Charles Gaba's blog

As I noted this morning, I'm expecting roughly 87,000 people to either enroll or renew their healthcare policies nationally via the assorted ACA exchanges (either HealthCare.Gov or one of the state-based exchange sites like Covered California, New York State of Health and so on) in the first 24 hours of the 2017 Open Enrollment period...which is to say, by midnight tonight.

I mention this because just moments ago in my post about Minnesota's exchange website and phone lines being attacked, I closed by light-heartedly noting that a straight national extrapolation of MNsure's enrollment figures from their first 2 hours of operation would suggest over 180,000 people enrolling nationally in just a few hours. I then brushed off that possibility as being extremely unlikely; my official projection has total 2017 exchange enrollments hitting around 785,000 the first week.

Remember three years ago when HealthCare.Gov launched with all sorts of horrible technical problems, and many people were speculating that at least some of the tech issues may have been the result of deliberate, malicious attacks (hacking, DDoS attacks, etc) by those opposed to either President Obama, the ACA or both?

Well, that turned out to be mostly hooey; while I'm sure there were some attempts at messing with the system, the technical problems were for the most part good old fashioned unintentional screw-ups by either the vendors, the HHS management or a combination of both. The Obama administration quickly brought in the Code Red crash team to fix the problems, and for the most part the federal exchange started working pretty well. Further improvements the past few years have completely transformed it into a pretty quick, easy, seamless experience for most people, to the point that it's now literally operating 100,000 times better than when the website first launched.

Me, last Thursday:

There you have it: The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

Those which implemented only one or two of the above provisions come in at around 26%. In a possibly coincidental quirk, all five fo the "halfway" state exchange states (Hawaii, Oregon, Nevada, Kentucky and New Mexico) just happen to also fall into this category as well, which is completely appropriate.

Finally, states which are fighting the ACA kicking and screaming (no Medicaid expansion, no state exchange and allowing transitional plan extensions as long as possible) are averaging around 30%.

Make of that what you will.

In honor of the launch of the 2017 Open Enrollment Period, I've whipped up a little widget:

Remember, this number includes all 50 states + DC. The number enrolling via HealthCare.Gov specifically should be roughly 77% of this figure.

(Put another way: Whatever the HC.gov enrollment figure is, increase it by ~30% to get the national total.)

The other day, I posted a bunch of charts which took a look at the average percentage rate hikes in various states depending on three different criteria: Whether they expanded Medicaid under the ACA or not; whether they allowed Transitional plans or not; and whether they ran their own full exchange (as opposed to just offloading the whole enrollment platform to the federal exchange). My conclusion, which has generated a lot of response, was that there's a definite pattern here:

The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding Medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

(sigh) OK, with three states still missing, you just knew I wouldn't rest until I was able to fill in the missing pieces of the puzzle. Sometime today, the HHS Dept. finally entered the approved rate hikes for individual makret carriers in two of those states: New Hampshire and Virginia. Louisiana is still AWOL for whatever reason.

It's important to note that sometimes the "Final Rate Increase" percentages listed at RateReview.HealthCare.Gov dont' actually end up matching the approved rate hikes found in the official SERFF databases or even at the state's Dept. of Insurance website. Normally I cross-check all three to make sure nothing weird is going on, but given that it's well past time to move on, I'm relying purely on the RateReview numbers for these states.

With that in mind, here's what it looks like in each:

I've received a ton of praise over the past few months from right-wing pundits and media outlets (as well as GOP politicians and their staffers) for accurately projecting the estimated 25% average rate increase for unsubsidized individual market policies. I'm even getting kind words from Avik Roy, and the Republican Presidential nominee is now citing my data (even if he's then bastardizing and denying it at the same time). While there are numerous important caveats and disclaimers attached to this estimate, as a supporter of the ACA in general, I obviously wish I had been overstating that number.

Now it looks like another projection of mine is gonna be proven (unfortunately) accurate.

A week and a half ago, the HHS Dept. confirmed that as of the end of the 2nd quarter (June 30), there were about 10.5 million people still enrolled in effectuated QHPs via the ACA exchanges. As I noted at the time, this was about 300,000 fewer people than I had assumed would be enrolled at that point, so I revised my projections for the second half of the year:

I assumed a similar pattern to last year, with roughly 15% net attrition as of the end of June, which would have resulted in roughly 10.8 million people having effectuated exchange policies as of 6/30/16. Instead, they say it was around 10.5 million. Based on this new data, I'm revising my net attrition estimates for the rest of the year to perhaps 9.8 million as of the end of September. If so, this would result in ending 2016 with around 9.2 million people enrolled in effectuated exchange policies, for a 2nd-half monthly average of around 9.9 million and a full-year monthly average of around 10.1 million.

The main focus of this Late Night with Seth Meyers segment is about how Donald Trump completely whiffed on what should have been a reasonably strong attack on Hillary Clinton: Namely, the 25% average unsubsidized individual market rate hikes which are coming next year.

In the process, however, Meyers actually did a fairly good job of summarizing the situation:

"Now, that's bad news on the surface...but it's still in line with the projections made by the Congressional Budget Office. Obviously, Obamacare is a nuanced, complicated issue that requires sober analysis and discussion...or, as Donald Trump put it..."

(Trump saying insane nonsense)

NOTE 10/29/16: For anyone who read this entry yesterday, please note that I've gone back and completely reworked all 4 the charts, along with adding a fifth one, for several reasons:

• I had to correct an error re. Medicaid expansion (I had Iowa not expanded and Wisconsin expanded by mistake)
• I was able to add the final approved averages for both New Hampshire and Virginia, leaving Louisiana as the only state with a "requested" average only
• The original graphs only listed the median rate hikes for each group; they now list the actual weighted averages for each group of states
• I even added a fifth chart which separates the states out into those which embraced all 3 provisions vs. those which only embraced 1 or 2 of them, and those which didn't implement any.

OK. I ran the numbers several different ways way back in August, when I had compiled the requested 2017 individual market rate hike averages for all 50 states (+DC). However, many things have changed since then. Not only do I have the approved rate changes for 48 states, there were a lot of other major changes along the way, including various carrier pullouts and rate filing re-submissions.

Now that the dust has settled and the 2017 Open Enrollment Period premiums are finally locked in, let's take another look at the average unsubsidized rate hikes by state, ranked by different criteria.

As noted before, I'm really trying to move onto the actual enrollment part of the 2017 open enrollment period, but I can't resist doing some more final cleanup of my Rate Hike project:

• SOUTH CAROLINA: This is one of the 5 states which I still didn't have approved rate changes for. Today the RateReview.HC.gov site finally added in the final numbers for SC, so here's what it looks like:

Aetna was a bit tricky--the total enrollee number is actually 41,988. They dropped out of the ACA exchange but are sticking around the off-exchange market, so I had to figure out how many of those 42K are on vs. off-exchange. The answer is in this article which notes:

More than 220,000 South Carolinians rely on the federal health care law for insurance. This year, only 8,000 of them are covered by Aetna plans.