California only targeting appx. 1.7 million QHP selections for 2016

The California ACA exchange, CoveredCA, released their 2016 budget today, and the outlook is...well, kind of underwhelming, frankly:

After using most of $1 billion in federal start-up money, California's Obamacare exchange is preparing to go on a diet.

That financial reality is reflected in Covered California's proposed budget, released Wednesday, as well as a reduced forecast calling for 2016 enrollment of fewer than 1.5 million people.

The recalibration comes after tepid enrollment growth for California during the second year of the Affordable Care Act. The state ended open enrollment in February with 1.4 million people signed up, far short of its goal of 1.7 million.

A number of factors contributed to the shortfall, but health policy experts said that some uninsured folks still find health insurance unaffordable despite the health law's premium subsidies.

Actually, when you include the #ACATaxTime special enrollment period, CA's 2015 QHP total ended up just barely breaking the 1.5 million mark (at least 1,503,200 confirmed, plus an unknown number via normal off-season enrollments, although those are likely cancelled out by people dropping out for similar reasons). However, yes, it was still a big disappointment for both the exchange and myself (they were calling for 1.7M; I was originally hoping they'd break 1.9M).

However, there's a couple of numbers in the LA Times article which need a bit of parsing. First of all, there's this:

The budget details include proposals to:

• Spend $58 million less compared with the current fiscal year, a 15% reduction.

• Devote the largest portion, $121.5 million, to outreach, sales and marketing. That's down 33% from the current year.

• Maintain the monthly $13.95 fee for each individual policyholder, which would raise $233.2 million in revenue.

The state also would draw on $100 million in federal money in reserves — the last of the start-up grant. No further federal funding is expected.

$233.2 million divided by $13.95 = 16,716,846. Divide that by 12 (the fee is monthly) and you get a projected average monthly effectuated enrollment of around 1.393 million.

According to my best estimates, the 2015 national monthly average enrollment number (assuming no massive disruption from, say, an unfortunate King v. Burwell decision) should be roughly 9.7 million people out of 13.8 million total QHP selections by the end of December. That's just over 70% of total selections actually enrolled/paying on average throughout the year.

For 2016, the open enrollment period is very similar to 2015's (Nov. 1st - Jan. 31st instead of Nov. 15 - Feb. 15), so a similar percentage of people should have their policies kick in at around the same dates (ie, around 63% on January 1st, 6% on February 1st, 17% on March 1st and the remaining 17% spread out throughout the rest of the year).

Assuming California follows this same pattern, that would mean CoveredCA expects the total number of QHP selections to be something like 2.0 million (1.393M = 70% of 1.99M).

However, later in the article it says:

One of the biggest changes in the budget blueprint is a more gradual increase in projected enrollment compared with previous state estimates.

Covered California projects 1.48 million people enrolled and paying on their premiums next year. It wants to reach nearly 2 million by 2019.

1.48 million paying enrollees would mean roughly 1.68 million total QHP selections at an 88% payment rate...or, assuming it's the same rather lame 82% who ended up paying in CA in 2014, that would suggest around 1.8 million QHP selections.

In the interest of caution, I'm going to assume that the 1.7 million number is what they're really targeting for 2016...which happens to be exactly what they were originally hoping to hit this year before coming up short.

For the record, if they hit 1.7M next year, that would be roughly a 20% increase over this year's open enrollment period (I'm not including the #ACATaxTime period since neither HHS nor CoveredCA are likely to repeat that offer again). A 20% year over year bump nationally would mean something like 14 million QHP selections during 2016 Open Enrollment, with perhaps 12.5 million actually paying up, around 12.0 million enrolled as of the end of 2016 and a monthly average of around 11.6 million.

However, that's massive speculation at this point; there's absolutely no way of knowing whether CA will hit 1.7M next year anymore than they did this year, or whether they'd be remotely representative nationally.