How much of an issue will the drop-off in NEW enrollments be?

Thu, 12/15/2016 - 11:05am

12/20/16: Updated w/newer data

I've noted several times that while the total enrollments so far have been tracking my pre-election projections almost perfectly, the drop-off in new enrollments suggest potential trouble ahead. That is, the main reason the overall enrollment numbers are at or even ahead of my expectations so far is because more current enrollees are actively renewing their policies earlier, cancelling out the smaller number of new enrollees signing up. Obviously once those current renewals dry up (which will mostly happen this week), the rest of the enrollment period can't count on that any further.

Let's take a look at the new enrollees I've confirmed so far:

That's a bare minimum of 1,415,867 new enrollees so far out of 7,689,986 confirmed QHP selections to date. However, 1.375M of those are from unspecified states, so I shouldn't even count those; the actual proportion is at least 1,415,867 out of 6,314,986, or at least 22% of the total.

However, the actual number is higher since not only does this not include any data from 4 states, but even among the states I do have, some of them are missing days or weeks of data. In addition, there are some (like Colorado) where I know the total enrollments but not the new/renewal breakout.

The most comprehensive estimate to use here is the Week 5/6 Snapshot report from HC.Gov, which covers 39 states in a consistent manner and is fairly recent (through 12/10). This has the current new enrollee ratio at 27.5% of the total (1,103,507 out of 4,015,709).

Last year, 12.7 million people selected QHPs during Open Enrollment. Of these, around 7.8 million were renewals plus another 4.9 million new enrollees...or roughly 38.6% of the total.

I've noted before that based on the attrition rate 2015 as well as the partial attrition data I have for this year so far, I estimate that there were appx. 9.6 million people still enrolled in effectuated exchange policies as of November 1st. Of those, I expect around 8.5 million to renew their policies nationally (either actively or automatically).

Assuming I'm correct about this, another 5.3 million new enrollees would have to sign up in order to hit the 13.8 million target (8.5M + 5.3M).

I won't know the total number of renewals until at least early next week, since several million autorenewals will be plugged in via HC.gov all at once. However, assuming that 27.5% rate were to continue, the final numbers would end up something like: 8.5 million renewals + 3.3 million new = 11.8 million total...or 900K below last year's total.

On the other hand, the "new" percentage increased dramatically between the first 4 weeks (24% of the first 2.14 million) and the next 2 weeks (31% of the next 1.88 million). Obviously, after today, practically all additional enrollees going forward will be new, since the renewals will have dried up entirely.

Last year, looking at HealthCare.Gov exclusively, the ratios were 35% of the first 2.04 million (first 4 weeks) and 38% of the next 2.13 million. The ratio started higher but only went up 3 points vs. this year's 7 point increase. Week 7, of course, had a mere 22% new enrollees...because it also included several million auto-renewals plugged in, skewing the ratio.

In other words, while the "new enrollee" issue is real, it's impossible to tell how much of a problem it'll prove to be until at least after the auto-renewal dust settles next week. We could be looking at a complete flatlining after this week (exceptions being the 3 states with later deadlines for January coverage: MA, RI & WA)...but even if that happens, it'd still be a lot better than the complete disaster that I was expecting to see immediately after the election.

OE4

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