Hawaii

As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.

If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.

Hawaii was one of the first states I ran a weighted average rate increase for, way back in July. With only 2 insurance carriers offering individual market policies either on or off the ACA exchange, and a small membership to being with, it was pretty basic: 

For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.

Ouch. Yup, that's a pretty ugly requested increase, no way around it.

The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.

If approved as is, this would have resulted in a 33.7% average rate increase, when weighted by market share between the two companies.

Thanks once again to Louise Norris for doing the heavy lifting in the Aloha State:

Hawaii Health Connector offers individual plans from two carriers: BCBS’s Hawaii Medical Service Association (HMSA), and Kaiser Permanente.

For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.

Ouch. Yup, that's a pretty ugly requested increase, no way around it.

The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.

In 2014, Hawaii's enrollment numbers were pretty bad, but they were at least consistent: About 400 through the end of November; 2,200 at the end of December; 3,600 at the end of January, 4,600 at the end of February and about 8,600 through mid-April. Their cumulative total through the end of the off-season last year was just shy of 11,000, which again, was pretty in line with what I'd expect.

As you can see from the reposts below, for 2015, Hawaii's numbers have been all over the place, making sense some days and completely out of whack on others. The official HHS Dept. ASPE report has Hawaii with 12,635 QHPs selected for 2015 as of Feb. 21st...which sound about right to me (ie, that's a pretty lame number, but it's still around a 47% increase over 2014). Then, a few days ago, CMS released the effectuated enrollment numbers as of 3/31. For Hawaii, this number is 8,200...a 35% drop. While that's a disturbingly heavy drop (the other states averaged just a 13% "drop" overall), it's at least plausible.

For months now, the ACA state exchanges in small states like Rhode Island, Vermont and Hawaii have been struggling mightily with either funding issues (RI) or both funding and technical problems (VT & HI). Most of my own focus has been on the 2 northeastern states.

Today, however (thanks to Sabrina Corlette for the heads' up), the HI Health Connector has apparently skipped ahead a few chapters and concluded that due to their inability to convince the state legislature to pony up more cash (they were originally seeking $10 million but only $2 million was approved), they're gonna have to close up shop:

May 09--The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat.

The ACA exchange enrollment reports out of Hawaii have been continually confusing as hell. One day it's 16,000 (more than twice 2014's total); a month later it's only 13,300; then just hours later, I receive "confirmation" (directly from the exchange director, supposedly) that it's actually 23,000...specifically for 2015 policies.

While this was screaming out as a big red flag, I grudgingly accepted it...only to have the rug yanked out from me when the official ASPE report came out in March, giving the official final number as 12,625...which is right in line with what I was expecting in the first place (around a 50% increase over their total in April 2014, and 17% over their total as of September 2014).

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

The enrollment data from Hawaii has been sporatic and a bit squirrelly, with the few numbers being thrown around sometimes including the cumulative plan selections including 2014 enrollees whether they renewed for 2015 or not. When I posted my last Hawaii update, I was suspicious (at 16.1K, it was nearly twice last year's tally), but the article seemed pretty confident about the numbers, so I went with it.

This evening, I was immediately concerned when I saw the lede...

The Hawaii Health Connector said about 13,356 residents signed up for Obamacare coverage in the three-month enrollment period that ended Sunday.

Well this one was unexpected: It's not a formal press release, but this story from the Hawaii Reporter--which actually has a pretty negative slant to it--is chock full of actual, current enrollment data points for Hawaii...and they're pretty good, relatively speaking.

None of the numbers are precise--they're all rounded off...but it's still a breath of fresh air from the Aloha state, and brings the number of states which haven't provided renewal data down from 3 to two (of course, the other two are California and New York, but still...)

Anyway...

...The Connector had about 1,000 people enrolled at this time last year. As of Thursday, that number had grown to 16,000.

...More than 365 small businesses, with 2,400 enrollees, have joined the Connector through the Small Business Health Options Program, or SHOP, in part because of tax deductions available to them, Kissel said.

Yesterday I publicly declared that total QHP selections nationally had reached the 9 million milestone. I based this on 4 data points:

  • The 6.59 million confirmed by the HHS Dept. for the 37 states run through HC.gov,
  • The 980K confirmed by the 14 assorted state-run exchanges,
  • The unreported renewals (both active and automatic) from California & New York, and
  • Another roughly 150,000 scattered amongst all 50 states & DC since the date of their most recent updates until today (which varies from as little as 1 day to as much as 25 days in the case of Idaho).

If you do the math, you'll see that the biggest missing piece here is the 3rd item above: Covered California and New York State of Health have, to date, still refused to give out any re-enrollment/renewal data for 2014 QHP enrollees. Not just autorenewal numbers, but active renewals as well.

Huh. OK, this one is unexpected, mainly because they waited until 4 days after the original 12/15 deadline to make the announcement:

The Hawaii Health Connector has extended the deadline for residents to enroll in health insurance that takes effect on Jan. 1.

The extension will be until noon on Dec. 31. The original deadline was this past Monday.

The state's health insurance exchange created by the Affordable Care Act, also known as Obamacare, signed up 3,500 residents in the first month of open enrollment , which started on Nov. 15. To enroll, call 1-877-628-5076 or go to www.hawaiihealthconnector.com.

So, that makes 3 states now which have bumped their deadline for January 1st coverage out until 12/31: Hawaii, Vermont and Minnesota.

Hawaii's updates are particularly frustrating because they have a tendency to only give the cumulative plan selections to date, mixing together 2014 & 2015 numbers regardless of whether they've actually enrolled/re-enrolled for 2015 or not. Therefore, it's refreshing to see a (relatively) straightforward update out of the Aloha state:

The Hawaii Health Connector enrolled 3,500 people in its first month of open enrollment, which ended on Monday, the exchange confirmed Tuesday.

The state's online health insurance exchange saw more than an eleven-fold increase in enrollment in comparison to its first month of enrollment last year, when the just 300 signed up for health insurance on the Connector.

Of course, they couldn't help but mix numbers together later in the story:

...To date, roughly 13,500 residents have signed up for health insurance coverage that will begin on Jan 1.

Kissel noted that the Connector has also connected 50,000 to the expanded Medicaid program, which came in with the Affordable Care Act at no cost to the state.

I'm actually a bit curious about the "new" specification here. Last week the head of the HI exchange gave an interview in which he gave the number as being 12,000, but it turned out that was a cumulative number which included all of the enrollments from last year (whether they had renewed yet or not) as well as the new additions. I thumbnailed it as being around 1,200 enrollments for 2015.

Therefore, I'm not sure how to take "nearly 1,500 new residents" in this case; that may mean "new for 2015 including renewals" or it may mean "new for 2015 not including renewals". Either way, the number isn't large enough to impact my spreadsheet/projections, but it's still a bit irritating:

Hawaii: Hawaii Health Connector has enrolled nearly 1,500 new residents as of Dec. 5. Last year glitches to the website caused enrollment to be delayed by two weeks. According to HealthInsurance.org, the state’s uninsured population has gone down from 8 percent of the population to 6 percent of the population since Obamacare went into effect..

I spent a few minutes this morning poking around all 15 ACA exchange websites (HC.gov plus the 14 state-run websites). Obviously I didn't go through and actually create an account or enroll/renew in any of them (although my wife and I did renew our own coverage via HC.gov on Saturday, and everything went fine). However, I at least visited all of the sites and clicked through as far as I could go without actually setting any accounts up.

For the most part, everything went smoothly. Yes, some of the sites have more confusing layouts/navigation than others, but my main concern was whether they load at all, how quickly pages load, whether any glitches or broken links pop up and so on.

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