Massachusetts: Highest ACA exchange enrollment AND effectuation in history; cites Individual mandate + navigator/outreach program!

This press release is mostly of interest because it came from the Governor's office, not the MA Health Connector itself:

Baker-Polito Administration Announces Health Connector Completes Successful Open Enrollment with Highest-Ever Membership, Covering 282,000 People with Health Insurance

Governor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.

Heh. "13-year history" took a moment to register...but of course Massachusetts has had a health insurance exchange website since 2006, when "RomneyCare" went into effect.

“The Health Connector just completed its most successful Open Enrollment since the start of the Affordable Care Act, signing up more than 65,000 new people with health insurance coverage,” said Governor Charlie Baker. “Massachusetts leads the way with the best insured rate in the country, with over 97 percent of our residents covered due in part to the Health Connector’s strong efforts to create a culture of coverage in the Commonwealth.”

“The Health Connector plays an important role in ensuring communities across the Commonwealth have access to affordable, high-quality health care,” said Lieutenant Governor Karyn Polito. “Over the last four years, the Connector has worked tirelessly to transform the exchange into a functional and reliable service as is evident by its current milestone enrollment figures.”

The Health Connector held Open Enrollment from Nov. 1-Jan. 23, twice as long as the federal government’s Nov. 1-Dec. 15 open period, to ensure Massachusetts residents had as much time as possible to shop for affordable coverage. Throughout Open Enrollment, Massachusetts residents were encouraged to get covered or stay covered, to provide security for their health and financial well-being, and comply with the state’s individual mandate. Assistance was available through community based health Navigators around the state.

“Massachusetts shines as a model for the rest of the nation when it comes to getting people enrolled in health insurance–and maintaining coverage,” saidHealth and Human Services Secretary and Connector Board Chair Marylou Sudders. “That success is built off outreach and education efforts that effectively and efficiently target the state’s under-insured communities and get more people covered. This year the Connector made inroads in these tough-to-reach uninsured groups.”

As of March 1, 282,114 people were enrolled in health insurance, including 209,973 people in the ConnectorCare program. Through the state’s innovative affordability program, ConnectorCare, state subsidies are made available on top of federal tax credits, resulting in lower premium costs for members – including $0 premiums for the lowest-income enrollees – while also offering zero dollar or low co-pays and no deductibles. Overall, Health Connector membership rose 13 percent, compared to a 4 percent enrollment decrease through the federal Healthcare.gov platform. In addition, 18,000 individuals receive dental insurance through the Connector.

It's important to distinguish the 282,114 effectuated enrollee figure as of March 1st from the 300,085 people who selected QHPs by the end of the 2019 Open Enrollment Period. That's a net attrition rate of just 6% as of March, which means well over 94% of those who selected policies ended up paying for the first 1, 2 or 3 months (most started in January, some in February or March), which is extremely impressive.

“With stable operations and a clear message to get covered and stay covered, this was our most successful Open Enrollment to date, with high retention rates and strong new enrollment,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We are going to keep working to ensure that everyone in Massachusetts is covered.”

Open Enrollment for Individuals

The Health Connector placed extra focus on outreach and public education about affordable coverage options in communities with higher rates of uninsurance and worked to raise public awareness about coverage generally. At the close of Open Enrollment, the Health Connector had enrolled more than 65,000 people who did not have Health Connector coverage at the start of Open Enrollment, about 22 percent more than last year. Nearly half of the new enrollments came from 21 communities targeted as under-insured through a data-driven strategy that included grassroots and creative enrollment and public awareness raising activities.

In a survey of more than 2,000 new members, more members who had been uninsured for significant periods signed up for 2019 coverage. In 2017, 20.2 percent of respondents said they were uninsured for six months or longer, and in 2019, 21.8 percent said they were uninsured at least six months.

This underscores the importance of the ACA navigator program, which offers personalized outreach, education and hand-holding throughout the process of enrolling in both exchange policies as well as Medicaid/CHIP, answering questions about how to use the insurance policy, how deductibles and co-pays work and so forth. The Trump Administration slashed both the marketing and outreach/navigator funding for the federal exchange by 90% and around 85% respectively, but exchanges like Massachusetts went the opposite way, with positive results.

The Health Connector finished Open Enrollment with a retention rate of 89.7 percent, about 2.7 percent higher than last year’s retention rate. Throughout Open Enrollment, the Health Connector engaged in a public social media campaign encouraging residents to #StayCovered, highlighting the continuing requirement that residents have health coverage that meets state standards, even as the federal individual mandate penalties end for 2019.

This proves my point from back in December, when I stressed that reinstating the individual coverage mandate penalty will only be effective if everyone KNOWS that there's a mandate penalty.

With stable premiums for 2019 (building off the Health Connector’s success of having the lowest exchange rates in the country in 2018, according to data from the federal Centers for Medicaid and Medicare Services), fewer renewing members switched plans in 2019, resulting in a stable membership experience moving into the new year.

Health Connector for Business

In response to the increasing costs of insurance for small businesses, the Health Connector reshaped its small-business platform last year to offer highly competitive, high quality and low cost health insurance coverage for companies with less than 50 employees. The Health Connector for Business currently helps 1,300 small businesses save money on premiums by offering health plan and coverage options to their employees. Currently nine health plans and more than 50 plan options are available for April coverage. Small businesses can compare premiums and save on average 20 percent than they might otherwise pay.

Additionally, small businesses can earn a rebate through the Connector’s new ConnectWell program,an online-based wellness program. The program offers employers a chance to save money while their employees improve their health and wellness. Employers can save up to 15% on the amount they contribute toward employees’ health insurance premiums if one-third of their employees’ successfully complete one of the program’s qualifying wellness activities. The average ConnectWell rebate for a business is $4,880. Employees enrolled in their group’s health plan will also have the chance to earn a $100 reward when they complete a qualifying wellness activity.

The Health Connector currently serves more than 1,300 business and 300,000 individuals and small-employer members with health and dental insurance. Access to affordable health coverage for individuals and small businesses can be found at the Health Connector’s website, MAhealthconnector.org.

This last part about the "Health Connector for Business" is interesting. This refers to MA's "SHOP" program which, as I've noted before, has mostly languished nationally. Both California and New York have overhauled their SHOP program over the past few years, with impressive results, so perhaps there's hope for it after all. The PR doesn't break out MA's SHOP enrollment...282,000 indy medical enrollees + 18,000 dental plan enrollees adds up to 300K even. Assuming those 18K with dental coverage are already included with the 282K medical plan population, that means perhaps 18,000 SHOP enrollees as well, or roughly 14 employees/family members per business enrolled.