Effectuated Enrollment

A few weeks ago, I tore apart an absurdly misleading Wall St. Journal editorial which grossly misinterpreted the then-ongoing 2026 ACA Open Enrollment Period data to falsely claim that the negative impact of the enhanced ACA tax credits expiring was far less severe than predicted.

After calling them out for some sloppy summary numbers which understated the enrollment drop by over 144,000 people out of the gate, I delved into the meat of their false argument:

...the above is fairly minor compared to the most egregiously misleading claim in the WSJ piece, which appears in the next paragraph:

The Congressional Budget Office’s ObamaCare baseline in 2024 assumed 18.9 million people would enroll in plans this year if the enhanced subsidies vanished.

Let's take a look at that CBO "baseline," shall we?

Long ago in a galaxy far, far away, during the first batcrap insane 2014 Open Enrollment Period, a common refrain from Republicans looking to attack the newly-ramping up healthcare law was to demand "BUT HOW MANY HAVE PAID???"

The gist of the attack on the ACA was that after the worst of the ugly technical problems experienced by HealthCare.Gov and many of the state-based exchange websites were resolved, there was indeed a rush of backed-up demand to enroll in healthcare coverage by millions of people, but that just because a lot of people signed up for insurance coverage via the exchanges, that didn't necessarily mean they were actually enrolled in that policy.

The reason for this, of course, is that you have to actually pay your first monthly premium in order to have your enrollment "effectuated" (i.e., put into effect).

Along with posting detailed data on February effectuated enrollment by state since 2017 yesterday, the Centers for Medicare & Medicaid Services (CMS) also included a spreadsheet with monthly effectuated enrollment broken out by state for every year since 2016.

While it's unfortunate that neither 2014 nor 2015 were included, I have partial data for the first two years of the ACA exchanges from a similar post I put together back in 2019.

It's important to understand the difference between someone selecting a Qualified Health Plan (QHP) from one of the ACA exchanges during the Open Enrollment Period and someone actually being enrolled in an effectuated policy...that is, just because you sign your family up for a policy on HealthCare.Gov or a state-based exchange, you aren't considered effectuated until you actually pay your first monthly premium.

Earlier this afternoon, the Centers for Medicare & Medicaid Services (CMS, which should really be CMMS) released a whole bunch of much-awaited (by healthcare wonks) Effectuated Enrollment data for Affordable Care Act on-exchange enrollment.

While nearly 21.5 million Americans selected Qualified Health Plans (QHPs) via the federal and state ACA exchanges/marketplaces during the official 2024 Open Enrollment Period (along with an additional 1.3 million signing up for a Basic Health Plan (BHP) program in New York & Minnesota, which CMS continues to inexplicably treat as an afterthought in such reports), not all of them actually pay their first monthly premium (for January) for various reasons:

Earlier this afternoon, the Centers for Medicare & Medicaid Services (CMS, which should really be CMMS) released a much-awaited (by healthcare wonks) Effectuated Enrollment Report for Affordable Care Act on-exchange enrollment.

While nearly 16.4 million Americans selected Qualified Health Plans (QHPs) via the federal and state ACA exchanges/marketplaces during the official 2023 Open Enrollment Period (along with an additional 1.2 million signing up for a Basic Health Plan (BHP) program in New York & Minnesota, which CMS continues to inexplicably treat as an afterthought in such reports), not all of them actually pay their first monthly premium (for January) for various reasons:

Normally I receive notices about these types of data reports directly from CMS via their mailing list, but this time around it wasn't emailed and in fact isn't even posted on the CMS newsroom archive  (at least not yet). Fortunately, my eagle-eyed colleague Andrew Sprung grabbed the link from a Health Affairs article and wrote up his own analysis of it.

This actually came out last week but I didn't have a chance to do a write-up on it until now:

July 23, 2020 - Early 2020 Effectuated Enrollment Snapshot

This report provides effectuated enrollment, premium, and advance payments of the premium tax credit (APTC) data for the Federally-facilitated and State-based Exchanges (“the Exchanges”) for February 2020 and for the 2019 plan year.

February 2020 Effectuated Enrollment Snapshot Key Findings