That’s down about 4% from the total 9.2 million plan selections in https://t.co/xUHYfJjU0M states last year. https://t.co/FfbDH8mUHm
— Emily Gee (@EmilyG_DC) December 21, 2017
This is preliminary data. I think The 8.8 million is referring to Healthcare.gov enrollments. If this is the case, there is an outside chance that total enrollment will be flat or slightly above 2017 enrollment as the state based markets (Covered California, New York, Massachusetts Health Connector etc) come in with later deadline dates and more active marketing.
I am happily surprised. A few reporters had asked me for an enrollment guess at various points this fall and the only answer I could give them was “Somewhere between 1 and 20 million”. For some odd reason, they never ran that quote.
The Exchanges had a lot of headwinds for enrollment:
- Strategic Messaging Environment (“It’s dead, Obamacare is Dead….)
- Decrease in federally funded outreach
- Headlines of large price increases for non-subsidized plans
- Short open enrollment period (this is not a bad idea just one more barrier to access)
The biggest tailwind was pricing. As we’ve discussed on Balloon-Juice, the threat and the reality of terminating Cost Sharing Reduction (CSR) payments led to Gold Gapping and Silver Loading:
Bronze plans are now much cheaper than Silver plans. Bronze plans in 2017 for this carrier were priced as if they were about 10 actuarial value points less comprehensive benchmark. In 2018, Bronze plans are priced as if they are 30 actuarial values points less comprehensive than the benchmark plan. A pair of 40 year olds earning $32,000 now could buy a Gold plan for $1 month. Bronze plans will be extremely inexpensive up to the edge of the subsidy income range. Lower net of subsidy costs will bring in more people.
CMS also made it easier for brokers and third party vendors to sell on-Exchange subsidized plans which helped as Healthsherpa.com reported a record open enrollment. This probably helped as well as an increase in insurer advertising.
Increase in health insurance ads during this open enrollment period is coming from insurance companies and other non-public sponsors https://t.co/p8vb2Feih2 pic.twitter.com/PWM0x398Wk
— WesleyanMediaProject (@wesmediaproject) December 13, 2017
The biggest take-away in my opinion is that pricing matters. Ineffective sabotage by terminating CSR payments after all insurers could survive till the end of the year and almost all had filed rates to protect themselves from CSR termination in 2018 made subsidized pricing far more attractive to healthy buyers than otherwise would have happened. If there was either effective CSR sabotage (termination of payments in May or June) or no dispute on CSR, enrollment would have been much lower.
Mike J
Mike J
And if you live in Washington, don’t forget that you have until Jan 15 to sign up. Another dozen or so states also have extended deadlines.
Mary G
Covered California has been marketing like crazy.
tobie
I’m not sure I follow how ineffective sabotage of CSR ended up lowering monthly premiums, but I am happy it did and that enrollment continued at a good pace in spite of every Republican effort to wreck the ACA.
Scott Robertson
With the unemployment rate dropping, I would expect more people getting employer based health insurance. Some proportion of these people were on the exchanges last year. Any data on this?
David Anderson
@Scott Robertson: I will look for this. ESI uptake has been fairly flat/stable over the past couple of years.
Jeffro
David you were spot-on: it really WAS between “1 and 20 million” :)
Yutsano
@Jeffro: Kan we haz lottery numbers 2 plz?
Bill
I’m wondering if Congress killing the mandate after the enrollment period closed is going to lead to people unenrolling. I’m considering not paying the second month’s premium on the shockingly expensive ACA compliant Bronze Plan I just signed up for, and replacing it with a catastrophic loss policy. The plan I have leaves my family uninsured up to $14,000 anyway. I assume others are doing the same calculations.
I hate that Congress killed the mandate because I philosophically agree with what the ACA is trying to do. But that same congress so screwed up pricing that what we have now is simply unaffordable for many people.
Jay S
@Scott Robertson: I think you need to look at work force participation rather than unemployment numbers, but I believe that indicates more workers as well.
ETA unemployment generally measures people actively looking for work.
Paul W.
I’d just go ahead and call this good news, all things considered.
Raven Onthill
I wonder if the Congressional fight over Obamacare didn’t act to publicize it.
Mnemosyne
@Jay S:
Workforce participation should start going down as the Baby Boomers retire. They are still a huge chunk of the workforce, and there aren’t quite enough Millennials to fully replace them.
ken
What about the hc.gov states and counties where enrollment is still open due to hurricane extensions? Any idea how many more will enroll from those areas during extended enrollment?