START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

Rhode Island

I first looked at Rhode Island's proposed rate hikes back in early July. At the time, the average increase for the two carriers participating in RI's individual market was 10.5% assuming CSR reimbursement payments are guaranteed for 2018. If they weren't guaranteed, however, I estimated at the time that an additional 19 percentage points would be added into the mix, based on an estimate by the Kaiser Family Foundation.

However, I realized a little later on that I was misinterpreting KFF's analysis; they were referring to how much they estimated silver plans would go up due to the lost CSR funds, not all metal levels. Furthermore, for Medicaid expansion states (which includes Rhode Island) they estimated the average was only 15%.. Based on these factors, the impact across the board on Rhode Island should have only been around 10.3%.

Rhode Island just released their 2018 Individual and Small Group market rate hike requests, and they're pretty straightforward. For the small group market, I don't have the weighted market share for each carrier, but overall it ranges from 5.8 - 12.8%, with an unweighted average of 8.8%.

On the individual market, as with 2017, there's only two carriers participating in 2018: BCBS of RI and Neighborhood Health Plan. They're asking for a 13.8% and 5.0% increase respectively, with a weighted average of 10.5%.

BCBS gave their enrollment as around 27,000; for Neighborhood, I estimated theirs based on dividing their projected total member months by 12 to get 16,345. RI's on-exchange enrolment was 29,456 during Open Enrollment this year, so that would leave roughly 12,800 off-exhange enrollees, for roughly a 2:1 on/off-exchange ratio, which sounds about right.

Oof. Regular readers know that I've compiled plenty of evidence showing that while the 39 states run through the federal exchange (HC.gov) showed a ~5% enrollment drop this year, the state exchanges have been showing an overall net increase of roughly 2% over 2016. Rhode Island, however, is the odd man out on this front, as shown in this email I just received (not up on their website yet):

Despite facing a unique set of challenges this open enrollment, 29,420 individuals selected 2017 coverage through HealthSource RI during open enrollment period (November 1, 2016 – January 31, 2017). As of January 31, 27,395 of those individuals paid, and are therefore confirmed, in 2017 coverage. We do anticipate these number will change as payments are made through the February 23 payment deadline and also as HealthSource RI remedies account issues incurred during the open enrollment period. It is difficult to point to one clear cause for this year-over-year drop in enrollment, but we believe several factors might have played a role:

1. System and service issues

As i noted last week, with all renewing enrollees accounted for, Rhode Island's ACA exchange is likely to come up short not only of my pre-election projection (40,000 enrollees), but will likely see a drop from last year's 34,670 QHP selections. They had only hit 29,312 QHPs as of Christmas Eve, and have only tacked on another 580 people since then:

INDIVIDUAL AND FAMILY ENROLLMENT • As of December 31, 2016

Rhode Island is one of three states (along with Washington and Massachusetts) which allowed people to enroll for January coverage as late as December 23rd. RI's numbers have also included auto-renewals for some time now, so today's report includes everyone whose 2017 policies will kick off effective this Sunday, January 1st:

INDIVIDUAL AND FAMILY ENROLLMENT  •  As of December 24, 2016

Last week, the Rhode Island exchange reported 27,555 QHP enrollees as of 12/10, a tiny increase over the prior week mainly due to auto-renewed enrollees dropping out, cancelling out most of the increase.

Rhode Island is one of 3 states which are still taking enrollments for January, but they've released another report (thorugh 12/17) which brings the tally up to 

INDIVIDUAL AND FAMILY ENROLLMENT As of December 17, 2016

Huh. Rhode Island didn't post any updates at all for the first 5 weeks of OE4, but has now posted weekly updates back to back:

INDIVIDUAL AND FAMILY ENROLLMENT As of December 10, 2016

I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this site and everything...)

Rhode Island, which issued regular weekly enrollment reports last year, has been unusually silent so far this year...until today:

HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, December 3, 2016 for Open Enrollment.

