Rhode Island

I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this site and everything...)

Rhode Island, which issued regular weekly enrollment reports last year, has been unusually silent so far this year...until today:

HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, December 3, 2016 for Open Enrollment.

INDIVIDUAL/FAMILY ENROLLMENT
As of December 3, 2016

Rhode Island, in addition to being one of the smallest states, is also one of the first states I crunched the rate hike numbers for back in late May. It was actually pretty easy to run a weighted average hike request since there are only 2 carriers even operating on the individual market next year: Blue Cross Blue Shield of RI and Neighborhood Health Plan (UnitedHealthcare is dropping out of the RI indy market entirely, but only has about 1,400 people enrolled to begin with).

Anyway, BCBS was asking for a 9% increase, while Neighborhood is among the very few carriers to actually request a rate decrease...of around 5%. As a result, Rhode Island has the honor of having the lowest average rate hike request of all 50 states (+DC) next year...a mere 3.6% overall, which is awesome.

Well, nearly 3 months later, the RI Insurance Commissioner has weighed in with even more good news: Rates will be going up even less than that in 2017:

This year only 3 insurance carriers are offering policies on the individual market in Rhode Island: Blue Cross Blue Shield, Neighborhood Health Plan and UnitedHealthcare. The bad news is that United is pulling out of RI, although they only hold about 4% of the on-exchange market anyway. The rest of the on-exchange market is split almost evenly between BCBS and Neighborhood.

Both Neighborhood Health Plan and BCBS have submitted their filings, and there's some great (and surprising, for this year) news:

Carriers file two average rate increase amounts with OHIC: the EHB base rate increase and the weighted average rate increase. These two percentages reflect different calculations.

Again, Rhode Island is the only state to continue with regular, weekly exchange enrollment reports during the off season. I would love it if every exchange did this:

INDIVIDUAL AND FAMILY ENROLLMENT • As of February 20, 2016:

• 36,004 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
• The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
• 8,657 of the 36,004 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
• 33,920* of the 36,004 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

*The number of paid enrollments is expected to increase as payments for March coverage are made by today’s deadline and processed over the next several days.

Last week I noted that the Rhode Island ACA exchange has become my newest BFF: They've decided to continue posting weekly enrollment reports even during the off-season!

Better yet, they're also making sure to include both the gross enrollment and net effectuated enrollment numbers. If every state exchange (and especially HealthCare.Gov, of course) were to do this, I'd be a very happy man indeed. In the meantime, I'll have to settle for RI's regular updates, although extrapolating anything nationally from a single state with just over 1 million people is a bit tricky.

Anyway, last week they reported (thru 2/06):

Once the dust settled on the 2014 and 2015 Open Enrollment periods, only a handful of state exchanges bothered continuing to report off-season exchange enrollments, but I was able to extrapolate those numbers pretty accurately nationwide: Around 7,500 people per day were still signing up via Special Enrollment Periods throughout the summer/fall of 2014, and around 8,500 per day did so last year (not including the time-limited #ACATaxTime SEP from mid-March through the end of April 2015).

This year, that number is expected to drop somewhat due to HHS supposedly cracking down on SEPs in both variety and eligibility verification, but I still wouldn't be surprised if at least, say, 6,000 people per day end up signing up between now and next November (or around 1.6 million total, give or take).

Anyway, even the state exchanges which did keep posting updates generally only did so monthly...which is why I was pleasantly surprised to see that the Rhode Island exchange appears to be sticking to their Weekly Enrollment Report guns even after the dust has settled:

This just in from HealthSource RI:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, January 31, 2016 for Open Enrollment.

INDIVIDUAL AND FAMILY ENROLLMENT • As of January 31, 2016:

• 34,670 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
• The majority of these individuals are 2015 HSRI enrollees that were auto-renewed into a 2016 plan.
• 7,538 of the 34,670 individuals have selected a plan for 2016 coverage and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

32,286* of the 34,670 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.
*The number of paid enrollments is expected to increase as individuals pay for March coverage through the February 23 payment deadline. 

Aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis. In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day. However, RI is also a tiny state with an even tinier ACA exchange population, in the 30K - 40K range, so it may be pointless to try and extrapolate nationally.

Having said that, their latest enrollment update, covering Week 12 of OE3, is...OK, I guess:

As of January 23, 2016:

As I've noted before, aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis (the other exchanges range from no updates at all to monthly to a "whenever they feel like it" schedule). In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day.

On the other hand, Rhode Island is also a very tiny state, with enrollment numbers in the 30-40,000 range, so I have to be careful about extrapolating out to the federal exchange, which covers 38 states and likely has over 9 million people enrolled by now.

Having said that, here's HealthSource RI's latest numbers:

INDIVIDUAL AND FAMILY ENROLLMENT • As of January 16, 2016:

Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.

(Note In the end, it turned out to be roughly 85-90% depending on the state/carrier in 2014; for 2015 the payment rate nudged up to around 90% overall, which is where it will likely stand going forward).