The Center for Medicare and Medicaid Services (CMS) released the final initial count of enrollments for Healthcare.gov’s open enrollment period last night.
| HealthCare.gov Platform Snapshot | Week 7: Dec 9 – Dec 15 | Cumulative: Nov 1-Dec 15 |
| Plan Selections | 4,322,450 | 8,454,882 |
| New Consumers | 918,648 | 2,025,611 |
| Consumers Renewing Coverage | 3,403,802 | 6,429,271 |
| Consumers on Applications Submitted | 4,291,903
|
10,612,387 |
Total plans purchased went down by 368,000 before the data gets cleaned up. Assuming this year looks like most other years, I expect to lose a net 50,000-100,000 more enrollments after files are reconciled. Charles Gaba has a very helpful chart that lays out the details year over year:
There are two things to note that I think tell the stories of enrollment. I am speculating wildly with little to no direct evidence but I think I have reasonably well grounded intuition.
The first story is that the renewals went up by a minuscule amount. We know that more people are being exposed to Silver Loaded and Silver Gapped deals due to Cost Sharing Reduction (CSR) subsidies having been terminated and baked into the premium structures. This is not uniform. It was a plus in North Carolina and Iowa but a big minus in Philadelphia and Phoenix.
Pricing for subsidized folks was an enrollment driver:
More states are silver-loading. Colorado and Delaware shifted from a broad-load of CSRs, meaning that CSR costs were incorporated into the premiums for all plans, to a silver load of CSR costs. North Dakota and Vermont are incorporating CSR costs into premiums for the first time. These steps will increase the value proposition for subsidized buyers.
The other story is to look at the new enrollees. This year saw a 15% decline in new enrollees.
I think this is a sign that the repeal of the individual mandate as well as increased focus on expanding eligibility for underwritten plans is working as expected.
I am speculating wildly right now.
I think that once someone shows up on Healthcare.gov, the odds of converting an account creation or even a windowshopping moment into a plan purchase is as high if not higher this year than in past years. The pricing due to CSR termination creates a lot of high value proposition deals. However the odds of someone who is potentially in the individual market for health insurance actually going to Healthcare.gov is lower this year than in prior years.
That is speculation. I think it is reasonable speculation but it is not evidence based (yet).
Overall, given the environment, this is a surprisingly strong end of the open enrollment period enrollment report for Healthcare.gov.
stinger
I always value your analyses.
David, if we went to Medicare for All or some simple, straightforward system where all Americans have basic health coverage at an affordable cost, would you have to become a full-time soccer ref?
David Anderson
@stinger: Nope, my knees won’t let me do that full time again… I am no longer 29
And honestly, there will never be anything straight forward about the US healthcare system. I can find some interesting question to poke and probe on for a very long time.
Brachiator
I wonder. Has there been an increase in the number of people getting health insurance through an employer?
David Anderson
@Brachiator: I would not be surprised if some of the enrollment loss on HC.Gov is due to more people being employed. That would make a lot of mechanical sense.
Another 100,000-130,000 enrollments lost can be explained by Maine and Virginia expanding Medicaid. People who would have bought an ACA plan are now going to be covered by Medicaid expansion.
Once factoring out Medicaid expansion, we’re looking at maybe 250,000 few net enrollments than 2018
Mary G
So appreciate all the Democrats who knew that they would very probably lose their jobs and still voted in the ACA, which wasn’t everything we wanted, but the crucial first step that the party had been trying to get done since FDR. And Nancy SMASH who got this done and held every one of her herd of cats in the resistance to every Republican vote to kill or wound it. I thought it was a goner when the 62 million idiots gave away the country in November 2016, and it’s damaged for sure, but still limping along.
Ted Doolittle
The failure of many consumers to understand the good deals available to the subsidized population is why the Connecticut Office of the Healthcare Advocate is recommending that the General Assembly look at requiring all health insurance purchases — ACA or not, and including the alternative plans such as Association Plans and Short-Term Limited Duration plans, and others — to go through the Exchange website in some way.
stinger
@Mary G: Yes, every word of this.
Juice Box
California doesn’t close open enrollment until 1/15/19. It’s not that we’re naturally slow, we just want everybody to have a chance to vote and enroll. Also, there are a lot of us.
ccswood
Do you expect the Hurricane Michael extension to have a significant impact?
https://politics.myajc.com/news/state–regional-govt–politics/dozens-georgia-counties-get-obamacare-enrollment-extension/x1zHZh07Nu2rxjXT3rWe6M/