Last year, I noted several times that regardless of what your opinion may be of the ACA's Individual Mandate Penalty (which was, until this year, either $695 per adult/$348 per child or 2.5% of your household income, unless you received an exemption), one of the key things to keep in mind about the penalty is that any impact it has on encouraging people to go ahead and enroll in ACA-compliant healthcare coverage is entirely dependent on two things:
NY State of Health Releases 2019 Open Enrollment Report
Essential Plan and Qualified Health Plan Enrollment Reach Record Levels
ALBANY, N.Y. (May 9, 2019)—NY State of Health, the state’s official health plan Marketplace, today released detailed demographic data on the more than 4.7 million New Yorkers enrolled in comprehensive health coverage through the close of the sixth open enrollment period on January 31, 2019. Marketplace enrollment is now at its highest point ever, and Essential Plan and Qualified Health Plan enrollment reached record levels of more than 1 million people.
“It’s evident in the numbers released today that there is high demand for quality, affordable health coverage,” said NY State of Health Executive Director, Donna Frescatore. “The 2019 record enrollment levels are proof that New York’s Marketplace remains strong.”
NY State of Health 2019 Open Enrollment Report Highlights
However, this report was released amidst a gusher of other major ACA/healthcare news stories over the course of the week, and I never really got around to a deep dive. I'm still swamped, but I figured I should at least go back and do a little more analysis today.
OK, first of all, I need to clean up the discrepancies between the OE6 enrollment data I had and what's in the official CMS report. Every year there are always slight variations in a few states, usually when it comes to the state-based exchanges, and this year is no exception. There were differences reported in six states; in five of them, CMS reported lower enrollment numbers; in one the CMS tally is higher:
The Centers for Medicare & Medicaid Services (CMS) today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirms another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases. Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the Exchanges began operations in 2014.
Access Health CT, Connecticut's state-based ACA exchange, released their 2019 Open Enrollment Period report, and it's one of the most extensively detailed & granual looks at the year's enrollment data. They've included the normal stuff, of course (subsidized vs. unsubsidized, metal levels, age and income brackets, etc)...but they've also done a very deep dive into data points I haven't seen before by cross-indexing categories.
For instance, not only did they break out "enrollment attrition reasons" (that is, why 2018 enrollees who didn't renew their policies chose not to), but they actually broke that out into what those enrollees' financial assistance status was.
The level of detail here is pretty impressive and somewhat overwhelming (there's 25 pages of charts & graphs), but if you're a healthcare nerd interested in what's going on in the Nutmeg State, knock yourself out!
Via Email from the Connect for Health Colorado exchange...
Customers Receiving Financial Help Through Connect for Health Colorado® Seeing a 14% Drop in Net Monthly Premium Cost
DENVER – Coloradans who get financial help buying health insurance through Connect for Health Colorado® are paying an average 14 percent less in “net premium” – what they pay after assistance – compared to the average net premium in 2018, according to data released today.
Three of every four current Connect for Health Colorado customers qualify for financial help to reduce the monthly cost of health insurance. The average net premium for those Coloradans is $117 per month, down from $136 per month last year.
“We are happy that we are able to make health insurance affordable for so many people,” said Kevin Patterson, Chief Executive Office of Connect for Health Colorado. “The number of our customers receiving help rose this year by seven percentage points, to 76 percent, an important increase. We know we have more work to do, and are committed to expanding our impact as we work with policy makers, our stakeholders and our customers throughout the state.
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.
Press Release: NY State of Health Releases 2019 Enrollment Data by Insurer
Mar 12, 2019
New Yorkers Value Choice of Plans
2019 Enrollment is Spread Across NY State of Health’s 12 Qualified Health Plan Insurers and 16 Essential Plan Insurers
ALBANY, N.Y. (March 12, 2019) - NY State of Health, the state’s official health plan Marketplace today released 2019 health plan enrollment by insurer. Twelve insurers offer Qualified Health Plans (QHP) and sixteen insurers offer the Essential Plan (EP) statewide in 2019. Most consumers have a choice of at least four QHP and EP insurers in every county of the state.
“We are pleased to once again offer consumers a broad choice of high-quality, affordable health plan options in every county of the state,” said NY State of Health Executive Director, Donna Frescatore. “And the wide distribution of enrollment across insurers shows us that consumers value this choice.”
