number of Minnesotans in coverage, O’Toole said.

“We’ve helped more Minnesotans than we have in any two day period in our history,” she said. “We’ve now enrolled more than 10,000 Minnesotans. That’s a benchmark that we didn’t hit until after Thanksgiving last year.”

Modern Healthcare has an OE4 Launch roundup of sorts; most of the data is stuff I've already written about, and there isn't much in the way of hard enrollment data, but in general it sounds like things are off to a pretty promising start. First they note the 150,000 submitted applications on Tuesday which I wrote about earlier today; after that:

Open enrollment so far “has been going really well,” said Ambar Calvillo, national director of field and partner engagement at Enroll America, a D.C.-based not-for-profit group that helps people sign up for coverage. Calvillo said the group, which works with enrollment assistors across the nation, hasn't seen any major obstacles. Before open enrollment, exchange shoppers scheduled more than 5,400 appointments for in-person enrollment assistance through Enroll America's Get Covered Connector tool, up 80% over last year. 

...State-run exchanges in California, Colorado, Idaho and Massachusetts reported no problems on the first day of enrollment.

Remember three years ago when HealthCare.Gov launched with all sorts of horrible technical problems, and many people were speculating that at least some of the tech issues may have been the result of deliberate, malicious attacks (hacking, DDoS attacks, etc) by those opposed to either President Obama, the ACA or both?

Well, that turned out to be mostly hooey; while I'm sure there were some attempts at messing with the system, the technical problems were for the most part good old fashioned unintentional screw-ups by either the vendors, the HHS management or a combination of both. The Obama administration quickly brought in the Code Red crash team to fix the problems, and for the most part the federal exchange started working pretty well. Further improvements the past few years have completely transformed it into a pretty quick, easy, seamless experience for most people, to the point that it's now literally operating 100,000 times better than when the website first launched.

I'm a little late on this, but the MNsure BOD held their monthly meeting on September 21st and provided some updated 2016 enrollment data.

To me the most noteworthy slide is the last one, which shows the effectuated exchange QHP enrollees for each month. While effectuated enrollment is likely down around 20% from the 12.7 million who had selected QHPs as of 2/01/16, Minnesota is showing a less dramatic drop-off (off around 16% from the 83,507 QHP selections as of 2/01).

Back in June, BCBS of Minnesota announced that they were pulling all of their PPO plans out of the state. Aside from that, and some hefty proposed rate hikes for everyone else, there hasn't been a whole lot of news out of the Land of 10K Lakes.

Today, however, they announced their approved rate increases, and the unsubsidized prices don't look pretty:

Health insurers are boosting individual market premiums by an average of 50 percent or more next year, increases that regulators say are necessary to save a market that otherwise was on the verge of collapse.

The increases were announced Friday by the state Commerce Department, and show premiums will jump even higher than proposed rates that were made public on Sept. 1.

At that point, carriers sought increases ranging from 36 percent to 67 percent. But the final average increases will range form 50 percent to 67 percent, depending on the insurer.

Here's how it actually plays out by the hard numbers:

Well, I've managed to put together estimates (some very rough, some pretty specific) of the weighted average requested ACA-compliant individual market rate hikes for 49 out of 50 states, along with the District of Columbia. This leaves just one state left: Minnesota. For whatever reason, I've been informed that Minnesota's requested rate filings won't be available to the public until September 1st, which is too late for my purposes...because by that point, many of the other states will have started releasing their approved rates for next year (in fact 3 of them--Oregon, New York and Mississippi--have already done so). Minnesota's approved rates will be posted on October 1st. It's always been my intent to lock down the requested rates for every state before the approved numbers are posted in order to run a comparison between what was asked for and what the final approved rate changes are.

The only real estimate I have until Sept. 1st, then, is this quote from Christopher Snowbeck's StarTribune article on June 23:

My posts have been pretty light of late; between being on vacation, a big work backlog when I got back, and getting wrapped up in the RNC and DNC craziness, I've been a bit off-track. I'm hoping to catch up a bit over the next week or so.

Case in point: Last week, the Minnesota exchange, MNsure, posted their latest monthly enrollment numbers. Normally they include a full slideshow dashboard report, but I can't find it for July. The basic numbers through July 20, however, are:

  • Medical Assistance: 244,736
  • MinnesotaCare: 72,972
  • Qualified Health Plan (including SHOP): 96,923
  • TOTAL: 414,631

As of 6/12, MNsure had 95,637 QHP selections, so this is an additional 1,286, or 34/day over the past 38 days. This is down substantially from the June report, when it averaged a whopping 179/day.

For the entire off-season period, MNsure has added 11,533 QHP selections, or an average of 68 per day. Extrapolated out nationally, that would be about 10,300 per day nationally, although in prior years off-season SEPs have averaged between 7,000 - 9,000 per day.

I'm still waiting on the 2017 requested rate changes for Minnesota's individual market, but there's one carrier which won't be asking for any changes: Blue Cross Blue Shield of Minnesota:

Minnesota's largest health insurer, Blue Cross and Blue Shield of Minnesota has decided to stop selling health plans to individuals and families in Minnesota starting next year. The insurer explained extraordinary financial losses drove the decision.

"Based on current medical claim trends, Blue Cross is projecting a total loss of more than $500 million in the individual [health plan] segment over three years," BCBSM said in a statement.

The Blues reported a loss of $265 million on insurance operations from individual market plans in 2015. The insurer said claims for medical care far exceeded premium revenue for those plans.

Hmmm...this is kind of interesting. As I noted a few weeks ago, here's what the QHP enrollment pattern has looked like in Minnesota since the end of the 2016 Open Enrollment Period:

  • 11/01/15 - 1/31/16: 85,390 (or 928/day); 33,333 MNcare; 73,173 Medicaid
  • 2/01/16 - 2/14/16: 85,690 (+300, or 21/day); 39,887 MNcare; 90,234 Medicaid
  • 2/15/16 - 3/06/16: 86,856 (+1,166, or 55/day); 45,621 MNcare; 111,449 Medicaid
  • 3/07/16 - 4/17/16: 90,696 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid
  • 4/18/16 - 5/22/16: 91,868(+1,172, or 33/day); 64,040 MNcare; 195,295 Medicaid

Here's the latest report from the MNsure 6/15 board meeting:

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