CMS releases Q3 Effectuated Enrollment Report as well!

Wow...I guess CMS really wanted to get the hell out of dodge for the holidays; they issued a massive data dump of ACA enrollment data today. In addition to the Weekly Snapshot with (most of) the Autorenewals included, they also finally released the 2015 Third Quarter EFFECTUATED policy report:

September 30, 2015 Effectuated Enrollment Snapshot

On September 30, 2015, about 9.3 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of September. HHS’s effectuated enrollment projection continues to be 9.1 million people for the end of 2015.

Of the approximately 9.3 million consumers nationwide with effectuated Marketplace enrollments at the end of September 2015, about 84 percent, or more than 7.8 million consumers, were receiving an advance payment of the premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $271 per month.

There were 6.7 million consumers with effectuated enrollments at the end of September 2015 through the 37 Federally-Facilitated Marketplaces, including State Partnership Marketplaces and supported state-based Marketplaces that utilize the eligibility and enrollment platform (collectively known as states) and 2.6 million through the remaining State-based Marketplaces. Effectuated enrollment for the 37 states that use platform as of June 30, 2015 was 7.2 million, and 2.7 million for the remaining State-based Marketplaces.

As regular readers know, while nearly 11.7 million people selected policies during the 2015 Open Enrollment Period, about 10% of them simply don't end up paying their first premiums at all, while others drop out throughout the year for a variety of reasons, including turning 65 and moving to Medicare; getting a job with ESI benefits; falling on hard times and moving to Medicaid; getting married and moving to their spouse's non-ACA exchange coverage; and so on. In addition, some are kicked off involuntarily; in the first half of 2015, 423,000 people had their policies cancelled because they weren't able to provide proper legal residency verification.

Of course, other people are also moving onto the exchange policies at the same time (variants of the above examples), but overall there has been a net loss throughout the year, as people dropping policies outnumber those being added.

For 2014, the effectuated numbers played out roughly as follows:

In other words, 2014 effectuations ended the year with a net attrition rate of 21.0%, of which around 4.5% occurred in the fourth quarter of the year.

So, how about 2015?

HHS says that they're still targeting around 9.1 million effectuations as of the end of December (12/31/15), and that seems pretty reasonable based on the September figure. That would actually be a worse retention rate than last year (22.1% instead of 21%).

So, aside from filling in the third quarter attrition number which I've been racking my brain trying to figure out for awhile now, what else do these numbers tell us?

Well, for one thing, look at the last third paragraph in the quote above:

  • 6.7 million effectuated via, 2.6 million via the state-based exchanges.

That's a ratio of 72% to 28%...which is different from the 76/24 split I've been assuming. This makes a big difference when trying to calculate how many potential auto-renewals there are.

Let's assume that HHS is correct that they'll end the year with exactly 9.1 million effectuations (which are all eligible for renewal, of course). If that 72/28 ratio holds true, that would mean only 6.55 million via as opposed to the 7.0 million I've been assuming.

So. 6.55 million, of whom 5.86 million have already renewed/re-enrolled (either actively or passively). That theoretically leaves up to 690,000 more people who could still potentially be automatically renewed.

Now, it's possible that there will be a nice surprise in the Week Eight Snapshot, but today's Week Seven report also specifically said that:

This snapshot, for the first time, reflects the vast majority of consumers who were automatically re-enrolled into 2016 coverage. The re-enrollment process has not yet been completed so as it continues, upcoming snapshots will include additional consumers who were automatically re-enrolled after December 19.

2.28 million have been automatically renewed via If there's 690K more to go, that would make those 2.28 million just 77% of the total.

Does 77% count as "the vast majority" of a given number??

I me, "the vast majority" means something like 85-90%, which would only allow for 250,000 - 400,000 yet to be added via the federal exchange. In fact, to err on the even more cautious side, I'm assuming an even lower figure: 150,000 more auto-renewals to be added next week.

In short, there's a lot of data to absorb here. I'm gonna have to take a fresh look at it all in the morning.