The Washington Health Benefit Exchange today announced that more than 200,000 people purchased their 2019 health insurance coverage through Washington Healthplanfinder, the state’s online health insurance marketplace, during the most recent open enrollment period held Nov. 1 through Dec. 15 of last year.
Even with the four percent decrease in total number of enrollments reported from February of 2018, the Exchange saw more than 90 percent of those who selected a 2019 health plan during the open enrollment period make their initial premium payment.
Vermont is among the few states which also releases their off-exchange numbers, and it's a good thing they do that because it helps explain the 12.3% drop in on-exchange enrollment this year. In short, thanks to VT making the move to active #SilverSwitching for 2019, several thousand people moved from on-exchange Silver ACA plans to nearly-identical off-exchange Silver plans.
Anyway, today they issued a formal press release with additional details...and at the same time bumped up the official enrollment tally by a bit:
2019 Individual Enrollment Report Shows More Vermonters are Covered
HealthSource RI enrollments up by nearly 2,000 customers as RI’s uninsured rate reaches all-time low
Feb 25, 2019
According to the latest Rhode Island’s Health Information Survey, only 3.7% of Rhode Islanders were uninsured in 2018, down from 4.2% in 2016.
HealthSource RI’s individual and family enrollments increased by 1,849. This Open Enrollment, 32,486 customers enrolled and paid compared to 30,637 last year.
The "...and paid" caveat is important. Last month HealthSource RI reported 34,533 QHP selections after the 2019 OEP wrapped up, so that's an impressive 94% paid/effectuated rate. For comparison, last year 30,637 paid out of 33,021, or 92.8%, so they've improved on that front as well.
By the close of this year’s Open Enrollment, Coloradans had selected 169,672 medical insurance plans, which compares to 165,777 medical plan selections for the 2018 Open Enrollment period.
Hmmm...I'll have to look into these numbers a bit further. Colorado's 2018 Open Enrollment total was indeed 165,777 according to C4HCO...but according to CMS's official report it was only 161,764 QHP selections. This is the same thing which happened last year, when C4HCO reported 172,361 QHPs vs. CMS's 161,568. It's therefore possible that the final/official 2019 CMS report will put Colorado's total around 4,000 enrollees lower than my own numbers.
However, either way, Colorado joins Massachusetts in increasing their ACA open enrollment numbers every year for five years straight, bucking the national trend!
Back in early December, I noted that while I applauded both New Jersey and the District of Columbia for creating their own individual healthcare coverage responsibility requirements (aka, The Individual Mandate) in response to Congressional Republicans repealing the ACA's federal penalty, doing so also required making sure that residents of NJ/DC *knew* they had done so:
There's only one problem with this: The impact of the mandate penalty is completely psychological in nature. It only works (to the extent that it does at all) if people know that they'll be penalized financially for not complying with the mandate.
I still expect the final national QHP selection tally to increase by around 35,000 more when the dust settles, including perhaps 1,000 more from DC, 5K - 10K more from New York and around 28,000 from Vermont (which hasn't reported anything so far this Open Enrollment Period). If so, the official total should end up around 11.47 million nationally, with the 12 State-Based exchanges coming in around 1.6% higher than last year (an all-time high for them collectively) vs. the 39 states on the federal exchange, which dropped another 3.8% this year. Nationally, the official total should end up around 280,000 enrollees short of last year.
Since then I've plugged in the final numbers from New York (which indeed added around 6,700 more enrollees), the District of Columbia (which added over 3,000 more) and, just this morning, Vermont (which only added 25,000 more, with a caveat). Net increase? 34,889 QHP selections.
That indeed brings the grand total to 11,465,327 QHP selections nationally...or 11.47 million...with the state-based exchanges increasing 1.6% year over year, and the national total dropping 285,000 enrollees.
UPDATE: The final, official CMS enrollment report came out in late April, and there's some minor discrepancies in a few states (especially Minnesota). Nationally, the official total is around 22,000 fewer than I thought. The table below has been updated to reflect this. The state-based exchanges still increased enrollment over last year, but only by 0.9%; nationally, enrollment dropped by 306,000 people.