The Patient Protection and Affordable Care Act (PPACA) public health insurance exchange system is nearing its first major 2015 annual enrollment period deadline: the Dec. 15 application deadline for coverage that starts Jan. 1, 2015.
The public exchange system generally seems to be much more functional this year than it was at this time a year ago.
In early December 2013, LifeHealthPro.com ran one article with the headline “Have you tried signing up for Obamacare — just for kicks?” and another with the headline “How will we know if HealthCare.gov is fixed?” Some of the other PPACA exchange article headlines were more negative than those.
PPACA watchers were complaining about a lack of exchange activity data coming from the U.S. Department of Health and Human Services (HHS), and HHS reported Dec. 29 that it had received qualified health plan (QHP) selection information for only 1.1 million people.
This year, the U.S. Department of Health and Human Services (HHS) has already published three batches of weekly activity reports for the exchange programs it runs.
Charles Gaba, the editor of ACASignups.net, is estimating that the exchanges may have received QHP signup information from a total of 2.6 million people, with about 2 million coming in through the HHS HealthCare.gov enrollment systems and about 660,000 coming in through the enrollment systems of state-based exchanges. He has information about 1.7 million confirmed QHP selectors.
Managers of most state-based exchange programs have also published at least one activity report, although some of the most recent available activity reports are old.
For a look at the latest exchange numbers, and what they mean, read on.
1. The public exchanges seem to be averaging about 700,000 QHP plan selections per week
HHS received QHP selection information for 617,548 people for the week ending Dec. 9. That’s higher than the three-week average of about 400,000 QHP selections per week, possibly because the second week in the enrollment period included the Thanksgiving holiday.
During the first two weeks of the enrollment period, about half of the HealthCare.gov QHP choosers were renewing existing coverage, and half were buying new coverage.
That trend continued this week: About half of the QHP choosers were new customers, and half were replacing in-force coverage.
Application submission volume and call center volume were a little higher than the three-week average.
The number of “window shoppers” — people who looked at the site without logging in — was close to the three-week average.
For 2014 coverage, the open enrollment period lasted for about 26 weeks in most of the country. Activity doubled or tripled near the application deadline for coverage that started Jan. 1, 2014, and around the end of the 2014 enrollment period, which petered out, in most states, over a period extending from March 31 through mid-April.
If the current level of reported PPACA exchange enrollment activity continued with no deadline-related surges, the exchange system might reach Feb. 15 with about 13 million people who had picked QHPs, including about 6.7 million people who had bought new coverage or changed coverage through HealthCare.gov; 2.3 million people who had bought or changed coverage through the enrollment systems of state-based exchanges; and about 4 million people who had been automatically re-enrolled into the same HHS exchange QHPs or state-based exchange QHPs they had been using in 2014.
Congressional Budget Office (CBO) analysts predicted a few years ago that the exchanges could have 13 million enrollees in 2015. HHS officials have estimated their plans might end 2015 with 9.9 million enrollees.
One possible piece of evidence for the idea that health insurers are happy with their public exchange operations at this point: Brian Wright, a securities analyst from Sterne Agee, raised his estimates on Aetna after hearing positive reports about the public exchange unit and other units at an investor event. Wright said Aetna is expecting public exchange enrollment to increase about 100,000 in the first quarter of 2015.
2. The 2015 enrollment figures could soar early next week, after HHS starts adding auto-renewals to its totals.
One figure that could throw off total 2015 exchange QHP enrollment projections is the behavior of people who had QHP coverage in 2014.
HHS is automatically moving most consumers who had QHP coverage in 2014 into the same or similar QHPs in 2015. HHS says it will start including the auto-reenrollees in QHP activity figures released after Monday. That adjustment could increase the HHS QHP selector total by about 6 million overnight.
States might use different approaches to reenrollment than the HHS exchanges, and some have used their own approach to breaking out figures for new selections of QHP coverage and renewal business.
Image: A banana slug. (National Park Service photo.)
3. Some states have still not published much, or any, data.
At press time, the NY State of Health exchange had not released any enrollment figures.
State-based exchanges that had not released enrollment figures since Nov. 21 include Connecticut, the District of Columbia and Washington state.
But many of the state exchanges that have reported say they are doing much better than they were a year ago.
In Oregon, for example, technical problems kept the exchange from processing 2014 applications for months. This year, the exchange says it had processed QHP selection information for 7,200 people as of Nov. 30.
Managers of Covered California say their exchange received QHP selection information for about 49,000 people during the first 18 days of the enrollment period. Daily QHP selection volume is about three times higher than it was early in the enrollment period for 2014 coverage.
Clarification: The original version of this article gave an unclear description of ACASignups.net’s QHP enrollment total. The total represents an estimate, based in part on confirmed QHP selection data and in part on extrapolations.