INDIVIDUAL/FAMILY ENROLLMENT
As of December 3, 2016

Rhode Island, in addition to being one of the smallest states, is also one of the first states I crunched the rate hike numbers for back in late May. It was actually pretty easy to run a weighted average hike request since there are only 2 carriers even operating on the individual market next year: Blue Cross Blue Shield of RI and Neighborhood Health Plan (UnitedHealthcare is dropping out of the RI indy market entirely, but only has about 1,400 people enrolled to begin with).

Anyway, BCBS was asking for a 9% increase, while Neighborhood is among the very few carriers to actually request a rate decrease...of around 5%. As a result, Rhode Island has the honor of having the lowest average rate hike request of all 50 states (+DC) next year...a mere 3.6% overall, which is awesome.

Well, nearly 3 months later, the RI Insurance Commissioner has weighed in with even more good news: Rates will be going up even less than that in 2017:

This year only 3 insurance carriers are offering policies on the individual market in Rhode Island: Blue Cross Blue Shield, Neighborhood Health Plan and UnitedHealthcare. The bad news is that United is pulling out of RI, although they only hold about 4% of the on-exchange market anyway. The rest of the on-exchange market is split almost evenly between BCBS and Neighborhood.

Both Neighborhood Health Plan and BCBS have submitted their filings, and there's some great (and surprising, for this year) news:

Carriers file two average rate increase amounts with OHIC: the EHB base rate increase and the weighted average rate increase. These two percentages reflect different calculations.

Again, Rhode Island is the only state to continue with regular, weekly exchange enrollment reports during the off season. I would love it if every exchange did this:

INDIVIDUAL AND FAMILY ENROLLMENT • As of February 20, 2016:

  • 36,004 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
  • The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
  • 8,657 of the 36,004 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
  • 33,920* of the 36,004 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

*The number of paid enrollments is expected to increase as payments for March coverage are made by today’s deadline and processed over the next several days.

Last week I noted that the Rhode Island ACA exchange has become my newest BFF: They've decided to continue posting weekly enrollment reports even during the off-season!

Better yet, they're also making sure to include both the gross enrollment and net effectuated enrollment numbers. If every state exchange (and especially HealthCare.Gov, of course) were to do this, I'd be a very happy man indeed. In the meantime, I'll have to settle for RI's regular updates, although extrapolating anything nationally from a single state with just over 1 million people is a bit tricky.

Anyway, last week they reported (thru 2/06):

Once the dust settled on the 2014 and 2015 Open Enrollment periods, only a handful of state exchanges bothered continuing to report off-season exchange enrollments, but I was able to extrapolate those numbers pretty accurately nationwide: Around 7,500 people per day were still signing up via Special Enrollment Periods throughout the summer/fall of 2014, and around 8,500 per day did so last year (not including the time-limited #ACATaxTime SEP from mid-March through the end of April 2015).

This year, that number is expected to drop somewhat due to HHS supposedly cracking down on SEPs in both variety and eligibility verification, but I still wouldn't be surprised if at least, say, 6,000 people per day end up signing up between now and next November (or around 1.6 million total, give or take).

Anyway, even the state exchanges which did keep posting updates generally only did so monthly...which is why I was pleasantly surprised to see that the Rhode Island exchange appears to be sticking to their Weekly Enrollment Report guns even after the dust has settled:

This just in from HealthSource RI:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, January 31, 2016 for Open Enrollment.

INDIVIDUAL AND FAMILY ENROLLMENT • As of January 31, 2016:

  • 34,670 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
  • The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
  • 7,538 of the 34,670 individuals have selected a plan for 2016 coverage and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

32,286* of the 34,670 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.
*The number of paid enrollments is expected to increase as individuals pay for March coverage through the February 23 payment deadline. 

Aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis. In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day. However, RI is also a tiny state with an even tinier ACA exchange population, in the 30K - 40K range, so it may be pointless to try and extrapolate nationally.

Having said that, their latest enrollment update, covering Week 12 of OE3, is...OK, I guess:

As of January 23, 2016:

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