Old n' Busted: 19M QHPs/BHPs combined. New Hotness: 22M QHPs/BHPs?

Just 3 days ago, I posted a revised 2024 ACA Open Enrollment Period projection, in which I upgraded my prior projection from 18.5 million Americans signing up for either Qualified Health Plans (QHPs) or Basic Health Plans (BHPs) combined nationally to over 19 million doing so. That 18.5M projection was itself a drop from my original projection of 19M QHPs + BHPs combined from a month earlier.

I delved into the various reasons for both my original and revised projections, but the bottom line is that I figured it would end up being somewhere in the neighborhood of 19 - 19.5 million, give or take, likely broken out something like ~18 million QHPs plus another ~1.3 million BHPs in New York & Minnesota only.

I even included 20 million as an outside possibility.

Cut to today's press release from the Centers for Medicare & Medicaid Services (CMS):

The Biden-Harris Administration announced today that the Affordable Care Act (ACA) Marketplace enrollment continues at a record-breaking pace. As of December 15, 2023, for HealthCare.gov states and December 9, 2023, for State-based Marketplaces, preliminary data projects that over 19 million consumers will enroll in 2024 coverage through the ACA Marketplaces — over 7 million more than when President Biden took office. This includes 15.3 million individuals who have selected a health plan using the HealthCare.gov platform.

Well, there you go. But there's a lot more going on here as well.

First: The CMS press release goes on to say that the 15.3M HealthCare.Gov figure represents a 33% increase year over year increase over the same point last year...except, as I noted this morning:

Last year, after auto-renewals were added to the mix, the federal exchange states (HealthCare.Gov) enrolled a total of 11,554,287 people as of December 17th, but you have to subtract Virginia since they moved to their own state-based marketplace (SBM) this year, bringing it down to 11,221,235, or an average of 238,750 per day for 47 days.

This year, CMS is giving a rough estimate of "more than" 15.3 million on the federal exchange as of December 15th not including Virginia, or 340,000/day over 45 days. That's actually 42.4% higher than the same point last year once you adjust for Virginia moving to its own exchange.

That's right...when you adjust for both Virginia's move as well as the extra 2 days from last year, federal exchange enrollment is actually up over 42% year over year.

Second: Remember, my 19 million projection included BHPs as well. Unless they're being deliberately obtuse, the 19M referenced in today's CMS press release only includes exchange QHPs, which means adding BHPs would bring the total to at least 20.3 million...blowing both my original and revised projections out of the water and total enrollment literally off the chart (my 2024 Graph originally only allowed for 19 million enrollees total).

Third: Speaking of The Graph, there have been several SBMs which have issued enrollment updates since the last official CMS Snapshot report a couple of weeks ago. Let's take a look:

• Colorado: Over 184,000
• Connecticut: 117,516
• Maine: 59,696
• Minnesota: 132,789 (may include some standalone dental and/or SHOP enrollees)
• New Mexico: 49,765 (in fact, it's up to 50,928 as of this writing)
• Pennsylvania: Over 405,000 as of this writing
• Washington State: Over 232,000

In addition, the last CMS snapshot report also included preliminary auto-renewal totals for the other 12 SBMs. Most of these have shrunk a bit since then as some of those auto-renewed actively switched plans or cancelled their renewals, but they should be pretty close for the most part.

When you add all of these up, you get:

• Federal exchange states: 15.3 million
• SBM states w/official auto-renewals: 1.18 million
• SBM states w/unofficial auto-renewals: 3.22 million

That's already 19.7 million QHPs nationally...more than the 19M CMS projects, and well over my ~18M projection.

Fourth: Remember, the 15.3M via HC.gov states runs through December 15th, but that third bullet (unofficial SBM auto-renewals) only includes data through November 25th. Plenty more people in those 12 states have signed up between 11/25 and today.

At worst, I figure those extra people signing up have at least cancelled out the "shrinkage" in preliminary auto-renewals since then, anyway.

But wait, there's more!

Again, when the ~1.3 million BHP enrollees are added into the mix, that brings the grand total to a stunning 21 million people.

Finally, remember that there's still nearly a month to go for people to sign up in most states (and up to 6 weeks in several).

How many more people either have or will enroll between 12/15 - 1/15 (or 1/31 in some states)?

Well, last year, nationally, 15,508,346 had selected QHPs as of December 17th. FInal 2023 OEP enrollment ended up being 16,357,030 people, which means 5.2% of the grand total signed up after 12/17.

Assuming a similar ratio this year (let's call it 5% even to be safe), that would mean final 2024 OEP QHP selections would come to roughly 20.7 million people. Adding BHPs would bring this to around 22 million QHPs + BHPs combined.

Yowzers.

Again, I had to modify The Graph from maxing out at 19 million to 22 million in order to fit all three categories (federal exchange, state-based exchanges, BHPs), like so: