I wrote about this last night as part of a larger piece, but the "Young Invincible Risk Pool" issue from yesterday's official Open Enrollment Report seems to be generating a lot of hand-wringing, so I decided to write something specifically about it.
One of the biggest concerns people have about the ACA exchanges is whether or not there are enough so-called "Young Invincibles" (ie, young adults aged 18-34 years old) in the market to help balance out the risk pool. The assumption is that "YI's" are considerably healthier than older folks, and therefore should help reduce the overall cost of medical services over the coming year. From an insurance carrier POV, it's a lot more profitable to have 10,000 healthy customers than 1,000 cancer or diabetes-ridden customers. In the past, of course, this meant that carriers would cherry-pick their enrollees; if they suspected you'd be a high risk customer, they'd simply tell you to go pound sand.
I'm not going to get into everything here, of course; a lot of this stuff is beyond my pay grade (which is to say, zilch, as I'm not paid to operate this site), while other stats just aren't of any particular interest to me, though obviously they may be useful to others. I'm mostly just running through all 81 pages (27 in the main report, 54 in the state-level supplemental) to see what catches my eye.
This entry will focus purely on the main report; I'll look at the supplemental report (which goes into state-level data) tomorrow.
Within the Marketplaces as a whole (all 50 states +DC):
(note: I'm live updating as I type this stuff, so keep checking back, I'll be adding more updates/analysis over the next hour)
Wow! OK, I'm back from my kid's field trip (nature center; they learned about how animals handle the winter via hibernation, migration & adaptation...learned about fossils...went on the nature trail to look for animal tracks...and even dissected owl pellets, hooray!!). Of all the days to miss a major HHS/CMS conference call, this was a big one. I'm furiously poring over the HHS Dept's ASPE January Enrollment Report which, as I expected this morning, was just released less than two hours ago.
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:
So what about this week? Well, it should play out very much the same: Practically all QHP selections going forward should be for new additions, and we have New Year's Eve and Day included. Sure enough, last year there were just 103K added to HC.gov from 12/27 - 01/02...slightly more than Christmas week.
Assuming this year follows a similar pattern, there should be roughly 80,000 people tacked onto the HC.gov total for Week 9, bringing the cumulative total up to just over 8.6 million.
If this does happen, then yes, I'll have to seriously re-evaluate my current 14.7 million OE3 projection...because that will suggest that the final 5 weeks are gonna play out a good 20% lower than my expectations.
And if that's the case, then instead of another 3.5 million new folks signing up, it'll only be around 2.8 million...bringing a grand total of right around 14.0 million even.
Three portions of the total are eligible to enroll in private policies through the ACA exchanges: "Tax Credit Eligible", "Ineligible for Financial Assistance due to ESI Offer" and "Ineligible for Financial Assistance due to Income" (22%, 15% and 12% respectively). It's important to remember that "Ineligible for Financial Assistance" means that they can enroll through the ACA exchanges, they just have to pay full price if they do so. Many of these folks will simply enroll off-exchange, directly through the insurance carriers, but there's nothing preventing them from going through the exchange instead.
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:
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.
Last week I asked "How many HC.gov auto-renewals are left to be added?" I noted that 5.86 million current exchange enrollees have been confirmed to have been renewed/re-enrolled via the federal exchange (71% of 8.25 million total), and that there could theoretically be up to 680K left to be auto-renewed, assuming that the currently-effectuated number is indeed still 9.1 million nationally:
The 9/30/15 number isn't what's relevant here; what we need to know is the December number. For that, HHS is still quite insistent that it'll end up being 9.1 million. While I was more optimistic earlier this year (I assumed it'd still be close to 9.7 million nationally as of now), it's pretty obvious that the attrition rate has indeed been higher than I figured, so I'll go with their 9.1 million.
If so, and assuming the federal-to-SBM ratio has remained the same, that suggests that as of December, HC.gov states are down to 6.54 million people as of today.
