Yesterday, in light of the Aetna announcement (coming on top of similar bombshells from UnitedHealthcare and Humana earlier this year), I took a stab at trying to calculate just how many current exchange-based enrollees will lose whatever plan they're currently enrolled in whether they want to switch to a different one or not. My conclusion is that up to 2 million of the 11 million or so will not, in fact, be able to "keep their plan if they like it" due to either the carrier going belly-up (4 more co-ops), the carrier pulling out of their county/state (UHC, Humana, Aetna) or the carrier dropping certain types of plans (BCBS of Minnesota). The number might be a few hundred thousand higher than that, actually, since there are other, smaller carriers here and there making changes to their plan offerings and/or participation levels.
This, of course, once again brings up President Obama's infamous "If You Like Your Policy, You Can Keep It!" promise, which he made a whole bunch of times throughout the contentious battle to get the ACA passed back in 2009-2010.
UPDATE: Wesley Sanders (via Twitter) pointed out that technically speaking, the headline above isn't quite accurate: In some cases, the enrollees in question will be automatically "mapped" to a different plan if they fail to actively shop around and pick a new policy themselves. So I suppose a more accurate headline would be "How many people will NOT have the same policy as of January 1st no matter what?"
The HHS guidelines indicate that an exchange cannot map enrollees to a plan offered by a different carrier. So if your health insurance carrier is exiting the exchange or pulling out of the individual market altogether – as is the case with 12 CO-OPs in November and December – the exchange generally won’t automatically re-enroll you in a similar plan from a different carrier. (New York State of Health made an exception for CO-OP members who lost coverage at the end of November.)
If your carrier is pulling out of the exchange but continuing to offer off-exchange coverage in your area, state regulations on guaranteed renewability will apply; the carrier may be able to auto-renew your coverage outside the exchange (which means you’d lose any premium subsidies and/or cost-sharing subsidies you were receiving in the exchange), or you may be directed to select a new plan during open enrollment.
That last paragraph is actually really important in the case of Aetna, who says that they plan on sticking around off-exchange in most of the areas that they're dropping on-exchange policies...if those enrollees aren't careful, they could end up "keeping their plans" after all...except that they'd suddenly go from paying, say, 20% of the full price to 100%.
UPDATE x2: OK, I've been informed by a source at the HHS Dept. that the above policies are NOT quite accurate after all:
"if an issuer no longer offers a particular plan, we work with states to enroll the consumer in as similar a plan, as best possible. Under some circumstances, this could be with a different issuer. (Of course, consumers still have the option to go back to HealthCare.gov and select a new plan during open enrollment.)
"Highlight #2 is not true."
I apologize for the confusion on this issue; it sounds like this policy may have changed for 2017. Louise assures me that she's updating her primer now.
Every year, both the HHS Dept. as well as myself make a point of strongly encouraging people to shop around, shop around, shop around when enrolling in ACA exchange policies, since doing so can usually result in a better deal being available. This remains the case this year: EVERYONE should shop around and see what's available, even if they end up sticking with the same plan in the end. You never know what you'll find.
However, there's a flip side to this advice: Every year, a substantial portion of current enrollees have no choice but to shop around, for a variety of reasons:
In 2013, a couple million people's policies were cancelled for not being ACA-compliant (about 5 million more were given a "transitional" period of up to three years, depending on the state).
In 2014, a million or so of those extended "transitional" policies expired. In addition, enrollees in Massachusetts, Maryland, Oregon and Nevada had to manually re-enroll whether they kept the same policy or not as those states switched to brand-new tech platforms.
In 2015, a dozen or so ACA-created Co-Ops failed, forcing around 800,000 people to have to shop around for a new carrier. Moda pulled out of a couple of states, Blue Cross dropped out of New Mexico and so on.
In 2016, 4 more co-ops have failed, plus the big drop-out announcements from UnitedHealthcare, Humana and Aetna.
In addition, throughout all 3 years, various carriers have dropped some types of policies in given states while retaining others...usually dropping PPOs but keeping HMOs, as Blue Cross did in Texas this year and is doing in Minnesota next year. In these cases, the enrollees may or may not have to switch carriers, but they will have to choose a different plan one way or the other.
Ever since the big Aetna news the other day, several people have asked me for my estimate of just how many people will have to shop around next year. Here's my best attempt to tally them up:
(Updated to add Jeffrey Young to the headline/body...I missed his name on the byline originally, apologies to him!)
Ever since Aetna dropped the bombshell 10 days ago that they were abandoning their previously-announced intention of expanding into additional state ACA exchanges next year and instead might even drop out of some of the states they're already participating in, plenty of people have smelled something fishy about the timing of the 180º turn, given that the original expansion announcement came in mid-May, followed by the Dept. of Justice annoucing that they were suing Aetna to prevent them from merging with Humana in July.
I noted this morning that several of the news stories about Aetna's announcement that they're pulling out of the ACA exchange in 11 states next year included this clarification:
In most areas it’s exiting, Aetna will offer individual coverage outside of the program’s exchanges.
At the time, I only mentioned it in terms of making it tricky to calculate how many current Aetna enrollees would be losing their policies and how much it might impact the average rate hikes for the individual market in that state. After all, if there are 10,000 exchange-based Aetna enrollees and 90,000 off-exchange in a given state, it makes a huge difference whether Aetna is dropping both on & off-exchange plans or on-exchange only.
Health insurer Aetna Inc. will stop selling individual Obamacare plans next year in 11 of the 15 states where it had been participating in the program, joining other major insurers who’ve pulled out of the government-run markets in the face of mounting losses.
Here's the full list of states Aetna is pulling up stakes in:
Arizona, Florida, Georgia, Illinois, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas
Here's the 4 states where Aetna will still be selling exchange-based policies:
Health Insurer Aetna Inc on Wednesday said it plans to continue its Obamacare health insurance business next year in the 15 states where it now participates, and may expand to a few additional states.
"We have submitted rates in all 15 states where we are participating and have no plans at this point to withdraw from any of them," said company spokesman Walt Cherniak. But he noted that a final determination would hinge on binding agreements being signed with the states in September.
Aetna sells the individual coverage on exchanges created by the Affordable Care Act, also called Obamacare. By also filing proposed rates in several other states, Aetna said it had preserved its options to participate in them as well next year. It declined to identify the potential new markets.
The 15 states where it currently participates are Arizona, Delaware, Florida, Georgia, Illinois, Iowa, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.
Now that the official ASPE Q1 2016 Effectuated Enrollment report is out, I can compare various state exchange reports against that to see how they're doing. In Washington State, 158,245 people were reported as being enrolled in active, effectuated exchange policies as of 3/31/16.
The WA HealthplanFinder has issued their July dashboard report, and their off-season retention numbers look pretty good: 168,958 people had paid their monthly premiums as of June...a 6.8% increase over the March figure. Even if this is off slightly due to methodology differences, it's still a good thing to see exchange enrollment up from earlier in the year, since overall enrollment is down at least 12.6% since the end of open enrollment due to non-payments, legal issues and so on.
The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of July), and the news is good. As I note every month:
Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.
The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.
As I keep noting, the DC exchange insists on presenting their enrollment numbers as cumulative since October2013.
As a result, I have to subtract the prior numbers from the current ones to find out the net increase in QHP selections, Medicaid enrollments and SHOP enrollments.
As I've been noting for a few months now, Connect for Health Colorado's monthly enrollment reports are chock full of data and confusing as hell at the same time.
As a result, I've started simply presenting them without much commentary. Here's the July report:
