SHOP

BeWellNM Logo

New Mexico's state-based ACA exchange, BeWell NM, has posted a powerpoint from a special Board of Director's meeting that they had last week.

For the most part it's unremarkable and full of inside baseball wonkery:

  • They're replacing WebEx with Zoom for video meetings
  • They're gonna split their Comms & Outreach into two separate divisions
  • They're preparing for the upcoming Medicaid Unwinding project

There's two items which are more noteworthy, however.

First, New Mexico is one of only three state-based marketplace (SBM) which handle premium bill payments as well as enrollment functions. The other two are Rhode Island and Massachusetts. Washington State's HealthPlanFinder tried dealing with payments within the exchange itself as well for a few years but eventually gave up on it due to it causing too many technical & administrative headaches.

Access Health CT Logo

via Access Health CT:

Access Health CT Waives Requirement for Certain Small Businesses to Enroll in a Group Health Insurance Plan Through December 15

  • Small businesses can enroll in group health insurance at any time of year, but they usually need a certain percentage of employees to participate in the plan

HARTFORD, Conn. (Nov. 23, 2022) — Access Health CT (AHCT) Small Business today announced it will waive the minimum number of employees typically required to enroll in a small group health insurance plan now through Dec. 15.

Small businesses can enroll in a group health insurance plan at any time of year. However, they usually need a certain percentage of employees to participate in the plan. During this period, any small business with 50 or fewer employees in Connecticut can enroll in a group health insurance plan regardless of how many employees participate.

This press release came out last week but I covered all the other state-based exchange Open Enrollment press releases so I figured I should include this one as well:

Covered California for Small Business Announces Expanded Choices and an Average Rate Change of 4.1 Percent for 2020

I don't analyze or write about the ACA's SHOP (Small business Health Options Program) exchange enrollment very much these days. The main reason for this is that SHOP enrollment is extremely difficult to come by. The federal exchange (HealthCare.Gov) has mostly pretended the program doesn't even exist, at least when it comes to enrollment...in fact, to my knowledge, they've only issued a single hard number for HC.gov SHOP enrollment...in 2015:

On November 15th, 2014 we launched the HealthCare.gov portal for 33 states to enroll in SHOP Marketplaces. As of May 2015, approximately 85,000[1] Americans have 2015 coverage through SHOP Marketplaces with about 10,700 small employers participating in SHOP Marketplaces. These totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015.

I don't write much about Rhode Island outside of the actual Open Enrollment Period each year, and I almost never write about the ACA's "SHOP" (Small Business Health Options Program...which should really be labelled SB-HOP) these days (the program has never enrolled more than perhaps 200,000 people nationally at most)...but both the state and the program could use a little love, so what the heck:

HealthSource RI for Employers enrolls its 700th small business

RUMFORD, RI (March 6, 2018) – HealthSource RI for Employers today announced it has hit a major milestone. The health insurance marketplace for small employers has now enrolled its 700th small business. These 700 local businesses reflect over 5,200 Rhode Islanders.

Regular readers know that generally speaking, I support the ACA overall. They also know that I also have significant criticisms of the law, and have compiled a lengthy list of fixes/improvements both small and large which I feel are necessary to stabilize the individual market. I've also written on occasion about the SHOP provision of the ACA: The small business version of the ACA exchanges.

The idea was to give small businesses with fewer than 50 employees an open marketplace to comparison shop, similar to the individual exchanges, and also to provide some amount of financial assistance to them along the lines of APTC for indy market enrollees. The ACA requires businesses with over 50 full-time employees to provide coverage, but it's voluntary for those under 50, so SHOP has always been more of a courtesy program than a necessary one.

I've decided that for all future ACA enrollment data reports, I'm going to tack on "...on brink of possible ACA repeal" to the headline. Seems appropriate.

It's been quite awhile since I've written much of anything about the ACA's SHOP programs, which are the small business counterpart to the individual/family exchanges. The reason is pretty simple: SHOP enrollment is mostly a rounding error compared to either the ACA's Individual exchange enrollments or Medicaid expansion numbers.

SHOP enrollment (a mere 120K - 170K nationally, as far as I can tell) is even dwarfed by BHP program enrollment (around 700,000)...and that's only available in 2 states (Minnesota and New York). Heck, I don't even bother tracking them on my spreadsheets or graphs (I tried in 2014 but gave up on it the following year).

Still, once in awhile there's a bit of SHOP news to report, and this press release out of Minnesota is such an occasion:

Long-time readers know that ever since I started this project in 2013, I gradually added and enhanced the healthcare coverage data that I was tracking. First it was exchange-based QHPs only; then I added (or separated out) Medicaid expansion, SHOP (small business) exchange enrollment, off-exchange individual policies and so on. The off-exchange numbers were always significant but spotty because most insurance carriers are very cagey about breaking out their membership in too much detail if they don't have to, and many state insurance departments don't bother to track (or at least publicly report) those numbers.

SHOP enrollment, on the other hand, should be very cut and dry. Like exchange-based individual QHP enrollments, there's no reason why these shouldn't be included in every regular exchange enrollment report, and several of the state-based exchanges do just that...although in some cases, even that's a bit fuzzy. For instance:

The Massachusetts Health Connector held their monthly board meeting last week and have released their September dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.

I've pasted screen shots of every page of the report below, but here's the main takeaways:

  • Effectuated QHPs have reached 179,470 enrollees...a whopping 38.930 higher (28%) than at the end of Open Enrollment.

While the national effectuation number is likely around 3% lower today than it was in March (9.9 million vs. 10.2 million), in Massachusetts it's 45% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.

  • In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 17,246 people drop their QHP policies, meaning a total of 196,716 people have selected a plan and paid at least their first monthly premium.
  • Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 218,000 people to date, which is only significant to me and The Graph.

But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,562 lives covered as of October 1st) and even Dental Plans!

Data nerds, go nuts!!

The Massachusetts Health Connector just held their monthly board meeting this morning, and have released the August dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.

I've pasted screen shots of every page of the report below, but here's the main takeaways:

  • Effectuated QHPs have reached 175,605 enrollees...a whopping 35,065 higher (25%) than at the end of Open Enrollment.

While the national effectuation number is 2.3% lower or so today than it was in March (9.95 million vs. 10.19 million), in Massachusetts it's 42% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.

  • In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 16,874 people drop their QHP policies, meaning a total of 192,479 people have selected a plan and paid at least their first monthly premium.
  • Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 213,000 people to date, which is only significant to me and The Graph.

But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,486 lives covered as of September 1st) and even Dental Plans!

Data nerds, go nuts!!

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