END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Massachusetts

This is a really minor update, but every person counts; as of December 10th...

260,391 plans selected and enrollments (reminder, we did auto renewal last month, so this includes current members)

29,115 plans selected and enrollments by people who currently don’t have coverage through the Exchange (these are part of the 260,391)

This is a mere 576 higher than MA's tally from four days earlier, but considering auto-renewals are included, it makes sense: The odds are that a couple thousand of those auto-renewed went back in and cancelled their renewals, partly cancelling out some of the new enrollment numbers.

Anyway, the CMS Public Use File lists Massachusetts as officially enrolling 247,121 people as of December 10th last year, so they're still running 5.3% ahead of that. They need 6,300 more enrollees (net) to break last year's record...but keep in mind that MA is one of the states with an extended deadline: Baystaters can still enroll as late as January 23rd.

Excellent news out of Massachusetts! I haven't posted any updates from the Bay State since 11/15, when they reported enrollments were up 40% year over year, but today they've given me very comprehensive and up-to-date numbers:

As of Dec. 6, we had a total of 259,815 plan selections and enrollments. This includes auto renewal of existing members. Of that, 26,074 are people who are new for 2018.

For comparison sake, for Dec. 6, 2016, we were at 244,845, and 25,746 for the new. These numbers also includes auto renewal, of course.

Obviously when you throw auto-renewals into the mix, the percentage increase drops substantially, but they're still up 6% over last year (nearly 15,000 people), and new enrolles are up about 1%.

Press release from the Massachusetts Health Connector...

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

This may seem a bit anticlimactic after yesterday's "200,000 on Day One!" HealthCare.Gov leak, but every data point helps.

I've received official numbers from the Massachusetts Health Connector through Day Five (November 5th).

Unlike most states, the Massachuetts exchange also handles premium billing/payments themselves, so they have a more elaborate enrollment reporting system. However, I've confirmed the following breakout:

  • 628: Current enrollees, plans selected
  • 3,860: Current enrollees, plans selected/paid
  • 445: Returning* enrollees, plans selected
  • 215: Returning enrollees, plans selected/paid
  • 1,375: New enrollees, plans selected
  • 472: New enrollees, plans selected/paid

Total: 6,995 total plans selected, of which 4,547 are fully enrolled (i.e., 1st premium paid).

*"Returning enrollees" means someone who's already in the MA exchange system because they were previously enrolled in an exchange policy in the past but isn't currently enrolled in one. For instance, they might have been enrolled from 2015-2016, but then left the exchange for 2017 and is returning for 2018.

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

Massachusetts has one of the stablest statewide insurance markets, no doubt in large part due to their having instituted the precursor to the ACA, "RomneyCare", 4 years earlier. Massachusetts also merged their small business and individual market risk pools, which helps stabilize things. As a result, they have a high number of carriers participating in their ACA exchange and are among the few states with single-digit average rate hikes...assuming CSR payments are forthcoming and the individual mandate is properly enforced.

Assuming CSR payments aren't made, I used the Kaiser Family Foundation's 19% average estimate for Silver plan hikes due to the CSR factor. Since a whopping 92% of MA's exchange enrollees chose Silver plans (it looks like MA's unique "ConnectorCare" plans are considered Silver as well), that means an average CSR factor of around 17.5 points across the entire individual market.

Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.

I just noted this morning that Rhode Island's enrollment numbers for 2017 are coming up significantly short of not only my own admittedly unrealistic hopes (I was hoping RI would buck the national trend and beef up enrollment by 15% this year), but is likely to actually come up lower than last year's 33.9K by several thousand people.

Fortunately, the opposite is proving to be the case in Massachusetts:

Through yesterday, we had 240,745 enrolled in January 2017 coverage...these are people who paid their bill. There are an additional 11,803 people who selected a plan but haven't paid for it yet. That's a total of 252,548.

That's, 252,548 QHP selections as of 12/28/16, of which over 95% have actually paid their first monthly premium (well above the 90% payment national average).

I noted a couple of weeks ago that Massachusetts has a unique methodology for reporting their ACA exchange enrollments. For one thing, they only officially count people who sign up for policies as "enrollees" after they've made their first monthly premium payment. In addition, like some other state exchanges, they "pre-renew" their current enrollees before the December deadline, and then reduce the official number from there as some people choose not to renew their coverage. As a result, instead of their "QHP selection" tally increasing, it actually starts out huge and then drops a bit as the enrollment period continues.

As a result, instead of 260,275 QHP selections, their number is a bit lower today:

Through Sunday, the 18th: 224,211 2017 enrollments. Plus, an additional 26,868 plans selected but unpaid at this point.

A couple of weeks ago, I noted that Massachusetts had confirmed just over 23,000 QHP selections for 2017 as of 11/17, consisting of around 15,800 renewing enrollees and 7,200 new people signing up.

Today I've received the latest enrollment data out of the Bay State:

As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.

That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.

OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.

A very quick update out of the Bay State:

  • As of 11/17: 23,026 total QHP selections (13,523 fully paid/enrolled for 1/1/17 coverage)
  • 15,800 renewals/reenrollees (69%), 7,226 new/returning enrollees (31%)

That's 1,355/day on average for the first 17 days; this is up from 1,281/day for the first 8 days.

For comparison, last year they only averaged around 575/day (for the first 7 days anyway), so it's definitely busier (2.3x faster) so far.

Even just looking at new enrollees: The first week averaged 183/day last year; this year it was 368/day the first 8 days and 425/day the first 17 days...again, more than twice last year's rate so far.

In addition to releasing their 2017 enrollment data for the first 8 days of November, the Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of October), and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.

The most recent hard current exchange QHP enrollment number I have for Massachusetts is 230,412 people as of September 1st. Due to MA's unique "ConnectorCare" program, they've actually seen a gradual increase in exchange enrollment during the off-season instead of net attrition like almost every other state.

Today I was informed that as of November 8th, they had a grand total of 2,942 new QHP selections via the state exchange...of which 510 are fully enrolled (i.e., they've paid their January premiums already). This does not, however, include any renewals / re-enrollments by current enrollees, which could be substantially higher.

UPDATE: OK, I have the total enrollment numbers now: 10,251 (7,309 renewals + 2,942 new additions). That's 1,281 per day, or about 4.8% of their total enrollment last season.

Minnesota and Massachusetts are the only state exchanges I have data for so far, and MN is a special case, so here's a simple extrapolation of MA's numbers:

Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.

The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.

Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.

The Massachusetts Health Connector has posted their latest monthly enrollment report (through the end of August), and the news is good. As I note every month:

Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.

The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.

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