HC.gov

Me, 3/31/20, 1:14pm:

Well, today I received a likely answer which is depressing but not surprising at all: According to my sources, there isn't any technical, logistical, personnel or support reasons why HealthCare.Gov couldn't launch a formal COVID-19 Special Enrollment Period at any time. The only logical conclusion is that the White House has decided not to allow one for political reasons.

...The more people who come to rely on the Affordable Care Act--especially the ACA exchange operated by the Trump Administration itself--the more difficult it's going to be to justify the Trump Administration continuing to support a lawsuit with the sole purpose of attempting to have the ACA struck down by the Supreme Court...which they're continuing to try and do even in the middle of a pandemic.

Susannah Luthi, Politico, 3/31/20, 5:19pm:

Trump rejects Obamacare special enrollment period amid pandemic

Three weeks ago I reported that there were growing calls from many quarters for CMS Administrator Seema Verma and HHS Secretary Alex Azar to open up a federal Special Enrollment Period at HealthCare.Gov tied specifically to the COVID-19 pandemic.

Over the next week or so, more and more of the 13 state-based ACA exchanges announced just such a COVID-19 SEP; eventually 12 out of 13 state-based exchanges did so (Idaho is the odd man out), and eventually even the health insurance industry (which is normally opposed to allowing exceptions to the official Open Enrollment Period) were onboard with a COVID SEP. Two weeks ago I was 95% certain that HC.gov would be announcing one at any moment.

And then...nothing. Nothing last week. Nothing yesterday. Nothing as of this writing.

One week ago, in light of the growing COVID-19 crisis, I noted that California, the District of Columbia and Maryland were each offering Special Enrollment Periods which had nothing whatsoever to do with the pandemic.

California's SEP is for uninsured residents who didn't know that the state had reinstated the individual mandate penalty and expanded financial subsidies to those earning 400-600% of the Federal Poverty Line; DC is offering one for those who didn't know they had also reinstated the mandate penalty; and Maryland passed a clever law last year which lets residents check a box when they file their state taxes if they're uninsured which tells the state to contact them to help them enroll.

I concluded that:

...as far as I know, there's nothing preventing other state-based exchanges from establishing Special Enrollment Periods for the coronavirus crisis if they want to.

Earlier today, CMS quietly issued the FINAL 2020 Open Enrollment Period HealthCare.Gov "Snapshot Report":

Final Snapshot: Nov 1-Dec 21

Approximately 8.3 million people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2020 open enrollment period.

These snapshots provide point-in-time estimates of weekly plan selections, call center activity and visits to HealthCare.gov or CuidadoDeSalud.gov. The final snapshot reports new plan selections, active plan renewals and automatic enrollments. It does not report the number of consumers who paid premiums to effectuate their enrollment.

As we do each year, CMS also plans to release a detailed 2020 final enrollment report in March, including final plan selection data from State-based Exchanges that do not use the HealthCare.gov platform.

Normally the Weekly HC.gov Snapshot Reports are released on Wednesdays. This week it was delayed until Friday in order to include the extra 2 1/2 days:

  • The final official day (Dec. 15th) fell on a Sunday this year
  • The additional 36 hour extension from 3pm on Monday 12/16 - midnight Eastern on Wednesday 12/18*

Not only is "Week 7" actually 9.5 days, but the final week of Open Enrollment also always includes a last-minute enrollment surge as people scramble to beat the deadline (both the original and the extension). In addition, it's also traditionally the week that CMS adds all of the auto-renewals to the report for current enrollees who neither actively selected a policy for 2020, nor did they cancel their coverage for the new year.

As a result of these factors, the numbers for Week 7 understandably dwarf each of the previous snapshot reports:

Week 7, Dec 8-17, 2019

The Week 6 HealthCare.Gov Snapshot Report from CMS should be released sometime Wednesday afternoon, covering enrollment in 38 states from Dec. 1st - 7th.

As a reminder, here's what the Week 5 report looked like (for Nov. 1st - 30th):

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around ~120,000 of the difference. Secondly, Nevada split off from HC.gov this year, which accounts for around ~19,000 of the gap the first 3 weeks. In addition, a small portion of the difference is likely due to Idaho and Maine expanding Medicaid; exchange enrollees earning between 100-138% FPL should be tranferred over to Medicaid instead.

The Week 4 HealthCare.Gov Snapshot Report from CMS should be released at any time, covering enrollment in 38 states from Nov. 10th - Nov. 23th.

As a reminder, here's what the Week 3 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around ~120,000 of the difference. Secondly, Nevada split off from HC.gov this year, which accounts for around ~19,000 of the gap the first 3 weeks. In addition, a small portion of the difference is likely due to Idaho and Maine expanding Medicaid; exchange enrollees earning between 100-138% FPL should be tranferred over to Medicaid instead.

The Week 3 HealthCare.Gov Snapshot Report from CMS should be released later on this afternoon, covering enrollment in 38 states from Nov. 10th - Nov. 16th.

As a reminder, here's what the Week 2 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around half of the 244,000 difference. The other significant difference is that Nevada split off from HC.gov this year, which accounted for around 12,000 of the gap the first 2 weeks.

If you assume around 130,000 of the difference is due to the missing day, that still leaves 2020 Open Enrollment around 100,000 short of the same time period last year on HealthCare.Gov.

This Just In from the Centers for Medicare & Medicaid...

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 2: Week 2, Nov 3-9, 2019

In week two of the 2020 Open Enrollment, 754,967 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

*("Week One" is a misnomer...see highlighted explanation below)

This Just In from the Centers for Medicare & Medicaid...

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 1

Week 1, November 1-November 2, 2019

In week one of the 2020 Open Enrollment, 177,082 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only two days long this year - from Friday to Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the federal exchange, HealthCare.Gov, in terms of open enrollment numbers year after year.

However, this can be a bit tricky to compare because some of the states have shifted back and forth...four states which ran their own platform for the first one to three years (Hawaii, Kentucky, Nevada and Oregon) moved home to the mothership in later years, while one state (Idaho) did the reverse--they stuck with HC.gov for 2014 but then broke off onto their own platform after that.

In the Weeks 8/9 Snapshot Report, HHS reported exactly 8,762,355 QHP selections as of New Year's Eve via HealthCare.Gov specifically (which only includes 39 states).

Then, last week, the ASPE department released their "Mid-Season Report", which included more detailed enrollment data for every state...but cut off a week earlier (only through Christmas Eve). After filling in all the blanks, I concluded:

Hot on the heels of Covered California's update just moments ago, the HHS Dept. has posted their latest bi-weekly Snapshot report. While the extra 2 weeks of data is obvoiusly important, the key number I've been anxiously awaiting is the auto-renewal number, which is finally included in today's report:

Biweekly Enrollment Snapshot  •  WEEKS 8 AND 9, DEC 18 – DEC 31, 2016

8.8 million Americans have signed up for coverage through HealthCare.gov since Open Enrollment began on November 1st.  This compares to about 8.6 million plan selections last year at this time, demonstrating Americans’ strong and growing demand for affordable, quality coverage.  Total plan selections as of December 31st, which include auto reenrollments, consist of 2.2 million new consumers and 6.6 million returning consumers. Among returning consumers, two thirds, or 4.4 million, actively selected a plan, an increase from last year’s already high levels of consumer engagement.