OE5

There were several stories over the past few days about a new, just-released report from the General Accounting Office (GAO) which examined how well/poorly the Trump Administration handled the 2018 Open Enrollment Period last year.

Many of the findings were things which I had been either predicting or documenting all year:

  • Enrollment through Healthcare.gov Was 5 Percent Lower in 2018 than 2017
  • Stakeholders Reported That Plan Affordability Likely Played a Major Role in Enrollment
  • HHS Reduced Consumer Outreach for 2018 and Used Problematic Data to Allocate Navigator Funding
  • HHS Did Not Set Numeric Enrollment Targets for 2018, and Instead Focused on Enhancing Certain Aspects of Consumers’ Experiences

We identified a list of factors that may have affected 2018 healthcare.gov enrollment based on a review of Department of Health and Human Services information, interviews with health policy experts, and review of recent publications by these experts related to 2018 exchange enrollment.

Factors related to the open enrollment period:

If you've followed this site for awhile, you may recall that about a year ago, I called out the Centers for Medicare & Medicaid (CMS) for trying to pull a fast one regarding the 2017 Open Enrollment Period data.

The short version is that they tried to make it look as though only 10.3 million of the 12.2 million people who selected Qualified Health Plans (QHPs) from the ACA exchanges actually paid their first month's premium and were actually enrolled (i.e., "effectuated"), or around 84%. They then tried using this "fact" as evidence of how the ACA was failing, etc etc, because this was supposedly down from 2016 levels.

The difference, as I noted at the time, is that the 2016 effectuation numbers were as of March, while the 2017 effectuation numbers were as of February. This made a big difference, because around 500,000 people who enrolled during 2017 Open Enrollment couldn't have been effectuated for February...because about half a million people enrolled between Jan. 16th - Jan. 31st, which meant their policies weren't even scheduled to begin until March.

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

OK, next up: HOW MANY HAVE PAID???

This Just In...

Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market
Reports show individual market erosion and increasing taxpayer liability

Um...yeah, deliberately sabotaging the ACA a dozen different ways and cutting off CSR reimbursement payments, thus forcing the carriers to load CSR costs directly onto premiums, which in turn jacks up APTC subsidies accordingly, will have the effect of "increasing taxpayer liability"). Go on...

A few days ago, I ran a comparison of the average unsubsidized (full price) 2018 premium increases for each state which I had projected last fall against a study last month by the Urban Institute in which they reported the actual average premium increases, by state, of some of the ACA policies available on the exchange. Urban wasn't able to examine every plan, but they did a full analysis on the Lowest Cost Silver, 2nd Lowest Cost Silver (benchmark plan) and Lowest Cost Gold policies in each market and statewide.

Urban's analysis concluded that depending on how you looked at their data, the overall national average increase was between 29-32% year over year...versus my own national projection of around 29.7%.

I didn't fare so well at the state level: I was within 5 percentage points of their actual averages in 31 states, and within 10 points in 6 more. I was way off in the other 14 for various reasons.

OK, I'm finally able to get back to digging into the meat of the FINALLY just-released 2018 Open Enrollment Report from the Centers for Medicare & Medicaid.

In Part 2, I'm looking at the actual 2018 Open Enrollment Period Public Use Files, which break out a ton of demographic info by state, county and even zip code depending on the state (some of it is available for all 50 states + DC, while other data is only available for the 39 states hosted by HealthCare.Gov).

First up: As I noted earlier today, there's around a 10,000 enrollee discrepancy between the national total I came up with back in early February and CMS's official total. I compared my state-by-state totals against CMS's report and found differences in 5 of the state-based exchanges:

NOTE: THIS IS A LIVE BLOG, SO CHECK BACK FREQUENTLY FOR UPDATES.

Yes, at long last (3 weeks later than last year, which itself was 4 days later than in 2016), the Centers for Medicare and Medicaid has finally released the official, final 2018 Open Enrollment Report. Let's dig in!

This report summarizes enrollment activity in the individual Exchanges during the Open Enrollment Period for the 2018 plan year (2018 OEP) for all 50 states and the District of Columbia. Approximately 11.8 million consumers selected or were automatically re-enrolled in Exchange plans during the 2018 OEP. An accompanying public use file (PUF) includes detailed state-level data on plan selections and demographic characteristics of consumers. The methodology for this report and detailed metric definitions are included with the public use file.

Regular readers know that I've developed a tradition over the past three years of tracking the average unsubsidized premium rate increases for the ACA-compliant individual market, painstakingly poring over the rate filings for every carrier in every state and running a weighted average by their market share.

Every year there are numerous challenges and headaches which get in the way, including things as obvious as "not every carrier publishes the number of enrollees they have covered" to complex situations like "carrier X is dropping out of the on-exchange market in half the counties of the state but is sticking around in the off-exchange market". In addition, many carriers submit an initial rate request...followed a few months later by a revised one...neither of which might end up matching the final premium changes approved by state regulators. Sometimes there may be 2-3 more revised filings along the way which muddy the waters even further.

Over a month ago I posted what I assumed was the final 2018 Open Enrollment Report from the Washington HealthPlan Finder. However, it appears that was just a partial report. Today they announced the official version:

The Washington Health Benefit Exchange today announced that 209,802 customers used Washington Healthplanfinder to purchase a Qualified Health Plan (QHP) for 2018 coverage during the most recent open enrollment period. This total is a nearly three percent increase over last year and is 50 percent higher than the number of enrollees recorded following the first open enrollment period in 2014.

Huh. This is kind of odd.

Minnesota's 2018 Open Enrollment Period was a month longer than the official half-length period pushed by HealthCare.Gov, but was still over 2 weeks shorter than it had been in prior years, ending on January 14th, 2018. Even so, they reported a slight increase in year-over-year policy enrollees, ending OE5 with 116,358 QHP selections.

Typically, you'd see the official QHP selection number drop off noticeably by the end of the first quarter...usually by around 13% or so. Roughly 10% of those who select policies don't ever actually pay for their first monthly premium, and another 2-3% generally drop off after only paying for the first couple of months.

I'm not sure how I of all people managed to miss this, but Connect for Health Colorado released their official 2018 Open Enrollment Period report over a week ago:

We released our End of Open Enrollment report this week, our most detailed look at the impact we are having across Colorado. This year, you will see that more of our customers are receiving help through the Advance Premium Tax Credit – 69 percent, compared to 61 percent last year – and the average level of monthly tax credit help climbed to $505 from $369 last year.

Not surprising...the 34% average rate increases (about 6 points of which is due specifically to CSR reimbursement payments being cut off...much lower than most states) meant that a lot more people qualified for tax credits in the first place, and of course the amount of credits went up accordingly...a bit more, actually (37% on average).

Press Release: NY State of Health Releases 2018 Enrollment by Insurer
Mar 14, 2018

Consumer Choice Continues to be a Hallmark of the Marketplace

ALBANY, N.Y. (March 14, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released data showing 2018 health plan enrollment by insurer. Statewide, 12 health insurers offer Qualified Health Plans (QHP) to individuals and 15 health insurers offer coverage to Essential Plan (EP) enrollees through the Marketplace. Ten health insurers participate in all individual market programs offered through NY State of Health allowing consumers a smooth transition if their program eligibility changes. Throughout the 2018 Open Enrollment Period, most consumers had a choice of at least four health insurer options in every county of the State. 

I just did a light analysis of how many people would be helped or hurt by CSR funding in 2019 in Rhode Island, and concluded that at least 28% of exchange enrollees would see their premiums increase if CSR funding was restored, while only perhaps 2-3% would see their premiums drop.

It turns out that over the weekend, my colleague Xpostfactoid did a much deeper analysis of the same situation in Maryland:

So there you have the enrollment results of full-bore on-exchange silver-loading of CSR costs in one state. In all, 49,993 on-exchange enrollees with incomes up to 400% FPL chose plans other than silver. About 48,000 of them were subsidized. That's 31.2% of all enrollees, within striking distance of Aron-Dine's upper bound of 36% for all marketplace enrollees.

HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and there's a lot going on here:

HealthSource RI sees 5% enrollment increase and nation leading lowest benchmark plan cost
State-based marketplace sees rise in enrollment of “young invincibles”

Over the past few weeks,I've posted partial 2018 Open Enrollment Period demographic data from Connecticut, Idaho, Maryland, New York and Washington State. Still missing are final wrap-up reports from the other 7 state-based exchanges...as well as The Big One: The official report from the Assistant Secretary for Planning and Evaluation (ASPE).

The 2014 ASPE report was released on May 1st, 2014...just 17 days after the first, tumultuous 2014 Open Enrollment Period ended (only 12 days, really, since the report actually ran through April 19th, 2014 even though the "overtime" period technically ended on April 15th).

Not sure when this was posted, but the trendline is interesting...according to the first chart, Colorado ended 2017 down only 16.3% from their total OE4 enrollment number (161,568 QHP selections).

The cumulative enrollment numbers are also important: During the entire off-season (from 2/01/17 - 12/31/17), 41,387 people selected QHPs via Special Enrollment Periods (SEPs), or roughly 124 per day. Of course, technically speaking the last day of SEP enrollment for 2017 should have been 11/15/17 (for coverage starting December 1st), but it looks like a few hundred people slipped in after that.

Colorado's SHOP enrollment, meanwhile, hovered right around the 3,000 person mark all year.

Press Release: NY State of Health Releases County-Level Enrollment Data

Feb 27, 2018

ALBANY, N.Y. (February 27, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released county-level enrollment data as of January 31, 2018, showing that overall enrollment increased in each of New York’s 62 counties. Total enrollment in the Marketplace is now over 4.3 million people, reflecting an increase of 700,000 people (19 percent) from 2017.  Many upstate counties saw significant enrollment gains in the last year.

“Consumers from Chautauqua to Suffolk and every county in between are shopping for health plans through the Marketplace,” said NY State of Health Executive Director, Donna Frescatore. “With affordable premiums and a robust choice of plans, NY State of Health is where New Yorkers go to get covered.”

UPDATE: (sigh) OK, it looks like the final number for the District of Columbia was slightly too low; I've received official notice from the DC exchange that it was actually 22,584, 115 enrollments higher than the NASHP report pegged it at. The Graph and spreadsheet below have both been updated...

OK, here it is...

This morning Covered California issued their final 2018 ACA Open Enrollment numbers. I was a bit disappointed to discover that instead of beating out last year slightly, they ended up coming about 2.3% short year over year...but there's a very good reason for that: Like Maryland, California not only utilized the full "Silver Switcharoo" strategy with individual market premiums, they actively encouraged current UNSUBSIDIZED on-exchange Silver enrollees to switch to off-exchange Silver plans instead.

Note: This is more of a placeholder for the moment; it'll be updated as soon as the numbers are available.

At around 10:30am this morning, Covered California will be announcing their final, official 2018 ACA Open Enrollment Period numbers, along with other various demographic info.

Keep in mind that California is second only to Florida in terms of ACA exchange enrollees, with around 13% of the national total each year, so this is a big deal.

The most recent updates from the largest state-based exchange pegged their numbers at 1,542,000 QHP selections as of January 21st, including:

  • "more than" 1.2 million renewing enrollees, and
  • "more than" 342,000 new enrollees signing up.

Last year Covered CA's 1/31 total hit 1,556,676 (or just under 15,000 enrollees higher). In 2016 they had their all-time high of 1,575,340, so they'd have to have tacked on about 34,000 more over the final 10 days of Open Enrollment this year in order to beat their record.

Maryland was originally one of 3 state-based exchanges which stuck to the "official" half-length, December 15th Open Enrollment Period deadline this time around. However, with just 2 days to go before the original deadline, the MD Health Connection announced that they had decided to bump out their deadline by an extra week after all, through December 22nd.

When the dust settled, 153,571 Marylanders had signed up for 2018 coverage, down about 2.7% from 2017. This made MD one of only three fully state-based exchanges to come in short year over year...and the only one to do so with an extended deadline (both Idaho and Vermont stuck with the 12/15 cut-off). Even so, achieving over 97% of their prior-year numbers is still pretty impressive, all things considered.

Look what I dug up on the Washington Health Benefit Exchange website!

That's right...it's time for another state-level Datapalooza!® The first two slides come from the Feb. 2nd board meeting Open Enrollment Report; the rest come from the "Open Enrollment For 2018 Plan Year Performance Dashboard" report, which is a bit different; it actually runs through January 26th instead of January 14th for whatever reason. so some of the numbers are slightly different.

Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:

d) Enrollment Update

Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.

At this point, the only significant top-line 2018 Open Enrollment numbers missing are the final 10 days out of California (which could add perhaps 40,000 to the total) and a solid month of enrollment from the District of Columbia (23 days, actually, but they extended their deadline by 5 extra days, which may or may not be included in the final, official report from CMS). DC's tally through 1/08 was 21,352 QHP selections. Their all-time high was around 22,700 set in 2016, so I can't imagine that they added more than perhaps 2,000 more since 1/08. In other words, about 99.5% of the 2018 OEP QHP selections have likely been accounted for.

That means it's time to move on to...breaking down the demographic data! Woo-hoo! Parrrr-tyyyy!!

The big, official CMS report from the Assistant Secretary for Planning and Evaluation (ASPE) presumably won't be released for a couple of weeks, but some of the state-based exchanges are faster about posting their demographics. First up: Connecticut!

This Just In, courtesy of Dan Goldberg of Politico New York...

