Massachusetts

2018 MIDTERM ELECTION

Time: D H M S

This post was inspired by a Twitter query by "Other Alex". He originally asked about the insanely expensive premiums for ACA policies in Charlottesville, Virginia, which I wrote about the other day. Anyway, after some back & forth between him, myself and Colin Baillio, Alex asked if I knew where the least-expensive ACA plans are.

I haven't looked it up by rating area yet (for instance, Virginia as a whole ranks 18th most expensive this year even though Charlottesville is the most expensive rating area in the country), but on a state-level basis, it appears that the least expensive state for ACA-compliant individual healthcare policies is actually...(drumroll please)...

Massachusetts.

I'm not really able to post a full analysis at the moment, but here's the final officlal OE5 enrollment numbers from Massachusetts:

Total enrollment:

  • 2018 – 263,026 enrolled + 7,662 plans selected = 270,688
  • 2017 – 253,146 enrolled + 10,863 plans selected = 264,009

New enrollments:

  • 2018 – 55,565
  • 2017 – 56, 977

Massachusetts is the 16th state to surpass last year's numbers, and the 11th state-based exchange (if you include Federally-facilitated SBMs).

UPDATE: Hmmm...according ot the official CMS report, Massachusetts actually enrolled 266,664 people into QHPs via their exchange last year, so they're only up 1.5% year over year, but it's still great news, espcially given how low their uninsured rate was to begin with.

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

I've confirmed with the Massachusetts Health Connector that their official QHP selection tally stood at exactly 262,534 as of Christmas Day (12/25).

This puts them a mere 232 higher than they were 6 days earlier (12/19), which seemed a little odd to me given that 12/23 was MA's deadline for January 1st coverage; normally I'd expect a last-minute enrollment surge in the final days ahead of a big deadline, although it's not nearly as big a deal in the states which still have later deadlines for February or March coverage. On the other hand, Christmas Eve and Day were included here, and no one enrolls in health insurance on Christmas, of course. I wouldn't expect much this week either with New Year's coming up; there's usualy a 9-day Dead Zone from 12/24 - 1/01 anyway.

This is a pretty minor update to my last Massachusetts post, but every enrollment counts: I've just received confirmation from the MA Health Connector that the Bay State has tallied up 262,302 plans selected or enrollments as of 12/19.

Their record to date was last year, when they had a total of 266,664 QHP selections through January 31st, 2017...and unlike most states, the deadline in MA is still a month away (residents have until 12/23 to enroll for January coverage and until 1/23/18 to enroll for February coverage).

This gives Massachusetts a full 5 weeks to add at least 4,400 more people to break that record. They've added 2,487 in the past 13 days; if they kept that pace they'd add 6,685 more between now and 1/23, so it's not unreasonable to think they can pull that off.

This is a really minor update, but every person counts; as of December 10th...

260,391 plans selected and enrollments (reminder, we did auto renewal last month, so this includes current members)

29,115 plans selected and enrollments by people who currently don’t have coverage through the Exchange (these are part of the 260,391)

This is a mere 576 higher than MA's tally from four days earlier, but considering auto-renewals are included, it makes sense: The odds are that a couple thousand of those auto-renewed went back in and cancelled their renewals, partly cancelling out some of the new enrollment numbers.

Anyway, the CMS Public Use File lists Massachusetts as officially enrolling 247,121 people as of December 10th last year, so they're still running 5.3% ahead of that. They need 6,300 more enrollees (net) to break last year's record...but keep in mind that MA is one of the states with an extended deadline: Baystaters can still enroll as late as January 23rd.

Excellent news out of Massachusetts! I haven't posted any updates from the Bay State since 11/15, when they reported enrollments were up 40% year over year, but today they've given me very comprehensive and up-to-date numbers:

As of Dec. 6, we had a total of 259,815 plan selections and enrollments. This includes auto renewal of existing members. Of that, 26,074 are people who are new for 2018.

For comparison sake, for Dec. 6, 2016, we were at 244,845, and 25,746 for the new. These numbers also includes auto renewal, of course.

Obviously when you throw auto-renewals into the mix, the percentage increase drops substantially, but they're still up 6% over last year (nearly 15,000 people), and new enrolles are up about 1%.

Press release from the Massachusetts Health Connector...

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

This may seem a bit anticlimactic after yesterday's "200,000 on Day One!" HealthCare.Gov leak, but every data point helps.

I've received official numbers from the Massachusetts Health Connector through Day Five (November 5th).

Unlike most states, the Massachuetts exchange also handles premium billing/payments themselves, so they have a more elaborate enrollment reporting system. However, I've confirmed the following breakout:

  • 628: Current enrollees, plans selected
  • 3,860: Current enrollees, plans selected/paid
  • 445: Returning* enrollees, plans selected
  • 215: Returning enrollees, plans selected/paid
  • 1,375: New enrollees, plans selected
  • 472: New enrollees, plans selected/paid

Total: 6,995 total plans selected, of which 4,547 are fully enrolled (i.e., 1st premium paid).

*"Returning enrollees" means someone who's already in the MA exchange system because they were previously enrolled in an exchange policy in the past but isn't currently enrolled in one. For instance, they might have been enrolled from 2015-2016, but then left the exchange for 2017 and is returning for 2018.

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

Massachusetts has one of the stablest statewide insurance markets, no doubt in large part due to their having instituted the precursor to the ACA, "RomneyCare", 4 years earlier. Massachusetts also merged their small business and individual market risk pools, which helps stabilize things. As a result, they have a high number of carriers participating in their ACA exchange and are among the few states with single-digit average rate hikes...assuming CSR payments are forthcoming and the individual mandate is properly enforced.

Assuming CSR payments aren't made, I used the Kaiser Family Foundation's 19% average estimate for Silver plan hikes due to the CSR factor. Since a whopping 92% of MA's exchange enrollees chose Silver plans (it looks like MA's unique "ConnectorCare" plans are considered Silver as well), that means an average CSR factor of around 17.5 points across the entire individual market.

Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.

I just noted this morning that Rhode Island's enrollment numbers for 2017 are coming up significantly short of not only my own admittedly unrealistic hopes (I was hoping RI would buck the national trend and beef up enrollment by 15% this year), but is likely to actually come up lower than last year's 33.9K by several thousand people.

Fortunately, the opposite is proving to be the case in Massachusetts:

Through yesterday, we had 240,745 enrolled in January 2017 coverage...these are people who paid their bill. There are an additional 11,803 people who selected a plan but haven't paid for it yet. That's a total of 252,548.

That's, 252,548 QHP selections as of 12/28/16, of which over 95% have actually paid their first monthly premium (well above the 90% payment national average).

I noted a couple of weeks ago that Massachusetts has a unique methodology for reporting their ACA exchange enrollments. For one thing, they only officially count people who sign up for policies as "enrollees" after they've made their first monthly premium payment. In addition, like some other state exchanges, they "pre-renew" their current enrollees before the December deadline, and then reduce the official number from there as some people choose not to renew their coverage. As a result, instead of their "QHP selection" tally increasing, it actually starts out huge and then drops a bit as the enrollment period continues.

As a result, instead of 260,275 QHP selections, their number is a bit lower today:

Through Sunday, the 18th: 224,211 2017 enrollments. Plus, an additional 26,868 plans selected but unpaid at this point.

A couple of weeks ago, I noted that Massachusetts had confirmed just over 23,000 QHP selections for 2017 as of 11/17, consisting of around 15,800 renewing enrollees and 7,200 new people signing up.

Today I've received the latest enrollment data out of the Bay State:

As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.

That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.

OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.

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