As noted yesterday, after seeing the writing on the wall for several weeks now and lowering my final 2016 Open Enrollment Period projection by around a million already (from 14.7 million down to a range of 13.6 - 14.0 million), I've gone ahead and lowered it once again to a range of 12.4 - 12.9 million. It's still possible that the final weekend will see a shocking vertical spike, of course, but it would have to shoot up something like 10-12x last week's daily average in order to hit the 14 million range (as opposed tolast year's 3-4x increase in the final week.).
So...what went wrong? Well, from the HHS Dept's POV, nothing...or at least nothing that they didn't already project last October. They had already openly stated that they didn't expect any dramatic exchange enrollment increases this year, giving a wide open enrollment range of 11.0 - 14.1 million QHP selections...which has a mid-range of 12.6 million.
The proper question here is how I managed to get it wrong, overestimating by what could be up to 2 million people, Obviously I can't be expected to nail every number, but that would be the least-accurate projection I've had to date.
I'll run a full post-mortem after the final numbers come in next week, of course (it may take even longer for a few of the state exchange numbers to roll in), but there are three four major factors I wanted to address right now (and no, none of these have anything to do with how affordable the policies are, whether the networks are too narrow or the deductibles too high, etc etc; those all contribute, of course, but are also a completely separate discussion):
Your Health Idaho has only issued one official enrollment data press release to date, back on 12/18, when they reported "over 93,000" private policy selections.
There was one additional update via the HHS Dept's ASPE report, which reported exactly 96,662 QHPs as of 12/26/15, which seems about right given that it included 8 extra days.
BOISE, Idaho – The deadline to get health insurance coverage through Your Health Idaho is just days away. If you want health insurance for 2016 you must enroll by January 31. Already, more than 95,000 Idahoans have selected health insurance plans through the state’s health insurance exchange.
I may have seriously lowered my final projection earlier today, but Washington State is still cranking along. Just a few days ago they reported having enrolled 180,000 people in private policies (thru 1/21). Today they report:
Through the first 12 weeks of open enrollment, more than 188,000 residents have selected a Qualified Health Plan for coverage in 2016. Those sign-ups represent a 30 percent increase in plans selected over the first 12 weeks of open enrollment last year.
I presume "the first 12 weeks" means as of 1/23, which would mean another 8,000 people in just 2 days, which is excellent if true (WA was one of 3 states to have a later February coverage deadline...of 1/23).
In any event, this brings WA up to 188,000 people, or 89.5% of my 210K target for the state.
That leaves just 1 week to enroll at least 22,000 people, or 3,142 per day, which actually seems doable after all.
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
Note that whle the enrollment numbers for most states below are current through January 23rd, most of the state-based exchanges are either slightly more current or up to a month behind.
A few hours from now, CMS should be releasing the HealthCare.Gov Week 12 Snapshot report. As noted last week, the "pre-purge" factor has completely messed up my projection model this year, since the numbers for weeks 1-10 could have been lopped down by several hundred thousand people (nearly 250K of which were confirmed to have happened in Week 11 alone). While the purge numbers for the previous 10 weeks were likely much smaller, it still screws up my methodology.
As a result, my original projection for this week of around 400,000 QHP selections has an important caveat: It depends greatly on how whether that number includes the purged/cancelled enrollments or not:
A few minutes ago I noted that Michigan Governor Rick Snyder, currently in the hot seat for poisoning nearly 100,000 of his residents, has formally requested full Medicaid coverage for every Flint resident under the age of 21 (around 30,000 people, as far as I can tell). While my post was sarcastic, the need is real, and while it's revolting that Snyder would try to get the federal government to literally pay for his administration's crime, the move itself makes sense.
Here's a related development which makes sense as well (thanks to Rachel Karas for the link): A letter from U.S. Senator Gary Peters and U.S. Rep. Dan Kildee to HHS Secretary Sylvia Burwell (emphasis added):
Snyder to seek aid for Flint children exposed to lead
Michigan governor seeks to expand Medicaid to help at-risk young people exposed to lead in Flint during water crisis
Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.
...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.
Aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis. In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day. However, RI is also a tiny state with an even tinier ACA exchange population, in the 30K - 40K range, so it may be pointless to try and extrapolate nationally.
The Congressional Budget Office released their latest massive 225-page 10 year economic outlook report today. Obviously there's a ton of stuff there, but the part of most interest to me is, of course, their revised projections for ACA-related matters, both in terms of people and dollars.
Last March, they were still inexplicably projecting that a whopping 21 million people would sign up for ACA exchange policies...actually, even more than that, since 21M was projected to be the average enrolled per month. In order to achieve that, the actual enrollment tally would have to be several million higher since a) around 20% of enrollees wouldn't be signing up until after the January deadline (meaning they won't have coverage start until February or March) and b) general attrition via non-payments and drop-outs throughout the year. A good half of the increase over their projection of 11 million people for 2015 was based on the assumption that roughly 5 million additional people will shift from employer-sponsored insurance over to ACA exchanges:
