Remember this from a few weeks back?

Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November

An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshedeven though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.

I know there’s a lot going on in The Graph (see below), so lemme break it down:

  • The pale blue lines show the enrollment trend for the 2016 ACA Open Enrollment Period via the 38 HealthCare.Gov states (the lower line) and all 50 states + DC (the higher line). This was the all-time record for the ACA: 9.7 million via HC.gov, 12.7 million nationally.
  • The pale red lines show the enrollment trend for the 2017 Open Enrollment Period via 39 HC.gov states & all 50 +DC (Kentucky moved from their own exchange to the federal exchange last year). This was down a bit from 2016: 9.2 million / 12.2 million.
  • The dotted black lines are my “official” projections for the 2018 Open Enrollment Period: 7.5 million and 10.0 million respectively, both way down from both of the prior years.
  • The filled-in green/blue sections are the actual, confirmed 2018 enrollment numbers to date. Note that there are still enrollments missing: HC.gov only runs through 11/11, while other states range from no data at all all the way through 11/15. I’ve confirmed 1.71M to date, but suspect the total is actually closer to 3.0 million as of today.
  • The little blue dots are my current projections through this Saturday the 18th: 2.3M and 4.0M respectively.

Connect for Health Colorado® Reports Increase in 2018 Medical Plan Selections

DENVER — Between Nov.1 and Nov. 15, more than 22,000 Coloradans selected health coverage for 2018 through the state health insurance Marketplace, according to new data released today by Connect for Health Colorado®.

“I am glad to see the number of initial sign-ups during the first two weeks of Open Enrollment,” said Connect for Health Colorado® CEO Kevin Patterson.  “There has been some confusion about healthcare coverage this year. I want everyone to know that the financial help to buy health insurance is still available for next year. I urge everybody buying their own health insurance to take a minute on our site, ConnectforhealthCO.com, to check to see if they qualify and then review their options and complete their enrollment before the last-minute rush.”

Covered California’s Open-Enrollment Period off to a Solid Start

  • More than 48,000 new consumers selected a plan during the first two weeks of open enrollment, which is slightly ahead of last year’s pace.
  • New subsidized enrollees are using increased tax credit money to purchase coverage that is more comprehensive.
  • The majority of consumers signing up will be able to pay lower prices in 2018 than they would have for the same plans last year.

SACRAMENTO, Calif. — Covered California issued its first enrollment snapshot for the first two weeks of the current open-enrollment period. From Nov. 1 through Nov. 14, more than 48,000 new consumers signed up for coverage through Covered California, which is slightly ahead of last year’s pace when more than 39,000 consumers selected a plan during the first two weeks of November 2016.

No precise numbers yet, but this tweet from Access Health CT gives the key numbers:

To date, over 17K CT residents have enrolled in a plan for 2018 - with 6K new to #AHCT. #shopshopshop #AHCTBoDMeeting #GetCoveredCT

— Access Health CT (@AccessHealthCT) November 16, 2017

Assuming "to date" includes yesterday (11/15), this gives us a perfect year over year comparison; last year AccessHealthCT had 16,085 people enroll in Qualified Health Plans in the first 15 days (9,455 renewals + 6,630 new), so they appear to be up about 6% year over year so far.

Now that we have a couple of weeks worth of hard enrollment data under our belt, it's time to start trying to break the numbers out by state and category (that is, Active Renewals, Auto-Renewals and most importantly new Enrollees). This is trickier than it sounds for several reasons:

  • HealthCare.Gov hasn't started breaking out their numbers across the 39 states which utilize their platform yet. For them, I had to base my estimates on what portion of the 39-state total each state had in the first 12 days last year (via CMS's Public Use File). I'm assuming the ratios within HC.gov are roughly the same this year.
  • Five of the state-based exchanges haven't released any enrollment data yet (CO, DC, ID, NY and VT)
  • The other seven state-based exchanges have released some hard data, but none of their thru-dates match up with the federal exchange (11/11).
  • Even then, some state exchanges have only released the number of new enrollees, not renewals (CA, WA and--I think--MD), while others have already baked in passive/auto-renewals (MN, RI), which means their renewal numbers may actually decrease over time as some who were auto-renewed already change their minds.
  • In addition, in those states which included auto-renewals (MN, RI), I don't know the breakout between active and passive renewal, so I had to take a guess.

With all that in mind, here's where things stand to the best of my calculations. Again, while the subsets within each category are estimates, the totals include confirmed QHP selections only. I suspect the actual total to date is well over 3 million as of 11/15/17:

The article is behind a firewall so I can only post the opening line, but it includes the key number:

Maryland health exchange enrollment is up 104% through first week 

Enrollment numbers totaled 16,198 as of Nov. 9. This time last year, that total was 7,941.

Crisp & clean and no caffeine: That's up almost 6,000 more in just a couple of days.

Breaking out of Minnesota:

More than 91,000 Minnesotans have Enrolled in Private Health Plans through MNsure for 2018

November 15, 2017

ST. PAUL, Minn.—Today, MNsure announced 91,623 Minnesotans have enrolled in private health plan coverage for 2018 through MNsure.

