HHS Open Enrollment Conference Call Liveblog!!

UPDATE 4:00pm: OK, the HHS call is over now (see notes below), but now I'm on the Covered California call...and my kid gets off the school bus in 10 minutes, so it'll be a bit before I can post a fuller analysis of anything.

OK, everyone, here we go...a press call with the heads of HHS/CMS/HC.gov:

  • Secretary Sylvia M. Burwell, U.S. Department of Health and Human Services
  • Andy Slavitt, Acting Administrator, Centers for Medicare and Medicaid Services
  • Kevin Counihan, CEO, Health Insurance Marketplace

Remember, last years' total exchange enrollment was around 11.7 million nationally (8.8 million via HC.gov). HHS's official projection for 2016 was only around 10% higher (officially between 11.0 - 14.1 million, with a midrange around 12.6 million or so), while mine was more ambitious (around 25% higher overall, or 14.7 million).

While things were looking excellent through the December deadline, they dropped off to almost nothing right after that. The near flatline during Christmas and New Year's weeks made perfect sense and was in line with last year, but things didn't pick up at all after that; the first 3 weeks of January were still pretty much a dead zone.

In addition, there was also the confirmation of at least 300,000 (likely more) cancelled or purged QHP enrollees from the federal exchange (mostly those who failed to pay their January premiums in time). While this is no different from the first 2 years, for 2016 the difference is that CMS finally has the ability to yank at least some of these numbers from the total during open enrollment instead of waiting until after the dust settles. This has no impact whatsoever on the number of people enrolled, it just means that they're pulled off the total sooner than in the past.

Here we go (Sylvia Burwell):

  • 12.7 million national
  • Through 2/01/16 (1 extra day tacked on? huh...)
  • 400K BHPs in New York (this is new, until now Minnesota was only one w/BHP; MN added 33.3K to BHP program this year)
  • 4 million new people in HC.gov alone
  • 17.6 million net gain in total coverage
  • Over 90% covered
  • Much more active enrollment: 61% of new enrollees signed up early (2.4 million by December deadline)
  • People are paying for full year instead of waiting until March
  • 70% of renewals actively enrolled vs. 50% last year
  • Over 4.1 million used new search tools for network/drug coverage
  • 5.6 million 2015 HC.gov enrollees are back even after cancellations/etc.
  • Youth: 2.7 million 18-34 year olds (HC.gov only I think), higher % than last year, overall remains stable

Additional points (Andy Slavitt):

  • Tech improvements: 2014 was just about making it work
  • 2015 was about smooth operations/scaling
  • 2016 was about improving experience at both front/back ends
  • In other words, an apples-to-apples comparison with 2015 = over 13 million.
  • We have better idea of how many have CANCELLED as well, helps carriers streamline operations/etc. as well.
  • 4 million new enrollees on HC.gov states alone
  • More info known about new consumers (younger, deadline driven, penalty-driven)
  • 70% of returning consumers did actively re-enroll (vs. 50% last year); increased even since December (60%)
  • Those who actively renewed were 38% more likely to keep their coverage
  • Improvements for consumers but how are carriers reacting? Next year is mostly about improving plans/etc.


Kevin Counihan:

  • Miami, Houston, Chicago, Dallas, etc. markets saw huge improvements
  • 8 of the 10 markets with largest growth were in Texas


  • Indiana: Number went down year over year, due to Medicaid expansion being launched last year (this is likely part of Pennsylvania as well)
  • What about UHC/Anthem/etc. gripes re. losing money/etc? Answer: We're all new at this, so are they, they'll figure out how to adjust.
  • The 4 million new enrollees make a difference re. risk pool (ie, might not be as sick/etc. as those they replaced)
  • Have we plateaued re. reducing the uninsured number from current 29M or so? A: Remember 3M are in Medicaid gap, 5M are undocumented immigrants, etc. Will keep pushing.
  • How does final week compare with last year? (Answer: 687K this year, last year it was 1.2 million (including 200K overtime period)); pushed hard to get them front-loaded in December instead of waiting for January.
  • 61% of new consumers came in by 1/1 vs. 40% last year
  • Re. 10 million end of 2016 projection? Answer: Yes, they still think it'll be 10M in Dec. 16
  • How did the tax penalty play into it? 
  • How about shifting open enrollment towards tax season? Answer: Nothing final yet, right now they're scheduled to keep it Nov - Jan
  • How about expanding SEPs? Example: Co-Op dropped hospital from network (ie, network adequacy for SEP?) Answer: Nope.
  • Which city won the POTUS visit for improving enrollment the most? Ask the WH, we'll release city by city info later
  • Why % of new enrollees being younger increased is relevant since overall % is about the same? 1/3 are new; hopefully this batch are less sick/injured than the old 1/3
  • Markets with most young people? (ie, regional/state-wide demographic breakdown)? Dunno that yet.
  • TOP LINE NUMBERS ONLY today, which means between Snapshot report and what I have so far, most states are known
  • 70% who actively re-enrolled: All switchers, or how many stuck with same plan? 61% of those 70% switched, 39% stayed w/same plan.
  • 5.6M renewals via HC.gov, 9.3 million (total) were effectuated as of 9/30; what was the 12/31 effectuation number & why did so many not return?
  • What about Flint, Michigan? (extension), and what about hardship exemptions? A: They're working with fed/state/local authorities & carriers; BCBSMI had extended hours/staff for Flint for both QHPs & Medicaid, etc. Dunno about increased hardships
  • "Above Expectations"? Range was 11 - 14.1M; they hit the upper half of that (12.55M); that range used old model without pre-purges. 12.7 million understates apples to apples comparison; also doesn't account for 400K NY BHP.
  • Final Question re. Indiana shift to Medicaid: Automated process to shift them over.