Victory dance over. What's actually *in* the CMS report?

OK, now that I've gotten that out of my system, let's look at today's CMS report itself:

2015 Special Enrollment Period Report – February 23 – June 30, 2015

The next open enrollment period for Marketplace coverage begins on November 1, 2015 for coverage starting on January 1, 2016. Some people can sign up for health coverage outside of open enrollment, before November 1, because they qualify for a special enrollment period (SEP). A consumer can qualify for a SEP for such circumstances as loss of health coverage, losing Medicaid eligibility, changes in family status (for example, marriage or birth of a child), or other exceptional circumstances.

This snapshot provides information about consumers who selected a plan between February 23 and June 30, 2015 through the platform, which includes 37 states with Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces.

Nearly 950,000 new consumers selected a plan through the platform using a SEP between February 23 and June 30, 2015.

“Life changes are often impossible to predict, but access to affordable and quality health care coverage should never be. So far this year, nearly 950,000 people have gained the peace of mind that comes with access to coverage by taking advantage of a special enrollment period, providing us with further evidence that the Health Insurance Marketplace is working for America’s families,” said Kevin Counihan, CEO of the Health Insurance Marketplace. “We want people to know that if they lose a job, get married, have a baby, or experience other life changes, we’re here to help them find coverage they can afford.”

Today’s Special Enrollment Period Snapshot only reflects plan selection activity and, as such, does not capture whether consumers effectuated their enrollment and continued paying for health insurance coverage following the plan selection.

Overall SEP Activity

Between February 23 and June 30, 2015, about 944,000 new consumers made plan selections through using a SEP. Eighty-four percent of plan selections occurred via three types of SEPs: 50 percent of plan selections occurred via SEPs for the loss of health coverage or “minimum essential coverage”, 19 percent occurred via SEPs for being determined ineligible for Medicaid, and 15 percent were as a result of tax season SEP (Table 1). The remaining 16 percent of plan selections were attributable to other types of SEPs (see glossary).

They broke out the 943,934 off-season QHP selections by type of Special Enrollment Period:

  • Tax Filing Season: 143,707 (these were already included in my "confirmed" tally before today). This has made up around 15% of the total.

As I noted in my update to the previous post, I originally inadvertently double-counted the Tax Season SEP enrollees, and had to subtract 147,000 of them (the earlier-announced number) from the grand total. On the one hand, this brings things down to 12.9 million (12,909,955). On the other hand, this was still as of June 30, so the grand total as of today (August 13) almost certainly is at least 13.1 million after all.

  • Loss of Coverage: 467,385 (around 50%)
  • Determined Ineligible for Medicaid/CHIP: 180,561 (this is actually higher than I would've expected...19%)
  • Other (became citizen, gave birth/adopted a child, got out of jail, etc): 152,281 (16%)

The best part about today's report is that they not only broke out the off-season enrollments by type, they also did so by state, allowing me to bring the Spreadsheet up to date as well (through the end of June, anyway).

WARNING: The spreadsheet below is not for the faint of heart, but it's not nearly as scary-looking once you understand what everything means:

The first few columns are pretty obvious: The official total QHP selection tally as of the end of Open Enrollment on 2/22, followed by the total reported off-season enrollments since then in each state. For most states the off-season number is cut-off as of 6/30 (ie, today's report). For the state-based exchanges (blue states), the cut-off date varies widely. Idaho hasn't provided any updated numbers since Open Enrollment ended, for instance, while Minnesota just updated theirs as of a few days ago. Other states range widely in between.

What I've done with the other columns is to subtract the tax season-specific SEP enrollments (since those were non-standard and stopped as of the end of April), then divide the balance by the number of days since 2/22 to get the daily average for each state. Then, I take that number and multiply it by the number of days since the last update.

For example, Alabama had 19,120 off-season QHPs from 2/23 - 6/30. However, only 15,578 of those are "normal" off-season enrollments (the rest were done via the special tax season SEP).

Divide 15,578 by 128 days (2/23 - 6/30) and you get 122 people selecting a QHP every day for reasons other than the tax season penalty issue. Assuming that rate has held steady since 6/30 (and there's no reason to think it has changed much), that's another 5,300 or so from 7/01 - 8/13.

For a state-based exchange example, look at Colorado. They didn't allow a "tax season" exception, so all of their 11,700 off-season QHPs are counted...73 per day from 2/23 - 7/31. Apply that to the first 13 days of August and you have an extra 951 so far this month. 

Last year I estimated that roughly 9,000 people per day nationally were still selecting QHPs during the off-season, which ran for 7 months from 4/16/14 - 11/14/14, and was proven pretty close to the mark.

This year I decided to play things more cautiously given the unknown factors involved. I dropped my QHP selection estimates during the off-season down from 9K to 7,500 per day.

However, based on today's CMS report, it looks like it's coming in much closer to last year after all: According to my calculations above, roughly 8,500 people per day have been signing up nationally, only a slight drop from last year.

Another way of looking at it is specifically noted in today's report for Healthcare.Gov:

Figure 1 illustrates SEP activity over the February 23 – June 30, 2015 period. From February 23 to March 14, prior to the beginning of the tax season SEP, SEP plan selections averaged over 5,000 a day. With the beginning of the tax season SEP on March 15, there was a gradual increase in daily SEP activity, culminating in more than 38,000 plan selections on April 30, the final day of the tax season SEP. Of the 38,000 plan selections, more than 17,000 plan selections were due to the tax season SEP. Since the end of the tax season SEP, SEP activity averaged over 6,000 SEP plan selections per day between May 1 and June 30.

Healthcare.Gov is responsible for roughly 76% of all exchange QHP selections, with the 14 state-based exchanges making up the rest. That would be around 7,900/day nationally.

It's safe to assume that the reality is somewhere in between 7,900/day and 8,500/day; splitting the difference brings it in at 8,200/day.

Based on this, I'm recalculating The Graph accordingly. Instead of breaking 13.1 million this week, it's far more likely that the 13.0 million mark was actually broken around the end of June, with the 13.1 million mark being hit about 3 weeks later, around July 18th...or roughly one month ago.

One other thing: The report also breaks out the SEP enrollments by age group, which is kind of interesting (remember, this is for Healthcare.Gov only, it doesn't include the state-based exchanges):

Hmmm...children and young adults (under 35) went from 36% of the total during open enrollment to 47% of the total, with the biggest jump being a doubling of the percent of children. This makes sense assuming that a large chunk of the 152K who fall under "Other" were babies being born and added to an existing policy.

Of course, without knowing the age demographics of those who are dropping their policies, there's no way of knowing what sort of impact (if any) this is having on the relative risk pool, but it's certainly a good thing that more younger people have been joining the mix.