OE4

I've decided that for all future ACA enrollment data reports, I'm going to tack on "...on brink of possible ACA repeal" to the headline. Seems appropriate.

It's been quite awhile since I've written much of anything about the ACA's SHOP programs, which are the small business counterpart to the individual/family exchanges. The reason is pretty simple: SHOP enrollment is mostly a rounding error compared to either the ACA's Individual exchange enrollments or Medicaid expansion numbers.

SHOP enrollment (a mere 120K - 170K nationally, as far as I can tell) is even dwarfed by BHP program enrollment (around 700,000)...and that's only available in 2 states (Minnesota and New York). Heck, I don't even bother tracking them on my spreadsheets or graphs (I tried in 2014 but gave up on it the following year).

Still, once in awhile there's a bit of SHOP news to report, and this press release out of Minnesota is such an occasion:

Welp.

Record Number of Idahoans Select Insurance through Your Health Idaho
Lawmakers Get Update on State’s Health Insurance Exchange

BOISE, Idaho – Your Health Idaho (YHI) executive director Pat Kelly went before lawmakers on Wednesday to give them an update on the third year of operations for Idaho’s state-based health insurance exchange. YHI set new records for enrollment during 2016 and led state-based exchanges across the country in per capita enrollment.

“Lawmakers’ choice to keep the federal government out of Idaho’s health insurance decisions and to do things our way has benefited Idaho immensely,” said Kelly. “Your Health Idaho gives consumers options when it comes to selecting a health insurance plan and we keep more money in Idahoans’ pockets by having lower assessment fees than the federal government.”

In federally managed states, consumer fees are set at 3.5percent. In 2016, YHI’s board of directors set the state’s assessment fee at 1.99 percent. To date, lower health insurance assessment fees have saved Idahoans more than $15 million.

OK, given the impending End of the World As We Know it (and, on a smaller scale, the potential End of the Affordable Care Act), this is a pretty minor thing, but worth noting.

This afternoon I did a write-up about today's Week 10/11 HealthCare.Gov Snapshot Report, which showed nearly flat enrollment growth from 12/31 to 1/14...two solid weeks with barely 64,000 additional signups across 39 states. As I noted, this particular stretch of Open Enrollment was expected to be pretty quiet, but even so, the numbers were still far lower than I expected.

In the Weeks 8/9 Snapshot Report, HHS reported exactly 8,762,355 QHP selections as of New Year's Eve via HealthCare.Gov specifically (which only includes 39 states).

Then, last week, the ASPE department released their "Mid-Season Report", which included more detailed enrollment data for every state...but cut off a week earlier (only through Christmas Eve). After filling in all the blanks, I concluded:

OK. We're past the "mini-deadline" for February 1st coverage in 47 states (+DC). New York has extended their Feb. coverage deadline out until Wednesday (1/18), while Massachusetts, Rhode Island and Washington State are taking enrollments through next Monday (1/23).

The real "final" deadline to sign up for 2017 healthcare coverage is Tuesday, January 31st. Anyone who signs up between the dates above and the 31st will be enrolled in a policy starting coverage on March 1st.

After that, under the ACA, the only ones who are supposed to be able to sign up for 2017 coverage are people who qualify for:

Back in mid-December, just about all of the ACA exchanges bumped out their enrollment deadlines for January 1st coverage by a few days. I was mildly surprised because improvements in the bandwidth, coding, layout and support staffing have meant a smoother process towards the big last-minute surge. Still, I wasn't blown away by the development or anything, as mid-December has always seen a massive spike in enrollment.

On the other hand, this announcement by the New York State of Health exchange is very surprising:

New Yorkers Now Have Until January 18 to Enroll in or Renew Health Insurance Coverage Beginning February 1

Consumer Demand Remains High Prompting Deadline Extension

ALBANY, N.Y. (January 12, 2017) – NY State of Health, the state's official health plan Marketplace today announced that consumers now have three additional days to enroll in a health plan with coverage starting February 1. The deadline has been extended through 11:59 p.m., January 18. The previous deadline was January 15.

Last week I noted that I overestimated the number of QHP selections in Connecticut by 9,900 (oops). Today they've reported that 818 of that gap has since been made up:

AHCT ANNOUNCES 105,313 CUSTOMERS ENROLLED IN 2017 HEALTH INSURANCE -  

CALL CENTER HOURS FOR MARTIN LUTHER KING JR. HOLIDAY

Call Center will be open Sunday, January 15 instead of Monday, January 16 in honor of Martin Luther King Holiday

HARTFORD, Conn. (January 13, 2017) - Today, Access Health CT (AHCT) CEO Jim Wadleigh announced that 105,313 people are enrolled for 2017 coverage as of January 12th.  In addition, Wadleigh announced that the AHCT Call Center will be open on Sunday, January 15th from 10:00 AM to 5:00 PM and closed on Monday, January 16th for the Martin Luther King Jr. holiday.

