HC.gov releases Week 5 Open Enrollment Report: Still down 10.4% year over year

Week 5 via CMS:

Week 5, Nov 25 - Dec 01, 2018

In week three of the 2019 Open Enrollment, 773,250 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 3.20 million people in 31 days, which is 11.3% lower than the 3,604,440 in the first 32 days last year.

Adjusting for the 1-day difference however, HC.gov enrolled around 3.57 million people in the first 31 days last year, so the 2019 season is running around 10.4% cumulatively lower year over year for the first 31 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, just over 11% lower for the first 17 days and just under 11% lower 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
  • down 6.0% in Week Five (773,250 vs. 823,180)

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 most are running ahead of last year, or at least holding steady, however.

The table below shows the cumulative state-by-state numbers through 12/01/18, last year's numbers through 12/02/17, and last year's estimated numbers through 12/01/17 adjusted for the 1-day difference:

As you can see, Virginia and Maine continue to show dramatic drop-offs (explained, again, by Medicaid expansion coming to both states), while Florida and Mississippi continue to perform the best relative to last year.

Louisiana, 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 NH and PA are purple.

Population? NH and WV are tiny, but PA is 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 5, HC.gov had 2.61 million active renewals vs. 990K new enrollees...a 2.64:1 ratio.

This year, as of Week 5, HC.gov has 2.39 million active renewals vs. 812K new enrollees...a 2.94:1 ratio.

So, how likely is HC.gov to reach last year's total in the final 2 weeks (remember, this report only runs through 12/01)?

  • Last year, 8,743,642 people selected QHPs via HC.gov total, so 2019 was still 5.54 million short as of 12/01/18
  • Of those 8.74 million, there are likely still around 6.16 million currently enrolled as of December
  • Of those 6.16 million, I estimate around 97% will eventually re-enroll (actively or automatically), for a total of 5.97 million renewals
  • That means HC.gov would need 2.77 million new enrollees total
  • 812K new enrollees have signed up so far, so they'll need at least 1.96 million additional new enrollees between 12/02 - 12/15
  • For comparison, last year there were 2.46 million new enrollees added to HC.gov

In other words, in order to equal last year's 8.74 million total, HC.gov will have to add 310,000 more new enrollees than they did last year (about 12.6% more).

This...is unlikely to happen. As I've noted repeatedly, I expect national enrollment to drop by around 4.9% overall...but for HC.gov specifically, I expect a drop of around 5.3%, or roughly 463,000 people.