2018 ACA Exchange Enrollment Continues to Beat Expectations

Questions lingered until the end of December 2017: Would the Trump administration’s shortened 2018 open enrollment period — and the president’s decision to slash marketing and navigator assistance and halt cost-sharing reduction (CSR) payments to health plans — hurt signups for the Affordable Care Act (ACA) exchanges? Then CMS announced Dec. 28 that 8.7 million-plus individuals either selected or were automatically re-enrolled in plans through federally facilitated exchanges in 39 states.

Now, in early January, comes initial word from a variety of health plans of varying sizes, types and service areas, along with state-based exchanges, that seems to indicate their 2018 ACA marketplace signups also were better, year-over-year, than anticipated.

“Exchange enrollment exceeded expectations in the federally-run Exchanges, and some State-Based Exchanges are running ahead of last year’s enrollment. Silver loading was good for some and bad for others, but it likely drove enrollment among lower income purchasers,” Michael Adelberg, a principal with Faegre Baker Daniels Consulting in Washington, D.C., tells AIS Health.

“For all the instability, people are buying coverage because they need coverage and insurers, even with diminished participation, continue to serve every U.S. county,” adds Adelberg, a former senior official in CMS’s Center for Consumer Information and Insurance Oversight (CCIIO).

Here is a sampling of how some payers and exchanges fared:

Centene Corp.’s exchange enrollment is ahead of estimates. “The marketplace performance with subsidized populations remains strong….We’re doing very well in that,” Centene Chairman and CEO Michael Neidorff told the J.P. Morgan Healthcare Conference on Jan. 8. He noted that his company continues to focus on previously uninsured and underinsured people below 250% of the federal poverty level. “That’s our sweet spot and we’ve said it all along. We have the networks tailored for it,” he said.

“The growth in the exchange has been so dramatic,” Neidorff said. “We enrolled [the week of Jan. 1] 270,000 people in one day. We had planned on incremental growth, but not that much. So we’ve had people working all weekend [on enrollment processing], playing catch-up.”

“We told you in December that we’d have about a 100,000-member increase in the exchange,” Neidorff noted in his update to investors. “Well, as of last night [Jan. 7], we had north of 1,425,000 [exchange members] paid....Until they pay, I don’t count ‘em.”

In a Jan. 8 note to investors, Credit Suisse analyst A.J. Rice said Centene’s latest exchange enrollment figure suggests the managed care company has added 400,000 exchange lives since the third quarter of 2017. “At its investor day on Dec. 15, Centene projected its [health insurance exchange] membership would grow organically by 100,000 lives in 2018, which we flagged as less than expected given other MCO exits,” the analyst noted. Centene “had cautioned at the time it had little clarity on auto-renewals, [so] the 100,000 figure could change.”

Some customers are disputing Centene’s description of its exchange coverage, however. A federal lawsuit filed Jan. 11 in Washington state alleges that customers were misled about the number of doctors in Centene’s exchange plan networks, which offers skimpier coverage to individuals than they signed up for, *Bloomberg *reported.

“Members have difficulty finding — and in many cases cannot find — medical providers who will accept Ambetter insurance,” according to the lawsuit. “After purchasing an Ambetter insurance plan, they learn that the provider network Centene represented was available to Ambetter policyholders was in material measure, if not largely, fictitious.”

Oscar Health enrolled 250,000 members in the individual market for 2018 — 150% more than in 2017, the health plan’s officials said in an email Dec. 21. Oscar was able to do this despite facing “a number of challenges” during the 2018 open enrollment period, including a shortened enrollment window, “decimation of federal advertising, uncertainty over the mandate, and higher unsubsidized premiums,” the company said.

Now in its fifth year, Oscar plans to fuel growth next year by “doubling its market presence to six states, strong organic growth of more than 60% in existing markets, the introduction of a new business line in small group plans, and two major strategic joint ventures with Humana Inc. and Cleveland Clinic,” the company said.

“This was a year in which Americans tuned out headlines and proved that a stable, core group of consumers make up most of the market,” Mario Schlosser, CEO and co-founder of Oscar Health, said on Jan. 9. “As we enter 2018 and pursue our mission to deliver quality, affordable care to everyone, we are more confident than ever that Oscar is charting an exciting growth trajectory in a resilient individual market.”

Statewide, 158,362 Coloradans had selected coverage through the state-based exchange, called Connect for Health Colorado, through Jan. 8 — a rate 2% ahead of signups a year ago, according to state data released Jan. 9. Overall, 20% of the 2018 plan selections are by newcomers to Connect for Health Colorado and 80% are renewing customers.

After releasing enrollment data just prior to the Colorado exchange’s Jan. 12 enrollment deadline, CEO Kevin Patterson pushed Coloradans to seek last-minute coverage, which would begin Feb. 1. “I urge anyone who does not have coverage yet to go to our site and see if they qualify for financial help,” he said.

“My message is, ‘Don’t leave money on the table.’ We know that too many Coloradans who qualify for financial help think that they don’t,” Patterson added.

Listen to Neidorff’s conference webcast at https://tinyurl.com/yagdqv52. Read the Bloomberg story at https://tinyurl.com/ybjdwndo. The case is Harvey v. Centene Corp., 18-cv-00012, U.S. District Court, Eastern District of Washington (Spokane).

by Judy Packer-Tursman and Diana Manos

Adapted from the 1/15/18 issue of AIS’s Health Plan Week