A few days ago I noted that MNsure, Minnesota's ACA exchange, has skyrocketed from last place to first in terms of achieving my personal OE4 enrollment targets, having enrolled 103,578 people in Qualified Health Plans (QHPs), plus another 19,960 in MinnesotaCare (MN's BHP program) and 65,164 in Medicaid.

Yestrerday they updated their numbers once again:

That's a further increase of 3,009 Minnesotans in QHPs in the past week or so. MN has already blown past my original projection (86K) and has reached 92% of my revised target (116K).

This isn't a particularly dramatic update given that CMS released their "mid-season" report yesterday, which already updated Washington's tally from 180K thru 12/20 to 194K as of 12/24...but an update's an update:

The Washington Health Benefit Exchange today announced that more than 200,000 customers have selected 2017 health and dental coverage through Washington Healthplanfinder since the open enrollment period began on Nov. 1 – an increase of almost 14 percent over the same point last year.

Hmmmm...the numbers look good, but that "...and dental" caveat is a bit troubling. I've asked for clarification; it's possible that the "dental" reference simply refers to the fact that some Qualified Health Plans also include dental coverage, as opposed to referring to standalone dental plans, which shouldn't be counted as QHPs.

OK, with this morning's CMS/ASPE "mid-season report" being released, I figured this would be a good time to take a look at where things stand on both a state-by-state and national level. All of the state enrollment numbers should be accurate with the possible exception of California; there's a potential discrepancy of around 93,000 enrollees which I'm still trying to clarify. The tables/graph below all assume that those disputed 93K are supposed to be included.

Here's my original projections for each state, sorted in order based on what percent of my personal target each state has reached. As you can see, Minnesota, Hawaii, Massachusetts and South Dakota have already broken 100%, with Utah, Vermont, Oklahoma, Wyoming, Colorado, Oregon and (possibly) California all over the 90% mark. Any state over 90% at this point should hit my targets by the end of January.

Along with today's HHS report which confirms more than 11.5 million 2017 QHP selections as of Christmas Eve, CMS has released an additional report which breaks the numbers out by state...and unlike HC.gov's "snapshot" reports (which only cover 39 states), the CMS/ASPE report also confirms the enrollment numbers for all 50 states (PDF).

As I've noted before, until today, there was one state which I had no OE4 data for whatsoever: Vermont (which is ironic given their historic support of healthcare reform, including Sen. Bernie Sanders). This blank has been filled in by today's supplemental CMS/ASPE report: 29,021 QHP selections as of 12/24, which is actually quite a bit higher than I expected for the state (my target for VT is only 30,000 total through 1/31).

As regular readers know, I've always made sure to report the number of people who enroll in the ACA's Basic Health Plan (BHP) programs in Minnesota (since 2014) and New York (since 2016). The HHS Dept. didn't really highlight BHP numbers in 2014 or 2015 because they weren't even a rounding error nationally (they had 43,000 enrolled in BHPs via MNsure in April 2014, for instance). In addition, the BHP program in Minnesota was really just a retooling/expansion of an existing program anyway. As a result, it was treated as more of a footnote in the national reports. Interestingly, the number of MN residents enrolling in BHPs through MNsure this year is quite a bit lower (20,000), although state-wide the number is much higher (around 62,000 as of this week). Basically, 1/3 of MinnesotaCare enrollees are doing so via the ACA exchange, the rest via traditional state agencies/processes.

Whoops! I think I owe the folks at MNsure a bit of an apology. A week or so ago I stated:

Minnesota is a different story. They started out Open Enrollment with a bang, racking up enrollees at up to 12x last year's pace...but that was mainly due to their unique "enrollment cap" policy this year. Once the caps were filled and current enrollees were all squared away, new enrollments appear to have dropped off dramatically. They're now dead last percent-of-target wise (again, I can't include NY or VT here since neither has enough data available).

It feels a little odd to be alternating estimates about how many people could lose their coverage in each state with the number signing up for it at the same time, but that's where we are: Remember, there's still 6 more days for people to enroll for 2017 coverage starting in February, and 16 days after that to sign up for coverage starting in March.

My last enrollment update for Colorado ran through December 18th; at the time the tally was 139,509 Medical QHPs via Connect for Health CO.

Today they issued another update:

Connect for Health Colorado Reports Increase in Healthcare Plan Selections for 2017 Coverage

DENVER —  More than 158,000 Coloradans selected healthcare coverage for 2017 through the state health insurance Marketplace through Sunday, January 8, a rate 18 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

Oops. Last week I reported that Access Health CT appeared to state that they had a total of 114,421 QHP selections during the current open enrollment period. The wording was slightly squirrelly ("currently active for 2016 and/or 2017"), especially since I also knew there were around 12,000 existing enrollees who still hadn't chosen a new policy...but an earlier update had given the number as "around 113,000" in a seemingly less-confusing way, so I assumed that all 114,421 applied to 2017.

It turns out I may have been wrong after all:

ACCESS HEALTH CT ENROLLS 104,495 SO FAR FOR 2017 HEALTHCARE COVERAGE
Consumers have until January 31, 2017 to sign up for coverage

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