HealthSherpa posts Week 2 Open Enrollment Stats

FULL DISCLOSURE: HealthSherpa has a paid banner ad at the top of ACASignups.net.

As I noted last week, HealthSherpa is indeed a paying advertiser on the site. However, since they happen to specialize specifically in selling ACA-compliant individual market policies through the ACA exchange (they're an authorized 3rd-party online brokerage), they're also an excellent "finger on the pulse" of Open Enrollment data, providing more-detailed weekly data than CMS usually does; I'd be posting their stats whether they were an advertiser or not.

According to HS's latest blog post, they've enrolled 78,684 people in ACA exchange plans for 2019 in the "first two weeks". I don't know if "two weeks" means as of November 14th or as of November 10th as CMS defines it (they run "weeks" from Sunday - Saturday, so Week 1 only included 3 days this year).

They have, however, confirmed that the total above only includes the 39 states covered by HealthCare.Gov, which means they've enrolled either 6.7% of all HealthCare.Gov enrollees (assuming it only includes 10 days) or around 5.8% (assuming it includes 14 days...I estimate HC.gov likely enrolled around 1.35 million people through 11/14). Either way, this is a pretty good base to extrapolate from nationally

Update: OK, HS has confirmed that this data is through 11/14, so it's not an apples to apples comparison. Assuming my HC.gov estimate of 1.35 million thru 11/14 is accurate, that means HealthSherpa has enrolled around 5.8% of the total across 39 states.

• Enrollments are up 32% year-over-year for the first two weeks

While this is obviously self-promotional, it's also relevant in terms of the debate over how CMS markets/positions HC.gov vs. how private brokerages are. CMS, under Seema Verma, has slashed their marketing budget by 90%, while I presume private brokerages are beefing up theirs, so the divergence between the two isn't terribly surprising.

• Gross plan premiums have declined 6% and net premiums (after subsidy) are down 36%, resulting in median net premiums of $30 per month for HealthSherpa shoppers

It's important to keep in mind that HC.gov and HealthSherpa only track on-exchange premiums, while my annual Rate Hike Project includes the entire ACA-compliant individual market, which also includes around 4 million or so off-exchange enrollees, which skew the average premiums to some degree; the off-exchange market makes up a smaller proportion of the total market every year, but still accounts for around 1/3 of it.

• Shoppers continue to gravitate toward Silver plans, which are comparable in quality and coverage to employer-offered health insurance.
• In addition to low net premiums, roughly 84% of HealthSherpa customers also qualified for cost-sharing reductions (CSRs) which help reduce their out-of-pocket costs.
• 56% of enrollments are by a female head of household, with an average of 1.46 enrollees per application.

The 1.46 ratio is important to keep in mind...this is significantly lower than the average 2.6 people per household nationally. I presume the lower average is because the larger the family, the more likely they are for the heads of the household to have employer-sponsored coverage...

• The leading states for enrollment are also states that had the closest gubernatorial and other statewide elections in the 2018 midterms, including Florida, Texas, Wisconsin, Georgia and North Carolina.

It's important to remember, again, that this only includes 39 states, so CA, CO, CT, DC, ID, MD, MA, MN, NY, RI, VT & WA aren't included. Then again, I think Connecticut was the only one of these where the gubernatorial race was close anyway).

Year-Over-Year Change in Key Enrollment Metrics

• HealthSherpa Enrollment Volume: Up 32% (2018: 78,684 vs. 2017: 59,444)
• Total Call Volume: Up 3%
• Median Net Premium: Down 36% (2018: $30.20 vs. 2017: $47.05)
• Median Gross Premium: Down 6% (2018: $818.61 vs. 2017: $874.55)
• Median Subsidy: Down 3% (2018: $724 vs. 2017: $747)
• Median Income: Down 1% (2018: $20,800 vs. 2017: $21,000)
• Average Applicants Per Policy: Up 3% (2018: 1.46 vs. 2017: 1.44)

Again, the CEO has some additional notes at their blog, including this interesting tidbit which goes to my point above about marketing/positioning efforts:

Regarding Red State enrollments, a 2017 UC Berkeley study found that those who identify as politically conservative were 20% more likely to enroll using HealthSherpa than they were using healthcare.gov. As such, the prospect of being able to enroll all or in part through a site like HealthSherpa, in addition to being easy to navigate and understand, may also encourage some to enroll who may otherwise have steered clear for political reasons. If that’s what it takes to get people covered — and to avoid wasting their money on short-term coverage — then we’re happy to be able to provide that service.

This is almost exactly what happened in Kentucky a few years back with "kynect". Every state-based exchange uses their own branding and marketing to promote ACA enrollments, but kynect had to deal with the additional hurdle of being a deep red state which was especially hostile towards President Obama and all things "Obamacare" related. Their state-based exchange was the product of a Democratic governor's executive order (and was later dismantled by his Republican replacement).

Kynect was nevertheless hugely successful in Kentucky...in no small part due to it everyone involved being careful to never mention "Obamacare" or "the ACA" when talking about/promoting it to enrollees.

This is a double-edged sword, of course. Aside from the hypocrisy factor of people being perfectly willing to enroll in a service as long as they don't think it's provided by someone they don't like, it also causes serious headaches when it comes to policy changes. I've discussed this extensively in a prior blog post regarding how Medicaid is branded in different states.

All that being said, this is still interesting info from HealthSherpa. And no, they aren't paying me extra to say that.