March 18, 2015 | Rosemarie Day

Open Enrollment #2 Results: A Deeper Dive

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The official federal results for the Affordable Care Act’s second open enrollment period were released last week and the total numbers continue to look pretty good.1  How good?  Let’s take a look.

OVERALL ENROLLMENT

  • 11.7 million people selected a health plan or were automatically re-enrolled in exchange marketplaces.  While this number falls short of the original CBO projection of 13 million, and the revised CBO projection of 12 million, it does exceed the administration’s projection of 9 – 9.9 million.
  • If the enrollments stick, this will represent a 75% growth rate (5 million enrollees).  And that’s remarkable, given that the exchanges had half of the enrollment time this year (only 3 months instead of 6 months) to do it.  It’s a testament to this year’s improved processes, which had far fewer glitches.

Words of Caution

11.7 million enrollees is not a final number.  There will be ups and downs:

  • On the up side, the federal government and several states authorized a “Special Enrollment Period” for uninsured tax filers who recently discovered that they will pay a tax penalty and would like to buy insurance to avoid a penalty in the next tax year.  It is hard to predict how much enrollment will increase due to this.
  • On the down side, the people have to pay for their insurance in order for it to really count.  We don’t have those numbers yet for 2015, but based on 2014 results, we can expect attrition of at least 10%, which would result in a final count of 10.6 million.  Attrition could vary from last year, because of auto-renewals (we don’t yet know if they will help or hurt the final count).

STATE BASED EXCHANGES

A decent share (one-fourth or 2.9 million) of the total marketplace enrollments were in the 14 state-based exchanges.  But state-based exchanges are having mixed results – some have enrolled more people than they did in 2014; others have fewer members.

  • The biggest state, California, has enrolled the same number as last year:  1.4 million.  One-third (474,000) were new enrollees while the rest (944,000) were renewals.
  • The second largest state, New York, appears to have slightly exceeded last year’s results with enrolling 408,000 compared with 370,000 in 2014.
  • The two states with the largest growth in enrollment are Massachusetts and Maryland, both of which have fixed their failed technology from last year. 

RENEWALS ARE COMING IN STRONG

The federal report shows that the total number of renewing members (non-dental) was 5.8 million (4.2 million federal and 1.6 million state).  If they all pay their premiums, this would translate to a renewal rate of 87% (5.8 million/6.7 million non-dental effectuated enrollment in 2014). This would fall in the range of typical commercial insurance renewal rates of 80-90%.  It’s worth noting that renewal rates vary across states and the federal government.  For example, California’s renewal rate appears to be 78% (944,000/1.2 million, which is where California ended the year after attrition).  It will be important to examine their different approaches.

OTHER AREAS

To round out the open enrollment picture, we’ll use future blogs to take a look at:

  • Small Business:  The federal government is still not reporting any numbers on small business (SHOP) enrollments through the marketplaces.  Most state-based exchanges are, though, so we can take a look at those results.
  • Medicaid has continued to expand, and we’ll update our view to incorporate 2015 open enrollment results.

THE BOTTOM LINE

Ultimately, one of the key measures of the ACA’s success or failure is whether the number of uninsured people has been reduced.  To that end, the latest Gallup poll shows that the uninsured rate has dropped to 12.3% in the first two months of the new year.  This is a decrease from 17.1% in the fourth quarter of 2013, and is the lowest since Gallup began measuring in 2008.

 

1. ASPE Issue Brief, March 10, 2015.