Healthcare.Gov

So I was reading this thread on Twitter...

When people say “oh the shutdown only affects government workers,” remind them that IT requires maintenance. GOV websites that help businesses are going offline by the dozens per week https://t.co/1wGeTgsCyy pic.twitter.com/sYmBwTYFSq

— Ned Pyle (@NerdPyle) January 17, 2019

How many government servers were not patched in the past month? How many applications and website frameworks were not updated? How many pentests were postponed? How many logs were not examined for intruders?

— Ned Pyle (@NerdPyle) January 17, 2019

Imagine if your private company simply stopped having employees show up for a month. The government is no different and the impact is larger than all but the most massive private sector orgs

— Ned Pyle (@NerdPyle) January 17, 2019

ACASignups.net, February 11, 2018:

That should mean that the average HC.gov premium is around $600 or so per month in 2018. The 3.5% surcharge hasn't changed for 2018, which means the federal exchange should take in something like $252/year per enrollee. Total enrollment in HC.gov plans was down 5% this year, so I'll assume average effectuated enrollment will be as well...somewhere around7.13 million per month. That means ~$1.8 billion in HC.gov revenue directly from the premium surcharge.

All of this brings me to my question:

As I warned back on December 19th when CMS released the Week 7 HealthCare.Gov Enrollment Snapshot Report, the final, official enrollment tally for the 2019 Open Enrollment Period was almost certain to end up slightly lower than the Week 7 cumulative numbers indicated. There are several reasons for this: Some people who were auto-renewed contact HC.gov to cancel their 2019 renewals, while others had their enrollments involuntarily denied or otherwise cancelled due to problems with verifying their identity, address or legal residency status.

Last year around 79,000 QHP selections were dropped in the final report; I expected this to be slightly lower, at around 75,000. I'm pleased to report, however, that according to CMS, only around 43,000 people were scrubbed from the 39 states hosted by HealthCare.Gov this year:

Final Weekly Enrollment Snapshot for the 2019 Enrollment Period

So, how likely is HC.gov to reach last year's total in the final week? Well...not very likely, but let's do the math anyway. Again, this is for the 39 states hosted by HC.gov only; it does NOT include the 12 state-based exchanges, which are mostly AHEAD of last year so far.

  • Last year, 8,743,642 people selected QHPs via HC.gov total:
    •  4,580,782 actively re-enrolled
    • 1,702,429 were auto-reenrolled
    • 2,460,431 were new enrollees
  • Of those 8.74 million total, there are likely around 6.16 million currently enrolled as of December
  • Last year, 97% of those still enrolled as of December re-enrolled (actively or passively). If that holds true this year, that'll be around 5.97 million total renewals
  • That means HC.gov would need 2.77 million new enrollees total

So, where did things stand as of 12/08?

Right alongside the 2019 Public Use Files being posted, HealthCare.Gov is now open for people to window shop for 2019 ACA individual market healthcare policies.

Remember, HC.gov only hosts the ACA marketplace for 39 states; 12 states operate their own marketplace websites, and most of those have been open for window shopping for several weeks now. In fact, Covered California has allowed people to actually sign up for 2019 since October 15th.

Fire up the Wayback Machine, Peabody, and take us to September 2015:

AP's NEW "HC.gov Security Flaws" story attacks problems FIXED UP TO A YEAR AGO.

Last night I posted what seemed, at first, to be a merely-amusing (if a bit depressing) story about a Florida news station website accidentally (?) reposting a year-old AP newswire story about potential security vulnerabilities at Healthcare.Gov:

"Critical" flaw found in HealthCare.gov security

WASHINGTON -- The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.

Those are among the conclusions of a report released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.

PLEASE NOTE IMPORTANT UPDATES BELOW.

I just received the following from a healthcare broker, who I trust from past communication exchanges, who wishes to remain anonymous. I'm presenting it as sent, with the only changes being breaking it out into paragraphs for readability & with their state's identifying information removed.

Glossery:

According to this article from last May, the total budget for operating HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states,was around $2.1 billion in 2016. Donald Trump proposed slashing the budget down by about 20% to $1.7 billion in 2017.

Where does that money come from? Well, HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states, is not funded out of the general federal budget. Instead, it's funded by assessing a 3.5% premium surcharge on policies sold on it.

OK, that's not quite true; the 3.5% only applies to the 34 states which are fully operated by the federal exchange; there are 5 states (Arkansas, Kentucky, Nevada, New Mexico and Oregon) which have their own exchange operations but "piggyback" on HC.gov's technical platform; those states were charged just 1.5% of premiums in 2017 and 2.0% for 2018. However, those 5 states combined only make up around 5% of all HC.gov enrollments, so the lower fees only knock perhaps 2% off the total user fee revenue.

