Colorado

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

via Email just moments ago...

Connect for Health Colorado® Reports Plan Selection Totals for 2018 in Line with Target and Nearly Matching Longer 2017 Enrollment Period

DENVER —  More than 165,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace by the close of Open Enrollment, according to new data released today by Connect for Health Colorado®. 

“These are positive results that show us holding steady and in line with our targets for the year,” said Connect for Health Colorado CEO Kevin Patterson.  “Despite the uncertainty that created some confusion in the market, we have seen volumes that nearly match last year’s longer Open Enrollment Period. I am happy to see so many families and individuals put this protection for their health and financial well-being in place for the year. We will be reporting our results in coming weeks in our annual End of Open Enrollment Report.” 

I'm a little late with this one (spent pretty much the entire day dealing with cleaning up the aftermath of my Terrible, Horrible, No Good Very Bad Day), but Connect for Health Colorado, the CO ACA exchange, issued their first update since December 17th with 3 days left to go before Open Enrollment ends for 2018:

Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Deadline is Friday
Posted on Tuesday, January 9, 2018

DENVER — More than 158,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through January 8, 2018, a rate 2 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, days ahead of the enrollment deadline.

FOR IMMEDIATE RELEASE

Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Continues to January 12, 2018

DENVER —  More than 149,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through the December 17, 2017, a rate 7 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, mid-way through the Open Enrollment period for 2018 coverage.

“It’s not over, but the first half of this Open Enrollment period has set a solid pace,” said Connect for Health Colorado CEO Kevin Patterson.  “We are still enrolling Coloradans who buy their own health insurance through January 12.  I encourage everyone who does not have coverage yet to go to our site and see if they qualify for financial help. My message is, ‘Don’t leave money on the table.’ We know that too many Coloradans who qualify for help assume that they don’t.”

A few days ago I noted that based on a rather cryptic press release from Connect for Health Colorado, I deduced that C4HCO had enrolled a minimum of 53,000 people in 2018 ACA exchange policies as of December 7th. Today, however, Louise Norris has clarified that the actual 12/07 tally in CO was 59,590...and that this does not include auto-renewals, as some of the other state-based exchanges have already done:

OK, I'm reaching a bit with this one. The press release put out today (December 8th)  by Connect for Health Colorado doesn't actually include any hard QHP selection numbers; all it says is this:

As I have said, the pace of plan selections continues to run ahead of all previous years but there are plenty of people yet to act to avoid a gap in coverage. Our message remains: Don’t leave money on the table. We know from our own survey that too often Coloradans who are eligible for financial help assume that they make too much to get an Advance Premium Tax Credit.

OK. Last year (OE4) was Colorado's best year so far, with 161,568 QHP selections as of 1/31/17. According to the CMS Public Use File, they hit 42,796 as of 12/03/16 and 59,407 as of 12/10/16. That's an average of 2,373 per day between 12/04 - 12/10, which means they should have reached a minimum of 52,288 QHPs as of 12/07/16.

This just in...

Connect for Health Colorado® Reports Increase in 2018 Medical Plan Selections

DENVER —  More than 43,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace in November, a rate 29 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

“With only two weeks left to enroll for January coverage, I am pleased with the pace of plan selections,” said Connect for Health Colorado CEO Kevin Patterson.  “I know people are busy this time of year but I encourage everyone who buys their own health insurance to check to see if they qualify for financial assistance, review the available plans, and complete an enrollment before the last-minute rush. Many will be surprised that they qualify for financial help.”

A week or so ago, Connect for Health Colorado reported that they'd enrolled 22,650 people in ACA exchange plans as of November 14th, up a full third over last year by the same date. Today they've posted their third week numbers, and while things have started to slow down, they're still running 25% ahead of last year.

