Week 6: Demand Surges as December 15 Deadline Nears But Falls Further Behind Last Year

CMS released the enrollment snapshot for Week 6 today — the final enrollment snapshot before the December 15 deadline to sign up for 2019 coverage. As expected, enrollment is surging as the final deadline to enroll approaches. Unfortunately, the trend from previous weeks continues with active renewals still trailing last year and troublingly, new enrollment is falling even further behind. Last week, we reported that total enrollment through HealthCare.gov was on track to decrease by 800,000. This week’s snapshot does not show the enrollment necessary to counteract that drop in enrollment.

Many factors are contributing to the decline in open enrollment, but most are the result of decisions made by the Trump administration to undermine the marketplaces: 90% cut to marketing, 80% cut to navigator funding, zeroing out of the penalty for not having coverage, expansion and promotion of short-term plans and the shortened open enrollment period.

Overall, cumulative enrollment is down 12% compared to this time last year. New enrollment is down by 20% and active renewal is down by 8%.

People are actively renewing their health coverage faster than they did during the first couple of weeks of Open Enrollment, but compared to last year, active renewal is behind by 8%. It is unlikely that active renewal will be able to catch up with last year’s performance. This means that more people will be automatically re-enrolled.

Given the wide availability of $0 bronze plans this year (4.2 million people are eligible according to KFF yesterday), we’d expect to see strong new enrollment this year. Unfortunately, new enrollment this year continues to underperform last year — down 20% overall. In Week 6, new enrollment is down even more than we’ve seen in past weeks — down 25% compared to Week 6 last year. This is particularly concerning because new enrollment typically surges close the deadline (so what happens to new enrollment in the final two weeks has a big impact on final enrollment totals).

Typically, new enrollment is highest at the end of Open Enrollment when people who are on the fence about getting covered make up their mind. These enrollees are more price sensitive and more likely to enroll because of advertising. New enrollment is an important source of younger and healthier enrollees each year and they collectively add stability to the Marketplace risk pool. This week’s new enrollment performance creates additional concerns for the final week.

Examining the difference in performance over the last three years between State Based Marketplaces and the federal marketplace reveals the importance of properly managing and promoting a marketplace versus the many actions the administration has taken to undermine the federal marketplace and undermine Open Enrollment. Overall, early State Based Marketplace enrollment performance continues to generally outperform the federal marketplace compared to last year. However, this is itself a flawed comparison. Enrollment in State Based Marketplaces remained relatively steady over the last three open enrollment periods. During that same period, federal marketplace enrollment and new enrollment in particular, has dropped significantly. Yearly comparison’s do not accurately take into account the multi-year decline we’ve been witnessing. Comparing federal vs state growth and contraction since the end of the third Open Enrollment period vs this Open Enrollment will offer a more accurate picture.

While only days remain before the final deadline, the remaining days are by far the most important. More people enroll in the final two days than during entire weeks of early enrollment.

State-by-State Comparison

Every state continues to show slower enrollment compared last year. The ten states showing the greatest enrollment decline since last year are: Virginia (due to the state expanding Medicaid), Missouri, Louisiana, West Virginia, Pennsylvania, Illinois, Maine, New Hampshire, Indiana, and Ohio.