UPDATE: OK, it looks like the big HealthCare.Gov Final Surge Report is gonna be released sometime Thursday morning. Unfortunately, I have a can't-miss meeting in the morning as well, so there's a good chance that after sitting at my desk and constantly refreshing/checking email all day today, I may ironically end up missing the big reveal and not being able to post about it for an hour or so after it comes out.

UPDATE 12/21/17: As of 2:00pm, still nothing. Speculation now brewing that they may be hoping to bury the report at 4:59pm on the Friday before Christmas. Hoping to be proven wrong.

UPDATE 2:35pm: h/t to Adam Sacarny for the head's up:

Exchange open enrollment for 2018 coverage ended w/ approx 8.8M people enrolling in coverage. Great job to the @CMSGov team for the work you did to make this the smoothest experience for consumers to date. We take pride in providing great customer service.

OK, here it is: OE5 data for HealthCare.Gov for the 2nd-to-last week:

UPDATE: Minor updates out of New York and Washington State added later today have nudged the official national QHP selection tally over the 7.0 million mark. All numbers below have been updated to include these additions.

UPDATE 12/14/17: With the latest update from California, the confirmed national QHP selection total has now officially broken 7.1 million.

Week 6, Dec 3- Dec 9, 2017

In week six of Open Enrollment for 2018, 1,073,921 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Anyone who's followed me either here at ACASignups.net or over at Twitter over the past eight months knows that no one has been sounding the alarm louder or more frequently than me about both the real and potential sabotage of the ACA being carried out (or at least attempted) by the GOP in general and Donald Trump/Tom Price specifically. Hell, back in July, I even warned of a half-dozen things to look out for, several of which have since already been proven true:

This brings me to the main point of this entry: This is likely just the beginning. I'm not going to say that any or all of the following will happen--it's possible that Trump/Price/Verma will show some level of restraint--but I wouldn't be at all surprised to see any or all of these happen during this fall's Open Enrollment Period (which runs from Nov. 1st - Dec. 15th, by the way):

NOTE: The original focus of this diary was on the deliberate sabotage by the Trump Administration/HHS Dept. under Tom Price of the individual insurance market in general and HealthCare.Gov in particular, but the screen shot mentioned in passing in the diary below is actually far more important and disturbing the more I think about it than I had originally thought.

As noted below, it's an anonymous note sent to me on Thursday. Since it was sent I’ve confirmed the identity of the sender. This doesn’t prove that their specific claim is true, but there’s absolutely no reason I can think of for this person to risk their job and reputation by lying about this issue, and it matches everything else in the diary.

Several professional journalists have since contacted me and I’ve gotten them in touch with the sender. Stay tuned, this could be a big deal.

via Gawker, November 2013:

Only Six People Signed Up on Healthcare.gov's First Day

UPDATE 2/07/17: Over at Balloon Juice, David Anderson (aka 'Richard Mayhew') tackled the "last-minute sabotage" issue from a completely different angle, using actual statistical analysis methodology (remember, I'm not a statistician regardless of what everyone thinks)...and came to the exact same conclusion I did:

2017 using my known flawed data was running .96% behind 2016 on the January 14th inclusive update.  2017 ended up running 5.25% behind 2016 on Healthcare.gov states.  The increment (using favorable to the null hypothesis data) slowdown in pace that can be attributed to Trump Administration actions is 5.25-.96 or 4.29% of enrollment was lost due to the executive order and other Trump administration actions such as shutting down some outreach and advertising in the last eleven days of enrollment.

IMPORTANT UPDATE:

I've received confirmation from CMS that this "in line by midnight" grace period ONLY applies to those who CALL THE FEDERAL EXCHANGE at 1-800-318-2596​ and LEAVE THEIR CONTACT INFORMATION.

In other words, it does NOT appear to apply to those who are using the website application/enrollment process only; you have to CALL HC.gov and leave your number to qualify.

Every Open Enrollment Period to date, most of the ACA exchanges have ended up offering some sort of deadline extension and/or "in line by midnight" overtime grace period to allow people who started the enrollment process by the deadline additional time to wrap up their paperwork and complete the process.

Each year, this overtime period has shrunk:

OK, for the first time this Open Enrollment Period, my expections were off base...significantly. The past two years, HHS was posting "weekly snapshot" reports of enrollments at the federal exchange (HC.gov). This year they switched to 2-week reports, but today they decided to issue a special "week-plus" version which covers enrollments through the (extended) 12/19 deadline for coverage starting January 1st.

As I noted last Friday, based on the massive surge in enrollments (a record-breaking 670,000 people) on the final original deadline day (12/15), I bumped up my estimates for the 4-day extension period from my original 6 million or so up to an even 7 million (assuming 250K/day). However, I later realized that two of those days fell over the weekend, when enrollments drop off substantially (and since the original deadline had already passed, even the extended deadline wouldn't make much difference weekend-wise). I pulled back my projection somewhat to 6.75 million.

However, it turns out I was still overestimating, although the numbers are still pretty impressive:

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