The numbers reported include new consumers, renewing consumers who have come back and shopped for a new plan for 2018, and renewing consumers who are continuing their previous plan for 2018.

"Our first two weeks have gone very smoothly," said CEO Allison O'Toole. "MNsure's enrollment is looking strong out of the gate. This year, we renewed twice as many people into coverage than last year, and we're also seeing a steady stream of new consumers."

By the Numbers

As I've been saying for months now, trying to predict not just the final number but the pattern of enrollments in ACA exchange policies for the 2018 Open Enrollment Period is a fool's errand given all the batcrap insanity surrounding the ACA this go around; this would be the case even without the actual enrollment period being slashed in half.

Having said that, the 2nd Weekly Snapshot Enrollment Report for HealthCare.Gov came out this morning and the enrollment period continues to defy expectations:

Me, just under a month ago:

Things were looking pretty dicey for two of Montana's three insurance carriers participating on the individual market the past few days. One of the three, Blue Cross Blue Shield, saw the writing on the wall regarding Cost Sharing Reductions (CSR) likely being cut off and filed a hefty 23% rate hike request with the state insurance department. The other two, however (PacificSource and the Montana Health Co-Op, one of a handful of ACA-created cooperatives stll around), assumed that the CSR payments would still be around next year and only filed single-digit rate increases.

I'm not going to speculate as to the reasons why they both did so when it was patently obvious that having the CSRs cut off was a distinct possibility, although I seem to recall the CEO of the Montana Co-Op said something about their hands being tied since CSR reimbursement payments are legally required, after all. Basically, it sounds like he was genuinely trying to avoid passing on any more additional costs to their enrollees than they had to.

Here's the Wikipedia entry for HealthSherpa:

HealthSherpa is a California-based technology company focused on connecting individuals with health coverage. The site was initially developed as an alternative to research plans from Healthcare.gov, and now provides individual health, dental and vision benefits to both part-time employees and retirees. As of February 2017, over 800,000 people have been enrolled in individual health coverage through HealthSherpa.

First, I want to clarify that I'm not shilling for HealthSherpa here. They aren't paying me for this post. I have no idea whether their customer service is awesome or sucks or anything like that.

Having said that, they are a pretty good resource for getting a feel for what the big picture situation is regarding open enrollment trends each year, and they have provided me with some internal data which they've OK'd me to share publicly.

It's important to note that all of the data here refers to exchange-based enrollments only. They reiterated to me that their individual market enrollments are on-exchange only:

At first glance, the graph below strongly resembles the Pictured Rocks National Lakeshore attraction in Munising, Michigan, which my family visited over the summer. It's truly gorgeous.

However, what you're looking at is, in fact, a visual breakout of the state-by-state proportions of total Qualified Health Plan selections on the ACA exchange throughout the 2017 Open Enrollment Period, which ran from Nov. 1, 2016 - Jan. 31, 2017. The data comes from the official Public Use Files from the Centers for Medicare and Medicaid. As you can see, most states follow a fairly obvious trend because 39 of them are run through the federal exchange at HealthCare.Gov.

Since all 39 are administered, entered into the system and reported the same way, the only variances between them are their relative population size: Large states are thicker, small states are thinner throughout the entire enrollment period as you'd expect.

UPDATE: To clarify, just like with Covered California's "6,000 on day one" notice, Washington State's 4,550 new enrollees in 8 days don't include renewals/re-enrollments of current enrollees. Last year WA had 10,265 QHP selections total in the first 5 days and 21,665 in the first 12, so assuming a similar number of renewals each year, their total 8-day tally this year is likely around 13,000 + 4,550 = 17,500)

Washington Healthplanfinder Traffic, New Enrollment Surges In First Week

State’s online health insurance marketplace saw a 24 percent rise in site visits, more than 50 percent increase in new enrollees

Every year, I painstakingly patch together Open Enrollment Period data from both the weekly (or bi-weekly, last year) snapshot reports for HealthCare.Gov as well as the dozen or so state-based exchanges to compile The Graph. Usually it's kind of bumpy and scattershot because the numbers for some of the state exchanges are released at (and through) seemingly random times. This means that the curve of the graph is usually a bit bumpy and skewed as I try my best to catch up.

Then, at some point the following year, CMS always compiles the data and posts it to a Public Use File (PUF) in a much more comprehensive, organized fashion. I knew this, and have used the PUF for prior years many times to analyze different demographics (income, age, metal level, financial aid, etc).

HOWEVER, what I didn't realize until tonight is that the same PUF also breaks out the enrollments by week in a nice, even fashion. This allowed me to more accurately recompile the enrollment graphs for both 2016 and 2017 at both the federal (HC.gov) and national (HC.gov + SBMs) level.

Working on this so check back frequently for updates...

Weekly Enrollment Snapshot: Week One: Week 1, Nov 1-4, 2017

In week one of Open Enrollment for 2018, 601,462 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only four days long this year - from Wednesday to Saturday.

Every week during Open Enrollment, the Centers for Medicare and Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges, the State Partnership Exchanges, 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.