Woot! HC.gov reports 1.6M enrollees in the 1st week of 2024 Open Enrollment!

OK, there isn't supposed to be a formal Open Enrollment Period report out for another week, but President Biden just tweeted out a pretty impressive topline number for the first week of the 2024 ACA Open Enrollment Period:

In the first week of Open Enrollment, 1.6 million people have signed up for a plan at HealthCare.Gov, including 301,000 new consumers – that’s a 50% increase from last year.

Join them by visiting HealthCare.Gov today.

— President Biden (@POTUS) November 9, 2023

This is excellent news, but it does bear some analysis even without any additional details being included.

First, I'm assuming "First Week" means the first full 7 days of Open Enrollment (Nov. 1st - 7th). The 1st fell on a Wednesday this year, and today's the following Thursday so that seems reasonable. This is important because the official CMS Public Use Files use Sunday - Saturday for their definition of "Weeks" which means the "First Week" of the 2023 OEP only included 5 days (Nov. 1st fell on a Tuesday last year).

Having said that, in the 1st "Week" (5 days) of the 2023 OEP, CMS reported that 811,305 people had selected Qualified Health Plans (QHPs) via HealthCare.Gov. Another 1,091,192 enrolled via HC.gov in the 2nd full 7-day week; 2/7ths of that would be another ~312,000 more people in the 6th & 7th day. Combine those and you get around 1.12 million enrollees on HC.gov in the first 7 days last year, so 1.6 million in the first 7 days this year is indeed a pretty damned impressive increase...around 43%, give or take.

This is actually even more impressive when you consider that:

  • Virginia split off onto their own state-based ACA exchange this year. Around 26,000 people selected QHPs in the first 7 days of OEP last year, so the denominator would be a bit lower...more like 1.1M, making this 45% higher
  • North Carolina is launching Medicaid expansion starting December 1st, meaning there's up to ~280,000 current ACA exchange enrollees in the "100 - 138%" range who are being moved onto Medicaid & who thus won't be enrolling in an ACA exchange plan for January 2024.

Next, let's look at the 301K new consumers part. I think CMS defines a "NEW" enrollee as someone who didn't enroll during last year's OEP. Depending on the definition of "new," a significant chunk of these "new" enrollees could be among the ~593,000 (thru July only!) "Medicaid Unwinding" population who were kicked off of Medicaid or CHIP and transferred over to an ACA exchange plan instead.

To be clear: There's absolutely nothing wrong with this! No one is "misrepresenting" the number of new enrollees here; it's just important to understand where these folks are coming from. It's still an impressive enrollment increase whether it includes Unwinding transferees or not, it's just that it's even more impressive if it doesn't include them, since that would mean 301,000 brand new enrollees already (ie, people who weren't already enrolled via a Special Enrollment Period).

It's also important to remember that the 1.6M figure only includes those who enrolled via the federal ACA exchange, which hosts 32 states this year. It doesn't include the other 19 states which operate their own exchanges. Last year these states (including Virginia) made up 27.5% of total OEP enrollment. If you extrapolate the 1.6M via HC.gov out to all 50 states +DC, it would make total Week 1 enrollment something like 2.1 million people nationally.

In any event, this bodes very well for the rest of the 2024 Open Enrollment Period. As I noted, I'm expecting total QHP enrollment to increase by up to a million more people, along with a significant increase in BHP enrollment in Minnesota & New York, for a total of perhaps 18.5 - 19.0 million combined total.

Stay tuned...