Given the whole Silver Load/Silver Switcharoo craziness, I was mildly surprised to see that the ratio between Bronze, Silver and Gold have barely changed year over year, and in fact Silver has inched upward by a few points...until I remembered that Colorado is among the few states which went with the "broad load" model, spreading the additional CSR cost across all metal levels both on and off the exchange. This makes the similar metal level spread more understandable, but it also makes the 25% enrollment increase even more surprising, since subsidized enrollees will pay pretty much the same (no more or less) than this year, but unsubsidized enrollees are seeing their rates shoot up no matter where they go. As you can see below, the average premiums for unsubsidized enrollees ("NFA" = "Non-Financial Assistance) is 36.6% higher this year than last.

Connect for Health Colorado® Reports Increase in 2018 Medical Plan Selections

DENVER — Between Nov.1 and Nov. 15, more than 22,000 Coloradans selected health coverage for 2018 through the state health insurance Marketplace, according to new data released today by Connect for Health Colorado®.

“I am glad to see the number of initial sign-ups during the first two weeks of Open Enrollment,” said Connect for Health Colorado® CEO Kevin Patterson.  “There has been some confusion about healthcare coverage this year. I want everyone to know that the financial help to buy health insurance is still available for next year. I urge everybody buying their own health insurance to take a minute on our site, ConnectforhealthCO.com, to check to see if they qualify and then review their options and complete their enrollment before the last-minute rush.”

When I last looked at Colorado's 2018 rate hike summary in early September, it appeared that they were looking at an overall average rate increase of either 33% or 41% without CSR reimbursement payments depending on your interpretation of a state DOI quote, or 26.7% assuming CSR payments are made. The confusion wasn't really cleared up much by the later announcement that Colorado is going with the "Broad Load" strategy for their "lost" CSR reimbursements.

Today I checked in with the Colorado DOI again, and they've posted the official, presumably final rate increases, assuming no CSR funding:

About a month ago, Colorado was among the first states to release their approved 2018 individual market rate hikes. At the time, the average unsubsidized rate increases assuming CSR payments are guaranteed for all of 2018 averaged around 26.7% statewide.

As for CSR payments not being made, however, the press release accompanying the rate tables was more vague; it stated that they would be "up to" 14 points higher, but didn't clarify whether that would apply to every individual plan or only the Silver policies, which is how most other states appear to be handling it. I assumed the "no-CSR" average would be roughly 32.9% if the load is only dumped on Silver plans, but 40.7% if spread across all metal levels.

More recently, Louise Norris (who lives in Colorado herself) gave me the bad news: That "up to 14 points" is being spread across everything:

(sigh) Colorado's state insurance division just released their approved 2018 rate increases (busy day!), and the situation appears to be similar to Maine: The average requested rates which I thought already assumed no CSR reimbursements appear to have assumed CSRs would be paid after all:

Division of Insurance approves health insurance premiums for 2018
Commissioner: Measures to stablize market for 2018 must happen by Sept. 30

DENVER (Sept. 6, 2017) – The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has approved the individual and small group health insurance plans for 2018. Average premium changes within each market - individual and small group - as well as the average change for each insurance company are listed below.

The Colorado Dept. of Regulatory Agencies has made it pretty simple for me:

Division of Insurance releases preliminary 2018 health insurance information
Final approval expected in late September / early October

DENVER (July 14, 2017) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released the preliminary information for proposed health plans and premiums for 2018 for individuals and small groups. From this point until August 4, Colorado consumers can comment on these plans.

All counties in Colorado
As the Division of Insurance noted in its June 21 news release, based on the plans filed, there is at least one insurance carrier planning to offer individual, on-exchange plans in every Colorado county. However, the insurance companies have indicated to the  Division that they may be forced to reevaluate their participation in the marketplace if the lack of clarity at the federal level continues.

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

While I've been embroiled in the sturm und drang at the national level, Louise Norris of healthinsurance.org has been reporting on some important stuff happening at the state level:

HAWAII:

Hawaii no longer has a SHOP exchange; Lawmakers consider bill to preserve the ACA and expand Medicaid to 250% FPL

As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.

...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017). 

Pages