.@charles_gaba NY releases final numbers --253,102 in QHP with 41% receiving NO financial assistance. (That's amazing!) 738,851 in Essential Plan 374,577 in Child Health Plus

— Dan Goldberg (@DanCGoldberg) February 1, 2018

New York had already broken their 2017 numbers (just barely) a couple weeks ago, so this is effectively icing on the cake: Total QHP selections are up 4.2% year over year vs. the 242,880 they signed up last year.

Nothing new or noteworthy here, but I've posted the "last call" press releases for California and DC, so I figured with just 8 hours left to go I should do so for New York as well:

ALBANY, N.Y. (January 24, 2018) – NY State of Health, the state’s official health plan Marketplace today announced that New Yorkers who have not yet signed up for coverage in a Qualified Health Plan (QHP) should enroll now so they are covered for 2018. Open Enrollment ends January 31st. Consumers across the state have a choice of multiple health plan options and for many, coverage is more affordable than last year.

Enrollment through NY State of Health continues to climb to record levels with more than 4.2 million enrolled across all programs. As of January 16, 2018, 243,600 consumers have enrolled in a Qualified Health Plan (QHP) and 726,300 have signed up for the Essential Plan, exceeding numbers at the end of open enrollment in 2017.

This announcement is far less surprising than the one from the DC exchange I posted a few minutes ago...

Final Day of Open Enrollment! Covered California Will Help Consumers Who Get Caught Up in Surge of Last-Minute Shoppers

  • Covered California’s open-enrollment period ends at midnight tonight.
  • Due to an expected increase in demand today, consumers who start an application before midnight will be able to work with a certified enroller to complete the process on Thursday or Friday.
  • Covered California Service Center representatives are available to help through midnight on the 31st and through 8 p.m. on Feb. 1 and 2. 

SACRAMENTO, Calif. — On the final day of open enrollment, with tens of thousands of people expected to sign up for health coverage, Covered California announced it would help consumers “cross the finish line” if they get caught up in the surge of last-minute shoppers.

Huh. Deadline extensions were fairly common in the first couple of years of Open Enrollment, but have mostly been phased out more recently. This is a bit unexpected from the DC Health Link:

.@MayorBowser has extended the deadline for individuals & families to enroll in quality affordable health insurance to Monday, February 5th at 11:59 pm. Take advantage of today's extended hours at enrollment centers across the city. Don't delay #GetCoveredDC pic.twitter.com/8R7zq0EzA1

— DC Health Link (@DCHealthLink) January 31, 2018

 

If you've been following this site for awhile, you know that for the 2018 Open Enrollment Period, I sort of partnered up with two grassroots healthcare advocacy groups: ACA Consumer Advocacy and the Indivisible ACA Signup Project. We created and disseminated a whole mess of blue-themed Open Enrollment infographics, in both English and Spanish, for all 50 states and the District of Columbia via our websites, social media and even in print via downloadable PDF versions distributed across various public locations.

Anyway, with Open Enrollment officially wrapping up in the final 3 states (well, 2 states + DC) on Wednesday, Jan. 31st, they shared a few metrics, which I'm proud to repost here as well:

Thread: So, about those blue images. We partnered with @2018ACASignup to try to help offset #ACASabotage around enrollment. Kinda impressed with how the whole thing worked. Here are some numbers:

A huge shout-out to Ken Kelly for calling my attention to this press release which was apparently sent out way back on December 19th???

Vermont wraps up 2018 open enrollment for Vermont Health Connect

News Release — Department of Vermont Health Access
Dec. 19, 2017

Vermonters who Didn’t Complete Plan Selection Urged to Call this Week

WATERBURY, VT – State officials reported that nearly 23,000 Vermonters had confirmed a 2018 health plan and qualified for financial help to make the plan more affordable. Total enrollment in qualified health plans, which typically includes 46,000 small business employees and 11,000 individuals who don’t qualify for financial help, is expected to surpass 80,000. While enrollment will be similar to past years, this year’s earlier deadline means fewer members will experience gaps in coverage. In past years, nearly 2,000 members missed out on January coverage.

I'm not really able to post a full analysis at the moment, but here's the final officlal OE5 enrollment numbers from Massachusetts:

Total enrollment:

  • 2018 – 263,026 enrolled + 7,662 plans selected = 270,688
  • 2017 – 253,146 enrolled + 10,863 plans selected = 264,009

New enrollments:

  • 2018 – 55,565
  • 2017 – 56, 977

Massachusetts is the 16th state to surpass last year's numbers, and the 11th state-based exchange (if you include Federally-facilitated SBMs).

UPDATE: Hmmm...according ot the official CMS report, Massachusetts actually enrolled 266,664 people into QHPs via their exchange last year, so they're only up 1.5% year over year, but it's still great news, espcially given how low their uninsured rate was to begin with.

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