New Hampshire

According to the official CMS report for the 2017 Open Enrollment Period, 53,024 New Hampshire residents "selected a Qualified Health Plan" from the ACA exchange as of January 31st.

Of course, as I (and others on both sides of the political spectrum) have written about many, many times, not everyone who selects a QHP (either on or off the exchanges) actually pays their first premium, and therefore is never actually enrolled in an active, effectuated policy. This amounted to roughly 12-13% of all QHP selections in 2014, but has improved over the past 3 years as people got used to how the system works and technical improvements were made. I've been using a 10% non-payment rate as a general rule of thumb for some time now.

In New Hampshire, assuming 58,000 people enroll in private exchange policies by the end of January, I estimate around 31,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 50,000 enrolled in the ACA Medicaid expansion program, for a total of 81,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

(sigh) OK, with three states still missing, you just knew I wouldn't rest until I was able to fill in the missing pieces of the puzzle. Sometime today, the HHS Dept. finally entered the approved rate hikes for individual makret carriers in two of those states: New Hampshire and Virginia. Louisiana is still AWOL for whatever reason.

It's important to note that sometimes the "Final Rate Increase" percentages listed at RateReview.HealthCare.Gov dont' actually end up matching the approved rate hikes found in the official SERFF databases or even at the state's Dept. of Insurance website. Normally I cross-check all three to make sure nothing weird is going on, but given that it's well past time to move on, I'm relying purely on the RateReview numbers for these states.

With that in mind, here's what it looks like in each:

When I originally calculated the average requested rate hike for New Hampshire, I came up with a weighted estimate of around 13.1%. A month later, the average dropped a few points...but not for a good reason: One of the remaining ACA-created Co-Ops, Community Health Options, decided to pull out of New Hampshire (they started out as a Maine-only operation, expaneded into nearby NH for the 2nd and 3rd year, but are pulling back to Maine-only again). Since CHO would otherwise have been requesting a more than 40% increase, them dropping out actually lowered the average increase for everyone else. This obviously illustrates a major caveat with my "average rate increase" methodology: It only applies to those who are able to renew their existing plans. The moment a carrier pulls out of parts/all of a state, or drops PPOs (while keeping HMOs), etc, I have to remove a portion of the existing enrollees from the equation completely.

Last month I estimated that the weighted average rate hike requested by New Hampshire carriers for the individual market was around 13.1% when you include the Premium Assistance (PAP) enrollees:

Today, I'm revising this estimate down a bit to 11.8%. Unfortunately, the reason behind this is not positive:

Community Health Options, a Lewiston-based health insurance cooperative, has gotten approval to withdraw from the New Hampshire insurance market in 2017.

The plan was approved this week by the Maine Bureau of Insurance, which has been monitoring CHO’s finances as it tries to recover from a $31 million loss in 2015. The nonprofit cooperative has set aside more than $45 million in reserves to try to avoid another big loss this year.

According to the official HHS Dept. ASPE Report, 55,183 New Hampshire residents "selected a Qualified Health Plan" from the ACA exchange during the 2016 Open Enrollment Period.

Of course, as I (and others on both sides of the political spectrum) have written about many, many times, not everyone who selects a QHP (either on or off the exchanges) actually pays their first premium, and therefore is never actually enrolled in an active, effectuated policy. This amounted to roughly 12-13% of all QHP selections in 2014, but got a bit better over the next two years as people got used to how the system works and technical improvements were made. In addition, another chunk of QHP selections were scrapped by the HHS Dept. or state exchanges at later points thorughout 2014 for a variety of reasons ranging from legal residency issues to other data matching problems. Again, this percentage has been gradually whittled down as improvements to the system have been made.

New Hampshire has only 5 carriers offering individual market policies, all 5 of which will still be participating in the NH market next year as well. Two of the five (Community Health Options and Minuteman Health) are among the 7 surviving ACA-created Co-Ops.

Even so, NH is proving to be a very tricky state to estimate, because only one of the 5 carrier rate filings includes their actual current rate-impacted enrollment data. As a result, I've had to take my best shot at estimating the market share of the other four. The only way I could think of to do this was to look up the latest NH DOI 2016 QHP Monthly Membership Report. New Hampshire, to their credit, is one of the only states without their own state-based ACA exchange which still actually posts regular reports about how many residents are enrolled in ACA exchange policies. Furthermore, they even break these numbers out by metal level and carrier, making the relative market share easy to calculate.

A few weeks ago I reported on some weirdness in New Hampshire's monthly exchange QHP enrollment data. They were showing an unusually high effectuated enrollment drop-off between March and April, especially odd considering that enrollment had supposedly increased from February to March.

It turned out to be a clerical error on the part of one of the carriers; this has since been corrected (though the earlier months were left as is), so the May report which was just released is back on track:

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.

A couple of weeks ago I noted that New Hampshire may be the only state on the federal exchange which actively tracks their effectuated exchange enrollment on a monthly basis.

At the time, I noted that unlike most states, their effectuated numbers seem to have increased from February to March (January doesn't really apply since Open Enrollment was still ongoing at the time):

  • January 2016 Exchange-Based QHP Enrollment: 49,937 (+33,604 PAP enrollees)
  • February 2016 Exchange-Based QHP Enrollment: 53,109 (+38,735 PAP enrollees)
  • March 2016 Exchange-Based QHP Enrollment: 55,212 (+43,732 PAP enrollees)

Well, thanks to Louise Norris for the heads up: NH's April numbers are out, and there's something odd:

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:

Huh. Here's something unexpected. New Hampshire officially closed out the 2016 Open Enrollment Period with 55,183 exchange-based QHP selections.

As it happens, New Hampshire is, to my knowledge, the only state operating on the federal exchange which has a policy of publicly posting their effectuated exchange-based enrollment numbers every month throughout the year, which is a godsend to me.

Now that we're into April, I decided to take a sneak peak, and was a bit surprised at what I found:

Regular readers may have noticed that I've been posting fairly lightly of late. Now that open enrollment is over and we're deep in the thick of primary season, I'm trying to catch up with the massive backlog which has built up in my day job.

However, there's still a lot of stuff going on; today, for instance, brought some very positive Medicaid expansion news out of two states:

New Hampshire House passes Medicaid reauthorization

The New Hampshire House on Wednesday approved legislation that would keep 48,000 people on their insurance plans by continuing the state's expanded Medicaid program beyond the end of the year.

The bill, which now goes to the Senate, includes work requirements for recipients and asks insurance companies and hospitals to cover the state's share of the program's costs.

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 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.

(sigh) OK, this one is not related to the Risk Corridor Massacre, since Community Health Options was actually profitable in 2014 and therefore never qualified for any RC payments anyway. Also, unlike the dozen ACA-created co-ops which are in the process of winding down operations by the end of the year, CHO is not going out of business, and in fact is remaining fully operational for 2016.

Having said that, this development is still a serious bummer given the carnage wreaked across the co-op landscape earlier this fall:

Maine's Community Health Options said Dec. 9 that it will cut short its sales of individual policies for 2016, in a sign that it is the latest Affordable Care Act-funded consumer operated and oriented plan to encounter financial difficulties.