New Hampshire

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

New Hampshire has only 5 carriers offering individual market policies, all 5 of which will still be participating in the NH market next year as well. Two of the five (Community Health Options and Minuteman Health) are among the 7 surviving ACA-created Co-Ops.

Even so, NH is proving to be a very tricky state to estimate, because only one of the 5 carrier rate filings includes their actual current rate-impacted enrollment data. As a result, I've had to take my best shot at estimating the market share of the other four. The only way I could think of to do this was to look up the latest NH DOI 2016 QHP Monthly Membership Report. New Hampshire, to their credit, is one of the only states without their own state-based ACA exchange which still actually posts regular reports about how many residents are enrolled in ACA exchange policies. Furthermore, they even break these numbers out by metal level and carrier, making the relative market share easy to calculate.

A few weeks ago I reported on some weirdness in New Hampshire's monthly exchange QHP enrollment data. They were showing an unusually high effectuated enrollment drop-off between March and April, especially odd considering that enrollment had supposedly increased from February to March.

It turned out to be a clerical error on the part of one of the carriers; this has since been corrected (though the earlier months were left as is), so the May report which was just released is back on track:

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

A couple of weeks ago I noted that New Hampshire may be the only state on the federal exchange which actively tracks their effectuated exchange enrollment on a monthly basis.

At the time, I noted that unlike most states, their effectuated numbers seem to have increased from February to March (January doesn't really apply since Open Enrollment was still ongoing at the time):

  • January 2016 Exchange-Based QHP Enrollment: 49,937 (+33,604 PAP enrollees)
  • February 2016 Exchange-Based QHP Enrollment: 53,109 (+38,735 PAP enrollees)
  • March 2016 Exchange-Based QHP Enrollment: 55,212 (+43,732 PAP enrollees)

Well, thanks to Louise Norris for the heads up: NH's April numbers are out, and there's something odd:

In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.

Investor's Business Daily's Jed Graham picked up on some of my work for his post today, including the enrollment data for both Minnesota and Connecticut...but in addition to that extra data point (which I'll come back to in a moment), he also nabbed the latest number out of a third state, Oklahoma, from one of Adam Cancryn's updates on what I'm calling the UnitedHealthcare Disenrollment Odometer:

Huh. Here's something unexpected. New Hampshire officially closed out the 2016 Open Enrollment Period with 55,183 exchange-based QHP selections.

As it happens, New Hampshire is, to my knowledge, the only state operating on the federal exchange which has a policy of publicly posting their effectuated exchange-based enrollment numbers every month throughout the year, which is a godsend to me.

Now that we're into April, I decided to take a sneak peak, and was a bit surprised at what I found:

Regular readers may have noticed that I've been posting fairly lightly of late. Now that open enrollment is over and we're deep in the thick of primary season, I'm trying to catch up with the massive backlog which has built up in my day job.

However, there's still a lot of stuff going on; today, for instance, brought some very positive Medicaid expansion news out of two states:

New Hampshire House passes Medicaid reauthorization

The New Hampshire House on Wednesday approved legislation that would keep 48,000 people on their insurance plans by continuing the state's expanded Medicaid program beyond the end of the year.

The bill, which now goes to the Senate, includes work requirements for recipients and asks insurance companies and hospitals to cover the state's share of the program's costs.

Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.

And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.

In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.

(sigh) OK, this one is not related to the Risk Corridor Massacre, since Community Health Options was actually profitable in 2014 and therefore never qualified for any RC payments anyway. Also, unlike the dozen ACA-created co-ops which are in the process of winding down operations by the end of the year, CHO is not going out of business, and in fact is remaining fully operational for 2016.

Having said that, this development is still a serious bummer given the carnage wreaked across the co-op landscape earlier this fall:

Maine's Community Health Options said Dec. 9 that it will cut short its sales of individual policies for 2016, in a sign that it is the latest Affordable Care Act-funded consumer operated and oriented plan to encounter financial difficulties.

I admit that given the carnage of the past couple of weeks, I'm almost afraid to post this entry...but I had to write something positive about the CO-OP situation.

With the ACA-created CO-OPs seemingly dropping like flies due to the #RiskCorridorMassacre, I thought this would be a good time to flip things around and look at which CO-OPs are doing well (or at least not badly).

This isn't much, but it'll do for now:

Wisconsin's insurance department says it has no intention of shutting down its #ACA co-op, which appears it will remain solvent next year.

— Bob Herman (@MHbherman) October 22, 2015

@charles_gaba and at this point, other than Maine, it's difficult to expect many others will last beyond risk corridors.

— Bob Herman (@MHbherman) October 22, 2015

Louise Norris has again done some of the heavy lifting for me over at healthinsurance.org, this time for New Hampshire:

In 2015, New Hampshire’s exchange had five carriers, up from just one in 2014.  There will still be five carriers in 2016, although there’s one swap:  Assurant/Time is exiting the market (nationwide), but Ambetter (offered by Celtic) is joining the exchange in New Hampshire.

...Two carriers in the exchange – Minuteman Health and Community Health Options – have requested double digit rate increases, although they have not yet been approved.  Both carriers are CO-OPs created under the ACA, and both expanded into New Hampshire at the start of 2015, so their claims data for the state is very limited. 

This article about New Hampshire reveals 3 noteworthy bits of information: First, it looks like at least one of the 37 HC.gov states will be reporting their exchange enrollments monthly during the off-season, even if the HHS Dept. itself refuses to do so:

The New Hampshire Insurance Departmentrecently began requiring insurance companies selling plans through the marketplace to submit monthly enrollment numbers.

Second, here's the first results of those monthly reports:

 According to the latest numbers, a total of 45,504 people had signed up for plans in New Hampshire by April 1

I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:

MICHIGAN:

For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

New Hampshire's ACA Medicaid expansion program got a late start, not kicking off until July 1st of this year. That makes the fact that they've already reached 50% of their total potential enrollment all the more impressive:

State officials had expected 30,000 to 40,000 of the estimated 50,000 eligible adults would sign up in the first year either through the state's managed care program for Medicaid or a program that subsidizes existing employer coverage. As of mid-week, just fewer than 25,300 had signed up.

 

Looks like New Hampshire is switching from "standard" Medicaid expansion to an Arkansas-like "Private Medicaid Option" program next year...and it includes an enrollment update:

"This waiver is an important part of our efforts to improve the health and financial well-being of Granite State families, businesses and communities through our bipartisan health care expansion plan, "Governor Hassan said. " Almost 24,000 Granite Staters have the security that comes with quality, affordable health insurance because of the New Hampshire Health Protection Program, and if approved, this waiver will allow these people to choose private insurance on the health insurance marketplace."

...The purchase of Qualified Health Plans via the marketplace will be paid for with 100 percent federal funds through December 31, 2016.

Through the 19th of November, 23,975 New Hampshire citizens had enrolled in the New Hampshire Health Protection Program.

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