New York releases a whole mess of 2015 Open Enrollment data

The New York State of Health (NY's ACA exchange) just released detailed numbers from the 2015 Open Enrollment Period.

Unfortunately, the data gets cut off as of 2/28/15, so this doesn't give any insight into the attrition rate since then (or a precise count of how many additional people enrolled during the #ACATaxTime special enrollment period which followed). However, it does give a lot of detailed analysis of the open enrollment period numbers, and does tack on an extra week's worth of private enrollments & 2 week's worth of CH+/Medicaid numbers (the official HHS report only ran through 2/21 for New York and the last press release with CH+/Medicaid numbers was as of 2/15).

As a result, the official numbers are slightly higher than what I had until now across the board:

• QHP Selections: 415,352 (up from 408,841 as of 2/21/15)
• Child Health Plus: 159,716 (up from 156,827 as of 2/15/15)
• Medicaid: 1,568,345 (up from 1,545,319 as of 2/15/15)

Again, this doesn't really change my current estimates for effectuated numbers, since the CMS division already released effectuated numbers as of 3/31/15; New York had 361,340 effectuated as of the end of March, or 87% of the total QHPs selected...which is exactly the ratio for the country as a whole (10,187,197 effectuated as of 3/31 out of 11,688,074 selected as of 2/22). Still, every additional data point helps. In addition, their Child Health Plus enrollment is 2,889 higher, while Medicaid is up 23,026, so that's another 26,000 New Yorkers covered, which is always a good thing.

Oh, yeah: With this update, the confirmed total number of QHP selections nationally has now officially broken the 12.1 million mark, although I'm also quite confident that there's an additional 900,000 which haven't been reported yet (i.e., 13.0 million total to date). This is more of a symbolic milestone than anything, however, since the number of people enrolled in effectuated policies is likely still somwhere between 10.3 - 10.4 million, but it's worth noting anyway.

Other useful tidbits from today's report:

ALBANY, N.Y. (July 29, 2015) - NY State of Health (NYSOH), New York’s official health plan Marketplace, today released demographic enrollment data on the more than 2.1 million New Yorkers who enrolled in a health plan through the Marketplace through February 28, 2015, the end of the open enrollment period. The data show that enrollment through the Marketplace increased more than two-fold and more than 89 percent of enrollees reported being uninsured at the time of application.

“Year two of NY State of Health was nothing short of an overwhelming success,” said NYSOH Executive Director Donna Frescatore. “We built upon our first year’s solid foundation with significant increases in enrollment and high satisfaction rates across the board. As we move closer to the third open enrollment period slated to begin on November 1, this data will inform our efforts to reach more New Yorkers. ”

As compared to the first open enrollment period, enrollment in Qualified Health Plans (QHP), Medicaid, and Child Health Plus increased in every county in the state, with 86 percent of those eligible to renew their QHP in 2015 doing so. The high renewal rate is indicative of the high level of satisfaction with the Marketplace, as was similarly found in independent consumer surveys conducted by the NYS Health Foundation.  

• More than 2.1 million people- over 10 percent of the state’s population- enrolled in health insurance coverage through the Marketplace as of February 28, 2015, the end of the second open enrollment. This represents a more than a two-fold increase from the first open enrollment period, when 960,762 were enrolled.

Seeing how over 10% (33 million people) are enrolled in an ACA-enabled policy nationally, this might not seem that noteworthy...except that NYSoH is saying that 2.1 million people have enrolled through their marketplace. That means their 10% doesn't include off-exchange private enrollment or people who enrolled in Medicaid via off-exchange means (ie, traditional means like filling out a form at their local social services office, etc).

In fact, it's even more impressive than that. The official total is 2,143,413. New York's total population as of 2014 was 19,746,227; it should be up to around 19.8 million as of today. That means NY State of Health has actually enrolled around 10.8% of the entire population.

• Consistent with year one, nearly three-quarters of individuals and families enrolled in a QHP received financial assistance to reduce the cost of their insurance. The average tax credit was $220 per month, up slightly from 2014. 

This is mildly noteworthy: According to the HHS 3/31 report, only 70.2% of NY's effectuated enrollees were still receiving APTC (federal tax credits) as of the end of March. That means that of the 54,000 people who either never paid in the first place or dropped their policy after the first couple of months, the vast majority of them were receiving credits originally (ie, far more than 3/4 of them). In other words, 74% of the 415,352 who selected a plan received credits, or about 307,360. However, by the end of March, this was down to just 253,758 (70.2%) out of 361,340 total. That means 53.6K people receiving credits dropped out, while only 400 people paying full price did so.

