Old 'n Busted: 23M ACA enrollments; New Hotness: 24.5M???


In my last 2024 ACA Open Enrollment Period projection on January 4th, I concluded that:

...we could now be looking at anywhere from 21.4 - 22.7 million QHPs, for a grand total of somewhere between 22.7 - 24.0M QHPs+BHPs combined by the time the dust settles in every state on January 1st. I'll stick with 23M for the moment just in case...

A week later, the Centers for Medicare & Medicaid Services (CMS) posted their final pre-deadline Open Enrollment Snapshot Report, which confirmed that over 20.3 million people had selected Qualified Health Plans (QHPs) through December 23rd.

How about since then, however? Well, the table below breaks out the hard enrollment data since 12/23 which has been published by 8 of the 19 state-based ACA exchanges, then averages the per-day increases and adjusts those to bring all of them up through January 15th.

Assuming these are all representative & proportional nationally, it would mean that total QHP enrollment increased by around 4.7% from 12/23 - 1/15 (I'm ignoring the extra day tacked on in most states yesterday to allow myself some wiggle room), or an additional 950,000 people nationally. Tack on perhaps 25,000 more in the 7 states with post-1/16 enrollment deadlines and that's nearly 1.0 million more people signing up on top of the 20.3M reported by CMS on Jan. 4th:

If you then add over 1.3 million BHP enrollees in Minnesota & New York (something CMS still seems to treat as an afterthought, although at least they've started including BHPs as a footnote), and throw on the 11,000 subsidized QHP enrollees in Colorado's OmniSalud program for good measure, you get to 22.67 million QHPs + BHPs total.

HOWEVER, there's one other important factor I have to take into account:

All 8 of the states with post-12/23 enrollment data available are state-based exchanges. The 19 SBMs as a whole have "only" seen QHP enrollment go up an average of 13.8% year over year...as opposed to the 32 states on the federal exchange, which have seen a stunning 40% y/y increase.

In other words, there's a good chance that FFM states have seen 2.9x the additional enrollment since 12/23 as the SBM states.

Assuming that's the case, here's what the post-12/23 enrollment could look like:

This would put total QHP enrollment at nearly 22.5 million, and total QHP+BHP enrollment at an astonishing 23.8 million people nationally...which would likely be more than current Medicaid Expansion enrollment, which topped out at 24.8 million back in May 2023 but which has likely dropped by several million people since then via the ongoing Medicaid Unwinding process.

Of course, it's also entirely possible that these 8 states aren't representative of the rest of the country at all. We'll find out soon enough...

UPDATE: OK, minor tweak: New Mexico just confirmed that their final enrollment total jumped by over 1,500 more people on the final day (yesterday). If I add that to the spreadsheet it would push the high-end estimate up by another 144,000 nationally if its representative (which, again, it may not be). If so, this puts the QHP total at over 22.6M and the QHP + BHP total at just shy of 24 million. I don't think it'll quite get there but you never know...

UPDATE 1/18/24: Whoa. Several more state-based exchanges have issued enrollment updates yesterday & today, including final numbers from Colorado, Maryland and Minnesota as well as a semi-final update out of Pennsylvania (which still has until Friday night before their deadline).

When I add these into the mix, it brings the number of states up from 8 to 11 (MD, MN & PA are new), and more importantly it bumps up both my low-end and high-end projections further yet to:

  • Low end: 21.4M QHPs, 22.8M QHPs + BHPs combined
  • High end: 22.8M QHPs, 24.2M QHPs + BHPs combined

UPDATE 1/18/24: Well, now. The WASHINGTON HealthPlanFinder has also posted their final 2024 OEP tally (rounded to the nearest thousand), which bumps my national projection up yet again:

  • Low end: 21.5M QHPs, 22.8M QHPs + BHPs combined
  • High end: 22.9M QHPs, 24.3M QHPs + BHPs combined

It's even conceivable that the QHP-only total will end up nudging just over the 23 million line.

UPDATE 1/18/24: ...and now CONNECTICUT has chimed in. Access Health CT has posted the slideshow for today's board of director's meeting, in which they report a 19.4% year over year enrollment increase. This further nudges my projection up:

  • Low end: 21.5M QHPs, 22.9M QHPs + BHPs combined
  • High end: 23.0M QHPs, 24.4M QHPs + BHPs combined

It's even conceivable that the QHP-only total will end up nudging just over the 23 million line.

UPDATE 1/19/24: MAINE has now published their final tally; while the Pine Tree State actually enrolled fewer people this year than last, they did see a final-week surge which still bumped up their post-12/23 average on my spreadsheet. In addition, Connecticut's official total appears to be slightly higher than I though yesterday.

Combined, the Maine & Connecticut updates nudge things up a smidge further; my national projection now stands at:

  • Low end: 21.5M QHPs, 22.9M QHPs + BHPs combined
  • High end: 23.1M QHPs, 24.5M QHPs + BHPs combined

Again, 23 million QHPs is now quite possible, and 24.5 million QHPs/BHPs is conceivable.

UPDATE 1/23/24: I've added a minor update out of the District of Columbia as well as the official, final total out of Nevada.

DC dropped the average slightly but this was more than made up for by Nevada:

  • Low end: 21.6M QHPs, 23.0M QHPs + BHPs combined
  • High end: 23.1M QHPs, 24.5M QHPs + BHPs combined