Charles Gaba's blog

Back on December 17, I noted that the Maryland ACA exchange had managed (with the help of automatic renewals) to achieve just under 150,000 QHP selections as of 12/15...which happened to be both their and my projected target for the full 2016 Open Enrollment Period. This was excellent for two reasons: They had effectively hit the target (well, 149,765, anyway)...and had done so with nearly 7 weeks to go.

Today they've updated their numbers and the performance since 12/15 has been, well, quieter:

1) More than 382,000 Marylanders have gotten coverage since Open Enrollment started.

As of Dec. 28, 362,520 Marylanders enrolled in health coverage for 2016, including 71,055 Marylanders who chose a new Qualified Health Plan, and 79,238 people already enrolled who renewed their plan for next year. This also includes 212,227 Marylanders who enrolled in Medicaid coverage through the state marketplace since Nov. 1.

As expected, Week Eight was extremely quiet; not only did the entire week take place after the (extended) deadline for January coverage, but there was also Christmas Eve and Christmas Day to contend with. Needless to say, very few people feel like enrolling in healthcare coverage on December 24th or 25th.

Last year, just 96,000 people chose to do so between 12/20 - 12/26 in the 37 states covered by HC.gov. I was expecting slightly more this year (100K even), but only 74,000 did...26% fewer than the same week in 2014. Whatever else is going on, it's safe to say that the Open Enrollment Periods are starting to become more and more "front-loaded".

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Kentucky, New York or Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

With all those caveats out of the way, here's where things stand. Just like last year:

When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

As I noted last Tuesday, the Week Seven HC.gov Snapshot Report threw a bit of a curveball; while they did add most of the bulk auto-renewals to the total, they also stated that some unknown number had yet to be added. As far as I can tell, that number could be as low as 1...or (theoretically) as high as 680,000. My best spitball take is that it was somewhere around 150,000, which presumably have all been added to this week's report.

As for new enrollments, with Week Eight taking place a) entirely after even the extended deadline for January coverage and b) the same week as Christmas Eve and Day, I'm not expecting many to be added; perhaps 100,000 or so, for a grand total of roughly 250,000 for the week, which in turn would bring the cumulative total (for the federal exchange only) up to right around 8.50 million even.

Today's New York Daily News has an article with the following headline:

NYC man sues health care provider Fidelis Care, says Obamacare gave him few options and insurer's site was 'plagued with errors'

Hmmm...OK, he's suing a private insurance corporation, saying that the private insurance corporation's website was error-plagued. So what part does the ACA play in this?

Trying to find a gynecologist for his wife on a New York state health care exchange gave a Manhattan lawyer a major headache.

In papers filed in Manhattan Supreme Court, Robert Neal Halpern says he and his wife were automatically enrolled in Fidelis Care after their previous Affordable Health Care Act insurer, Official Health Plan Marketplace, went belly-up in November.

Every time Covered California issues a press release, it's like Lucy pulling away the football from Charlie Brown; I always think that this time they're gonna finally let me know how many current ACA exchange enrollees have re-enrolled for 2016...but it never has that number included. Considering that it could potentially be as high as 1.3 million people, that's kind of a big deal (although I realistically expect the number to be somewhere between 1.0 - 1.2 million at most).

Anyway, today is no exception: Zilch on the renewal numbers (and not even any updated new enrollment figures since the 197K they announced as of 12/15)...although they did include one interestingly-worded tidbit which is subject to quite a bit of speculation:

Covered California Highlights Major Health Insurance Changes for the New Year — New Penalties, New Requirements and, for Those With Coverage, Improved Benefits, More Options and More Access to Care

Now that we're past the official (and extended) deadlines for January coverage in most states, I no longer have to add the auto-renewal caveat for states which "pre-loaded" them such as Rhode Island, Connecticut and Massachusetts. Having said that, Rhode Island, which already had one of the later deadlines in the first place, just bumped it out even later...all the way out through tonight (12/29).

Having such a small population, Rhode Island's latest update doesn't have much impact nationally, but it's still worth noting the weekly trend (remember, today's update still doesn't include the final 3 days of their extended deadline):

INDIVIDUAL AND FAMILY ENROLLMENT As of December 26, 2015:

Between the #RiskCorridorMassacre which helped wipe out a dozen ACA-created Co-Ops and UnitedHealthcare's peculiarly-timed panic attack last month, the conventional wisdom is that the ACA exchanges are causing health insurance carriers to go bankrupt by the bedpan-full, sapping their precious bodily fluids like a woman having sex with Brigadier General Jack D. Ripper.

According to Mark Farrah Associates and Allison Bell of LifeHealthPro, however, it turns out that the reality isn't quite that lopsided:

Some insurers said they were doing fine, and the biggest insurers reported solid 2014 profits.

...Mark Farrah Associates (MFA) has now published a review of 2014 medical loss ratio (MLR) data that implies that carriers in some states might have done a good job of setting premiums at a high enough level to generate underwriting gains.

Regular site visitors know that I spent several months last fall poring over various insurance carrier rate filings in order to patch together, as best as I could, a rough idea of the weighted average premium rate increases for each state (and nationally) based on the average rate hikes by individual carriers, weighted by their market share by effectuated enrollees.

This project was helped to some degree by the introduction of the HealthCare.Gov Rate Review Database, where you can easily search for different carriers by state/other criteria and find out what their average rate hikes (proposed and, later on, approved) will be for 2016.

Unfortunately, as I noted last June, there's a catch: The Rate Review site only included requested rate hikes greater than 10%. This was a serious problem for a couple of reasons:

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