This makes sense if you think about it: Anyone who can afford to pay full price in the first place is a lot more likely to have a stable income, and is therefore less likely to have either their cash flow or other circumstances change.

• Previously Uninsured
  Overall, 89 percent of those enrolled as of February 28, 2015 reported that they were uninsured when they applied for coverage through the Marketplace, a nine percentage point increase from 2014.

OK, gotta be careful with this one, since it combines private enrollees (QHPs) with Medicaid and CH Plus. Fortunately, they break the "previously uninsured" rate out by category in an infographic: 68% of QHP enrollees were previously uninsured, 95% of Medicaid enrollees and 79% of CH Plus enrollees. The Medicaid number isn't particularly surprising, but the 68% QHP figure is excellent, and far higher than the 53% national average estimated by the Commonwealth Fund last month.

• Enrollment by Region and County
  New Yorkers from every region and county in the state have enrolled in the Marketplace, with 56 percent of enrollees in New York City and 44 percent of enrollees in other areas of the state. Counties with the largest enrollment are Kings (Brooklyn), Queens, Bronx, New York, Suffolk, Nassau, Westchester, Erie, and Monroe, which are also the most populous counties in the state. Enrollment by county and program is included in the full report.

• Enrollment by Age
  Marketplace enrollees include a mix of New Yorkers across all age groups. 60 percent of individuals who enrolled in coverage through the Marketplace are under age 35. Thirty-two percent of individuals enrolled in a QHP are under age 35, 18 percent are between ages 35 and 44, 23 percent are between ages 45 and54, and 25 percent are between ages 55 and 64.

32% under 35 years old is a bit lower than the national average of 35% this year.

• Enrollments by Gender
  Enrollment remained nearly evenly split between males and females, with females comprising 52 percent of total enrollees across all programs.

• Enrollment by Race and Ethnicity
  ​The report includes data on enrollment by race and ethnicity, as self-reported by applicants. Across all programs, 36 percent of enrollees self-reported that they are white, non-Hispanic, 16 percent reported being black/African-American, 13 percent reported being Asian/Pacific Islander and seven percent reported race as “other”. Nearly one-third of applicants did not respond to the optional question about their race.
  25 percent of Marketplace enrollees self-reported that they are Hispanic, an increase of four percentage points from the end of the 2014 open enrollment period. Twelve percent of applicants chose not to respond to the optional question about ethnicity.

• Statewide Enrollment by Insurer – Individual Marketplace
  All of the health insurers offering QHP coverage through NYSOH enrolled members into their plans. Nine health insurers enrolled five percent or more of total statewide QHP enrollees.  The four insurers with the highest percentage of statewide enrollment are:  Fidelis Care (20 percent), Health Republic (19 percent), Healthfirst (10 percent) and Empire Blue Cross Blue Shield (10 percent).

It's great that they included a carrier market share breakout; I should be able to plug these into the 2016 rate filings to get a weighted average, although again, this doesn't include off-exchange enrollees. New York's total individual market was around 411,000 people in 2014 (of which about 325K were enrolled via NYSoH), and presumably has grown somewhat this year, so there should be another 100K or so off-exchange enrollees out there. Then again, a chunk of those should be in "grandfathered" plans, so the exchange-based ratios should be fairly representative of the total:

• Fidelis Care: 20%
• Health Republic: 19%
• Healthfirst: 10%
• Empire BCBS: 10%
• MetroPlus: 7%
• MVP: 6%
• Emblem: 6%
• Oscar: 5%
• Affinity: 5%
• Excellus BCBS: 4%
• UnitedHealthcare: 2%
• North Shore: 2%
• BCBS West. NY: 1%
• CDPHP: 1%
• Independent: 1%
• Univera: <1%
• Wellcare of NY: <1%
• Empire BC (Upstate): <1%
• BlueShiled of NE NY: <1%

• Service Area Enrollment by Insurer- Individual Marketplace
  Insurers approved to participate in the Marketplace have county-level service areas ranging from four to 55 counties. Nine insurers have 13 percent or more of the enrollment in their respective service areas.  The insurer with the highest share of enrollment in its service area – Excellus – has 28 percent of enrollment in the counties it serves. Compared to 2014, six insurers had an increase or decrease in total service area enrollment of five percentage points or more between 2014 and 2015. A closer look at market shifts in New York City suggests that significant premium changes from year to year are associated with changes in relative market share.

