Wisconsin: 9,300 QHPs down, 7,900 QHPs UP: You can't have it both ways.

Hat Tip To: 
Markos Anderson

In response to my Paid/Unpaid Brouhaha update last night, a commentor brought this story out of BizTimes.com to my attention, which in turn links to this memo (PDF) from the Wisconsin Insurance Commissioners Office.

In the middle of it we find this (partial) paid/unpaid data, which indeed only applies to January and February start-dates:

4. How many consumers have enrolled in coverage through the federal exchange? How many consumers have paid their premium?

  • Total federal exchange enrollment into plans with a January 1 effective date:  34,329. Insurers received premium for 28,178 of these plans (unpaid 18%).
  • Total federal exchange enrollment into plans with a February 1 effective date: 12,733. Insurers received premium for 9,604 of these plans (unpaid 25%).
  • Total federal exchange enrollment into plans with January 1 and February 1 effective dates: 47,062. Insurers received premium for 37,782 of these plans (unpaid 20%).

Hmmm...in the case of Wisconsin, it does sound like even when applying the "policies already started" criteria for January and February, the paid percentage kind of blows. It's annoying that they didn't include March, April or May data for comparison (although the wording of the memo makes it obvious that they're only addressing the Jan/Feb starts...for the same reason I laid out above: If their policy hasn't started yet, those aren't worth making a fuss over).

So, fair enough: I've added Wisconsin's data to the chart at the top (which keeps it at 81% overall), and true to my word, I'm separating out Wisconsin's documented unpaid enrollees from the total on the spreadsheet. which reduces their total by 9,280.

If this proves to be the case with other states with regard to their January or February enrollments, then the "unpaid" argument might start holding water after all, but so far we only have the breakouts by month from 2 states (Vermont and Wisconsin), which average out to 83% for January and February.

At the same time, however, this Wisconsin memo also contains some data on another topic I talk about a lot: Off-Exchange QHP enrollments!

This only includes Off-Exchange numbers through January 15, but it's still better than nothing:

5. How many consumers enrolled in a plan in the individual market outside of the federal exchange?

  • Total enrollment, outside of the federal exchange, into plans with January 1 and February 1 effective dates: 7,885. 

Amusingly, these additional 7,885 off-exchange enrollments instantly cancel out almost all of the 9,280 of the Jan/Feb unpaid enrollments that I just subtracted...just as Scott Gottlieb noted in Forbes a few days ago:

Off exchange enrollment could be as high as 20%, according to one Wall Street analyst. If that holds true nationwide, these enrollees would probably offset the number of people who sign up on the exchange, but will never pay their first premium (and thus never be truly enrolled).

And that's how the game is played. YOU CAN'T HAVE IT BOTH WAYS.

If you're going to subtract everyone who hasn't paid their premium, you have to also add anyone who's purchased an ACA-compliant QHP...regardless of whether they did so on-exchange or off, since they're all part of the SAME RISK POOL.

So, Wisconsin loses 9,300 but gains 7,900 overall, for a net loss of 1,395.

Feel free to subtract a certain percentage of the exchange-based QHP enrollments for nonpayment...but if you do so (or even if you don't really), you also have to add the off-exchange enrollments as well.

As a reminder, nationally, I've already documented over 550,000 off-exchange QHP policy enrollments to date...from 2 states (WA and WI) and a handful of companies. My guess is that there's easily 3-4 million more which simply haven't been sourced yet.

Oh, yeah, and there's also about 65,000 SHOP exchange enrollees nationally. A rounding error, I know, but every number counts.

This is why I list all of the different scenarios whenever I have the data for it, so that people can understand the full picture as clearly as possible.