Updated: #ACATaxTime Wrap-up: ~210K QHPs should put the kibosh on the "move Open Enrollment to Spring" movement

Yesterday I estimated that total #ACATaxTime-specific enrollments were likely around 200,000. Today, thanks in part to CNBC's Dan Mangan, I can pin this down even further. The bold-faced states are the ones where the number is provided by Mangan's report:

  • Healthcare.Gov (37 states): 147,000
  • California: 33,000
    Update: It turns out CA's actual #ACATaxTime total was 43,929
  • Colorado: n/a
  • Connecticut: 1,429
  • DC: est. about 420 (assuming 30% of 1,400 total since 2/21)
  • Hawaii: Zilch.
  • Idaho: n/a
  • Kentucky: 3,047
  • Maryland: 4,709 (I actually reported this a few weeks ago but it slipped my mind)
  • Massachusetts: n/a
  • Minnesota: est. about 1,290 (assuming 30% of 4,296 total since 2/21)
  • New York: (unknown)
  • Rhode Island: 32
  • Vermont: est. about 240 (assuming 2.5x people in 97 households)
  • Washington State: est. about 4,800 (asuming 30% of 16,000 total since 2/21)

TOTAL (not including New York): 195,967 206,906

OK, so that's 207K...plus whatever New York's number is. There's really no way of knowing this without the official report from the NY exchange, but assuming it's proportionate to most other states based on their Open Enrollment Period population, it should be somewhere between 6,000 - 8,000 people, meaning a grand total of roughly 202K - 204K people nationally. 214,000 nationally

The new numbers provided by Mangan's article for Kentucky, Rhode Island and Vermont bring the confirmed grand total QHP selections for 2015 up to:

  • 11,998,634 12,024,658

Again, this doesn't include a likely 450,000 or so additional off-season enrollments due to life changes (marriage, birth, adoption, moving, turning 26, losing current coverage, etc.).

What this does mean (to me, anyway) is that healthcare pundits and reporters should stop pushing for the HHS Dept. to move the Open Enrollment Period from the fall/winter season ahead to the following spring. I'll repeat what I wrote 3 weeks ago:

In the end, it appears that the type of person who still didn't know that there was a tax penalty even after 5 years of people screaming about it on every news media outlet every day tends to also be the type of person who still won't sign up even when you give them an extra 6 weeks to do so.

There's been a lot of discussion about whether it's better to keep open enrollment in the fall/winter season or to move it to the spring. The thinking is that as it stands now, people are distracted by the holiday season (Thanksgiving, Christmas, New Year's, Hanukkah, Kwanzaa), scrambling to deal with end of year finances and so forth. In the springtime, the thinking goes, matching the enrollment period up with the tax filing season would let people enroll at the same time they file their taxes, while discussing the penalty for not doing so with their tax preparer, etc.

However, while 140K 202,000 is a decent number of people, in my view it's not nearly enough to justify shifting things to the spring in the future, for a few reasons:

  • First, it's much easier to market and remember to align things with the calendar year. "Sign up now for January 1st coverage" is easier for people to get.
  • Second, if you enroll in late March, your policy won't even kick into effect until May...and if you enroll in late April, your policy won't start until June! That means that new enrollees could go uncovered for up to 5 months of the year, which is insane.
  • Third, even worse, insurance deductibles are based on the full calendar year. If you have a $3,000 deductible, instead of having 12 months to "use" it, you'd only have 7-8 months to do so before it's used up, which means you're effectively losing money (assuming you get injured/sick a few times per year, of course)
  • Fourth, this would play havoc with the insurance actuaries when trying to set rates for the following year.
    • Last year, due to the first-year special 6-month enrollment period and the ugly technical problems at the launch, only about 2 million exchange policies, or 28% of the peak enrollment total, actually started on January 1st; another 400K started in February, 800K in March, 1.1 million in April and 2.4 million in May, at which point things slowed down considerably.
    • This year, with the shortened period and improved exchange technology, as well as the huge auto-renew pool, a whopping 75% of the likely 10.1 million peak enrollment number was already effectuated out of the gate on January 1st (around 7.6 million). Another 600K or so started in February, 1.8 million in March...at which point things dropped off.

Next year open enrollment is also 3 months, but pushed back a couple of weeks (Nov. 1st - January 31st). With luck, the January 1st effectuations will increase a bit further to, say, 85% or so of total 2016 enrollments. The more people (and higher percentage) start their coverage at the very beginning of the year, the easier it is to track things like attrition, doctor visits, prescriptions, procedures and so forth.

Now, what the HHS Dept. probably should do in the future is actually something along the lines of what they just did...except more formalized. Something like:

  • Oct. 1st - Jan. 31st: Open Enrollment
  • Apr. 1st - Apr. 30th: Tax SEP Only

They don't have to make a huge thing out of it, and the numbers would probably be nominal going forward as more and more people get used to how the system works, but it would help diffuse (or even defuse) the number of people griping about the tax penalty every spring. The key thing is to lock down the dates consistently instead of them bouncing around like they have been until now.