HC.gov releases Week 4 Open Enrollment Report: Still down 11% year over year

Week 4 via CMS:

Week 4, Nov 18-24, 2018

In week three of the 2019 Open Enrollment, 500,437 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

The cumulative number is 2.42 million people in 24 days, which is 12.8% lower than the 2,781,260 in the first 25 days last year.

Adjusting for the 1-day difference however, HC.gov enrolled around 2.73 million people in the first 24 days last year, so the 2019 season is running around 11% cumulatively lower year over year for the first 24 days.

Enrollments were down 20% (adjusted for the 1-day difference) year over year in the first three days, 13% lower for the first 10 days, 11% lower for the first 17 days...and are still around 11% down for the first 24 days.

HOWEVER, on a per-week basis, enrollments were:

  • down 20% in Week One (3 days vs. 4)
  • down 8% in Week Two
  • down 6.3% in Week Three
  • down 0.8% in Week Four (500,437 vs. 504,181)

The reason the overall drop is still around 11% in spite of Week 4 being nearly the same is a matter of rounding (from just over 11% to just under).

Keep in mind that I'm actually expecting HC.gov enrollment to drop around 5.3% year over year due to a combination of sabotage factors (around 460,000 people), as well as one positive development (Medicaid expansion in Virginia will likely siphon off around 85,000 exchange enrollees, plus up to 15,000 or so in Maine), while I only expect the 12 state-based exchanges to drop by around 2.3% (110,000 people).

So far, the limited data I have for state-based exchanges suggests that they're holding steady or actually have increased their enrollment numbers year over year, however.

In addition, CMS has started breaking out the HC.gov numbers by state. The table below shows the cumulative numbers through 11/24/18, last year's numbers through 11/25/17, and last year's estimated numbers through 11/24/17 adjusted for the 1-day difference:

As you can see, Virginia and Maine continue to show the most dramatic drop-off (explained, again, by Medicaid expansion coming to both states), while Florida and Mississippi continue to perform the best relative to last year (although both are actually starting to fall off...Florida went from running 3.5% ahead to just 1.5%, whiile Mississippi went from being 1.2% ahead to slightly behind).

Louisiana, Illinois, Missouri, New Hampshire, Pennsylvania and West Virginia all continue to lag over 20% behind last year...and unlike Virginia and Maine, there doesn't appear to be any obvious reason why they're so far behind other states.

Ideology? LA, MO and WV are pretty red states these days...but Illinois is pretty blue, and NH and PA are purple.

Population? NH and WV are tiny, but IL and PA are large...and LA & MO are mid-sized.

Every state except West Virginia is either #SilverLoading or #SilverSwitching, so that doesn't appear to be a factor. Huh.

UPDATE: Let's take another look at the topline numbers, specifically the New vs. Active Renewal numbers:

Last year, as of Week 4, HC.gov had 2.06 million active renewals vs. 718K new enrollees...a 2.87:1 ratio.

This year, as of Week 4, HC.gov has 1.84 million active renewals vs. 588K new enrollees...a 3.12:1 ratio.

Put another way, when you account for the missing day, renewals are only down around 9%..but new enrollees are down around 16.4% so far.

If you're looking for signs that the Trump Administration's massive slashing of both the marketing and navigator budgets for HealthCare.Gov are having a negative impact, it's that second number that I'd concentrate on.