Minnesota

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

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:

It's time to take a breather from my ongoing 2017 Rate Hike Request project to check in on a couple of off-season enrollment numbers. First up is Minnesota. Here's how the QHP tally (cumulative, not currently effectuated) has gone since open enrollment ended in the Land of 10,000 Lakes (note: Michigan actually has 11,000, so there!):

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

...and here's the May report:

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:

As everyone who's been following the ACA over the past few years knows, the October 2013 launch of HealthCare.Gov and 16 state-based marketplace websites was not one of the prouder moments in the Obama administration's history. The federal exchange (which covered 35 states at the time) was a disaster out of the gate, as well about half of the state-based websites.

Over the past three Open Enrollment Periods, of course, most of the technical headaches have been worked out of most of the sites. HealthCare.Gov operates like a dream now (update: well, relatively speaking, anyway) and major improvements have been made in most of the state exchanges as well. In 5 cases, the solution was to either scrap the original platform and start over (Maryland and Massachusetts) or to say "to hell with it", drop their own platform completely and move home to the Mothership (Oregon and Nevada in 2015; Hawaii starting this year). Washington State kept their own platform but gave up trying to handle billing for their enrollees, joining just about every other state in letting the carriers handle payments directly.

During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Unlike most of the state exchanges (and HC.gov itself), MNsure has been dutifully continuing to update their data every month or so during the off season, providing an interesting glimpse into how the Special Enrollment Period (SEP) is going:

  • 11/01/15 - 1/31/16: 85,390 QHPs Cumulative since 11/01/15 (or 928/day); 33,333 MNcare; 73,173 Medicaid
  • 2/01/16 - 2/14/16: 85,690 QHPs Cumulative since 11/01/15 (+300, or 21/day); 39,887 MNcare; 90,234 Medicaid
  • 2/15/16 - 3/06/16: 86,856 QHPs Cumulative since 11/01/15 (+1,166 QHPs, or 55/day); 45,621 MNcare; 111,449 Medicaid

,,,and in the latest update:

  • 3/07/16 - 4/17/16: 90,696 QHPs Cumulative since 11/01/15 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid

Didja notice that? While the private QHP enrollment rate obviously dropped off tremendously after open enrollment closed (duh!), the SEP enrollment rate has dramatically increased since then, from 21/day in early February, to 55/day in late Feb/early March, to 91 per day over the past month. While it's still just 10% of the Open Enrollment rate, over 4x as many people are signing up for QHPs via MNsure now as were at the start of the off season.

During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Yesterday they held their March board meeting and updated their numbers through the first 5 weeks of the off season:

During Open Enrollment, MNsure averaged 928 QHP selections per day. During the off season, this has dropped down to 42 per day, or about 4.5% of the OE3 daily average.

If you extrapolate this nationally (and of course there's no way of knowing whether Minnesota is remotely representative), that would translate to around 6,200 people selecting exchange-based QHPs per day during the off season, which is lower than the past two years (7,000 - 9,000/day) but certainly within reason.

During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Earlier today they gave their first off-season update.

That's 300 more people who signed up for QHPs in the first 2 weeks of the off-season, plus another 6,500 added to MinnesotaCare and over 17,000 added to Medicaid (both of which are year round).

The QHP number (just 21 per day) is kind of interesting when compared to Rhode Island, which has has averaged 90 additional people per day in the first 2 weeks of February, yet has a population only 1/5th the size of Minnesota's. When adjusted for total population, Rhode Island's off-season rate is over 21x that of Minnesota.

The big difference, of course, is that Minnesota's BHP program (MinnesotaCare) cannibalizes the QHP market tremendously. When you add those 6,500 to the mix, MNsure has averaged 485 per day...or slightly higher than Rhode Island when adjusted for inflation (around 97/day when divided by 5).

MNsure, the Minnesota ACA exchange, is the first one to report their final, official 2016 Open Enrollment numbers, and they have much to be proud of:

85,390 Minnesotans Enroll in Private Coverage Through MNsure During the 2016 Open Enrollment Period

Enrollment goal exceeded, Minnesota leads the nation in new enrollees

February 01, 2016

ST. PAUL, Minn.—Today, MNsure announced 85,390 Minnesotans enrolled private health insurance coverage through the state exchange during the 2016 open enrollment period, November 1, 2015, through January 31, 2016. MNsure's goal was to enroll 83,000 in private coverage.

In addition, 33,333 Minnesotans newly enrolled in MinnesotaCare and 73,173 newly enrolled in Medical Assistance. MNsure also enrolled 7,144 Minnesotans in a dental-only plan. These numbers are preliminary and are not yet final.

MNsure has broken the 75K mark:

At yesterday's MNsure Legislative Oversight Committee meeting, CEO Allison O'Toole reported that as of January 15, MNsure had enrolled 75,000 Minnesotans into private health insurance coverage since the beginning of open enrollment, November 1, 2015.

As of January 10, MNsure had enrolled 69,671 Minnesotans into private coverage. This means MNsure has seen an increase of 5,329 private plan enrollments in five days. In addition, about 45 percent of private plan enrollees are new to MNsure for 2016. This is the highest percentage of new enrollees nationwide.

MNsure's goal is to enroll 83,000 Minnesotans by the end of open enrollment.

This will be the final enrollment update until preliminary end of open enrollment numbers are released on Monday, February 1.

As a reminder, the 2016 open enrollment period ends on Sunday, January 31. The MNsure Contact Center will be open extended hours on Saturday, January 30, from 8 a.m. - 8 p.m., and on Sunday, January 31, from 8 a.m. - midnight.

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