• Qualified Health Plan Enrollment Level – Individual Marketplace
  The Marketplace offers QHPs at four different metal levels: Platinum, Gold, Silver, and Bronze. Twelve percent of enrollees are enrolled in Platinum plans, 10 percent are in Gold plans, 58 percent are in Silver plans, 18 percent are in Bronze plans, and two percent are in Catastrophic plans. Fifty-five percent of enrollees are in health plans with no annual deductible or deductibles of $600 or less. 

• Plan Selection in the Individual Marketplace
  Standard versus Non-Standard Plans – The Marketplace offers standard and non-standard plans. Standard plans cover all Essential Health Benefits and have the same cost-sharing across insurers within each metal level.  To increase consumer choice, insurers may also offer a limited number of non-standard plans on the Marketplace. Twelve insurers elected to offer both standard and non-standard plans on the individual Marketplace in 2015.  Sixty-one percent of enrollees opted to enroll in a standard plan and 39 percent enrolled in a non-standard plan. The most popular non-standard plans covered services not covered by the standard plan, such as adult dental and/or vision care, acupuncture and a limited number of physician sick visits with no copayment.
• Plans with Out-of-Network Benefits- QHPs with out-of-network benefits were offered on the individual Marketplace in 11 counties of the state. Twenty-one percent of enrollees in those counties selected one of these plans.  With a few exceptions, plans that included out-of-network benefits were more expensive than the most popular plan at the same metal level.
• Plan Cost- An analysis of enrollment in silver QHPs by county shows that relative premium cost is strongly associated with the most popular plan.  In more than 80 percent of counties, the silver plan most often selected by consumers ranked in the bottom third in cost and, in every county, had an annual deductible equal to or less than the deductible in the standard plan and the lowest cost silver plan. This limited analysis suggests that consumers are selecting plans based on both premium and out-of-pocket costs.

• ...Small Business Marketplace
  Small businesses with 50 or fewer employees can enroll in the Small Business Marketplace (SBM) throughout the year. As of February 28, 2015, over 3,700 small businesses had offered coverage and nearly 15,000 employees and dependents had enrolled through the SBM. Eighty-seven percent of employers took advantage of the employee choice model, offering their employees the choice of two or more QHPs. On average, SBM employers contributed 70 percent towards the cost of the employee’s coverage. Sixty--two percent offered coverage to their employees’ dependents, up 14 percentage points from 2014. As projected, the average small business that enrolled through the SBM had three employees.

Wow! This is actually brand-new info, and relatively impressive given how anemic the SHOP program has been until now. For comparison, last year only around 80,000 people were enrolled in SHOP policies nationally, 10,000 of which were in New York. This year, I didn't have any NY SHOP data until today; this report instantly beefs up the confirmed number from around 53K to 68K (and increases my national ballpark estimate from around 180K to around 200K). Still a pretty minor number compared to the 10.4 million QHP enrollments nationally, but nothing to sneeze at either.

• ...Stand-Alone Dental Plans
  Stand-Alone Dental Plans (SADPs) are offered as an option for dental insurance on both the Individual and Small Business Marketplace.  Eleven SADPs participate in the Individual Marketplace and eight participated in the SBM.  Combined, the SADPs provided dental coverage to 41,334 people including 38,934 individuals and 2,400 SBM enrollees. 

I don't really cover standalone dental plans, but it's nice that they included them. Teeth and gums are important. I've never understood why dental coverage is separate in the first place, frankly.

...During the next open enrollment period, NYSOH will add a new program called the Basic Health Program (BHP) to the suite of insurance coverage options available through the Marketplace.  The BHP, which will be called the “Essential Plan,” will provide comprehensive coverage to qualified individuals based on income at even more affordable rates.

This is gonna be really important. So far, Minnesota is the only state with a BHP ("MinnesotaCare"), and that's mainly because it was already in place prior to the ACA. Adding the BHP to the mix will change New York's QHP enrollment strategy and numbers significantly, since a big chunk of those currently selecting QHPs will likely be moved into the BHP instead.