UPDATE: Have QHP enrollments have INCREASED since June?

When I updated my #OE3 state-level enrollment projections yesterday, I came across this official projection for #OE3 from Your Health Idaho's Sept. 18th board meeting minutes:

Rep. Rusche asked what our target enrollment is for this cycle and what barriers we see in making those targets. Mr. Kelly said the team is focused on the 80% goal of 92,000 as our enrollment target.Premium increases are a potential barrier. Net premium is a relatively small increase for most consumers, and each consumer will experience something different depending Page 5 of 14 on their plan, their location, their carrier, etc. We feel that while the premiums are increasing the relatively small net premium increase will mitigate this barrier to a large degree.

When I asked for clarification, they informed me that:

We currently have 86,659 effectuated enrollments with Your Health Idaho, as of September 15. The 92,000 would also refer to effectuated enrollments.

As noted yesterday, the 92K "effectuated" number means that their actual projection for QHP selections is more like 105K or so, which is pretty close to what I had projected anyway.

However, there's another noteworthy data point here: They stll had 86,659 people enrolled in effectuated policies as of 9/15.

This is important because it gives some insight as to net exchange attrition during the off-season. Here's how things have played out nationally this year:

That's an 87.2% retention rate nationally (-12.8%) and a near-identical 87.5% in Idaho (-12.5%)

Hmmm...the national effectuated number went down another 2.3%...but in Idaho it went up by nearly 1,000 (+1.2%)

  • As of 9/15/15: ??? effectuated nationally / 86,659 in Idaho (+0.8%)

Up several hundred more!

How about other states? Well, I don't have data since June 30 for most of them, but for the ones I do have:

    • 2/21/15: 109,839 selected
    • 3/31/15: 98,269 effectuated (-10.5%)
    • 6/30/15: 92,213 effectuated (-6.2%)
    • 10/1/15: 95,601 effectuated (+3.7%)
    • 2/21/15: 120,145 selected
    • 3/31/15: 114,559 effectuated (-4.6%)
    • 6/30/15: 120,517 effectuated (+5.2%)
    • 9/30/15: 120,617 effectuated (+0.08%)
    • 2/21/15: 140,540 selected
    • 3/31/15: 124,010 effectuated (-11.8%)
    • 6/30/15: 156,448 effectuated (+26.2%)
    • 9/30/15: 179,470 effectuated (+14.7%)

I should note that Massachusetts is a special case; they have a unique situation with their "ConnectorCare" program which has open enrollment year-round.

I guess my point here is that while there was substantial attrition nationally from the end of 2015 open enrollment through June 30, the vast bulk of this was due to a) open enrollee period additions not paying at all, and b) the 423,000 people who got kicked off for legal residency verification issues.

While there have obviously been some cases of both since June, judging by the 5 states above (CT, CO, ID, MD & MA), it looks like the "net attrition" issue may no longer be an issue.

In fact, in all 5 states above, effectuations have increased since June. However, none of these 5 states are on/near the Mexican border, where I'm assuming the vast majority of "legal residency verification" issues can be found. Also, their combined populations only make up 23.3 million people, or 7.3% of the total popluation, whereas several of the border states are huge (Florida, Texas, California). Therefore, I'm gonna hedge my bets and assume a small enrollment decrease after all. Hopefully HHS will issue a 9/30 national number just ahead of #OE3.

If these 5 states are representative, however, the national effectuated number going into November may not have dropped since June after all or could conceivably have gone up...which is why I still have it pegged at around 9.7 million as of December 1st, even though the HHS Dept. is still sticking with their 9.1 million end-of-year projection.

UPDATE: Here's the District of Columbia exchange enrollment data:

INDIVIDUAL MARKET: On September 1, 2015, we estimate there were 14,789 people enrolled in the individual market. To give another point in time as a reference on July 1, 2015, estimate of enrollees in the individual market was 14,534. These are people who are actively enrolled.

  • 2/21/15: 18,465 selected
  • 3/31/15: 14,960 effectuated (-19.0%)
  • 7/01/15: 14,534 effectuated (-2.8%) (alternately, use the CMS report form 6/30, which had DC at 14,637, or -2.2%)
  • 9/01/15: 14,789 effectuated (+1.8%)

Once again, effectuated exchange enrollments have increased since the end of June. That's a solid increase across 7.5% of the national population. Put another way, across these 5 states (+DC), combined effectuated enrollments have increased 5.8% from June through September, from 603,893 to 638,987. However, I'm going to remove Massachusetts since it's a special cae, which drops the increase to a less-dramatic-but-still-noteworthy 2.7%.

Again, I won't be sure about this until I get a currently-effectuated border state number, but if that rate is representative, the current national effectuation number could be as high as 10.2 million as of today.

If I'm correct about this, it's important for a couple of reasons. First of all, on a personal level, it'll mean that my 9.7M estimate for December will (again) be far closer to reality than the HHS Dept's 9.1M projection.

More importantly, however: If December effectuated exchange enrollments are that high (or anywhere close to it), that's up to 1.1 million more people who could potentially renew their policies for 2016 than HHS has projected (right now they're officially assuming 9.1 million enrolled, of which about 8.0 million will renew their policies).

This doesn't change my projection at all (I was already expecting about 9.0 million renewals out of 9.7 million), but it does make my higher renewal projection much more likely than theirs.

UPDATE: Unfortunately, neither Florida nor California were able to provide updated numbers since June (and I'm not even gonna bother trying Texas). I'm checking in with a few other states to see if they have any additional numbers, but for now my theory is based on 6 states representing around 7.5% of the population:

UPDATE 10/22: I've received a hard September effectuation number from MNsure (Minnesota's exchange). This is the first state I've found to have a net reduction in effectuated QHPs since June...but it's still only a 2.1% drop.

UPDATE 10/22: Washington State has released their September effectuation number; it's the first state with a significant drop (7.1%), which lowers the likely national increase to just 2.7% if you include Massachusetts, or a very slight (0.1%) drop without MA: