Colorado

When I updated my #OE3 state-level enrollment projections yesterday, I came across this official projection for #OE3 from Your Health Idaho's Sept. 18th board meeting minutes:

Rep. Rusche asked what our target enrollment is for this cycle and what barriers we see in making those targets. Mr. Kelly said the team is focused on the 80% goal of 92,000 as our enrollment target.Premium increases are a potential barrier. Net premium is a relatively small increase for most consumers, and each consumer will experience something different depending Page 5 of 14 on their plan, their location, their carrier, etc. We feel that while the premiums are increasing the relatively small net premium increase will mitigate this barrier to a large degree.

When I asked for clarification, they informed me that:

We currently have 86,659 effectuated enrollments with Your Health Idaho, as of September 15. The 92,000 would also refer to effectuated enrollments.

Just 3 days ago, Colorado HealthOP was stunned by the announcement by the state insurance division that they were pulling the plug on the ACA-established CO-OP:

Dear Member,

It is with a heavy heart that I write to you today. This morning, the Colorado Division of Insurance (DOI)announced Colorado HealthOP will not be selling plans through the Connect for Health Colorado marketplace.

Please be assured that, as a Colorado HealthOP member, your coverage will remain in effect through December 31, 2015, so long as you continue to pay premiums. In two weeks, on November 1, 2015, the Connect for Health Colorado marketplace will open and you will have the opportunity to find another health insurance provider that will begin coverage for you on January 1, 2016.

Needless to say, we are astonished and disappointed by the DOI’s decision. We believe it is both irresponsible and premature.

As I noted in the update to my post on the "Transitional Policy" decision a few days ago, the ACA's CO-OP program had a lot going against it from the get-go:

The program has been under siege from the start, including from the insurance industry. Before the law’s passage, government grants to help them get going were switched to loans. None of that money could go for advertising — a wounding rule for new insurers that needed to attract customers. Moreover, the amount available was cut from $10 billion to $6 billion and then later, as part of the administration’s budget deals with congressional Republicans, to $2.4 billion. Federal health officials abandoned plans for a co-op in every state.

So, let's see here: You're trying to create start-ups to enter an existing, mature market which is already dominated by major, behemoth-sized competitors which have almost unlimited funds. Naturally it makes total sense to a) make the seed money a loan with a tight payback time table; b) prevent them from advertising in a saturated market; and c) slash their budget by 75%.

In spite of all of this, and even in spite of any impact from the decision to allow relatively healthy, low-risk enrollees to stay on transitional policies (which the CO-OPs had none of, since they were brand-new) through their competitors, 23 out of 24 of the CO-OPs did manage to survive the first full year (CoOportunity of Iowa/Nebraska didn't even make it that far), and a few of them (Community Health Options of Maine and New Hampshire, as well as (last I heard) Consumers' Choice Health Plan of South Carolina) actually do quite well the first year.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.

Colorado is one of the few ACA exchanges issuing monthly reports during the off-season. Until now, these reports, while chock full of data, have made it rather confusing to separate out the key number which I'm looking for: The cumulative number of 2015 QHP selections and the currently effectuated QHPs, because of their tendency to mix SHOP and Dental policies into the mix.

In any event, CO's official QHP selection total as of 2/21/15 was 140,327, and as of the end of April, it was up to 146,506...of which 129,055 were actually effectuated as of 4/30.

Louise Norris has provided some valuable information about 2016 individual market rate change requests in her home state of Colorado:

For 2015, Colorado HealthOP cut premiums aggressively, and ended up with the lowest-cost plans in eight of the state’s nine rating areas.  Unsurprisingly, that resulted in the CO-OP garnering the highest market share in the exchange during the 2015 open enrollment period, with nearly 40% of exchange enrollees selecting Colorado HealthOP coverage (among our own clients, Colorado HealthOP was even more popular, including among those who selected off-exchange coverage).

...In 2015, Colorado HealthOP got almost 40% of the exchange’s market share, and Kaiser was a close second with 35%; the two non-profits accounted for three-quarters of all the private plan enrollees in Connect for Health Colorado this year.

Colorado just released an updated enrollment report bringing things all the way up through April 30th...and as always, CO's report is both extremely comprehensive and extremely confusing at the same time.

Here's the relevant section:

The numbers, as I noted last time, need to be parsed quite a bit, since some of the numbers mix in SHOP (small business) enrollees while others mix in Dental coverage (which we all know is a big no-no!!)

If I'm reading/understanding this correctly, it looks like it breaks out to:

OK, this isn't a huge thing, but it's noteworthy.

Historically, Medicaid (and to a lesser extent, the CHIP program for children) has carried a certain stigma, since it's traditionally been reserved for the very poor. Many people enrolled the program have been embarrassed/ashamed to admit that they needed the assistance, and many who qualified for the program even under the pre-ACA rules never actually signed up based on the "shame" factor (still others didn't enroll because they simply didn't know that they qualified or didn't understand the procedure/paperwork for doing so).

With that Affordable Care Act, that all changed (well, in the states which expanded Medicaid, anyway). Yes, it's still limited to the poor, but there's a difference between being "dirt poor" and "working poor" (and yes, I understand that many "dirt poor" people work their butts off...I'm talking about general societal perception here). Suddenly, millions of people who considered themselves "lower middle class" (or otherwise "not poor", anyway) found themselves being able to enroll in Medicaid alongside the "dirt poor".

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