BCBS NC ACA private plan enrollment through May 1, 2014

Blue Cross/Blue Shield of North Carolina posted an overview of their ACA exchange enrollment on their blog today. They reported:

  • 232,000 persons “actually enrolled” as of May 1, 2014.
  • 70% of these 232,000 were not BCBS NC customers in 2013. This is noteworthy since (BCBS NC) is the dominant insurer in North Carolina, with around 90% of the individual market and 70% of the group market.
  • BCBS NC says their ACA customers are are older and sicker than they expected. A question I have: where does the self report health data come from? Not the exchange, which has no such questions. I would like to see more on the methods of how these data were collected. How it was asked? What was the response rate? It is not an illegitimate question, it is just that this sort of data is not collected via the exchange enrollment process.
  • They say that many of their customers who stuck with pre-ACA plans after the administration allowed this were “child only” policies. I wonder if there are similar patterns in other states? It looks like the biggest “miss” between expected and actual enrollment is for these “child only” policies, the type of plan BCBS NC says was the most likely “held over” policy. If many of these expected kid sign ups are signed up in BCBS plans, is that a big risk pool problem?

Questions that I have.

  • HHS says that 357,495 North Carolinians signed up for private insurance via the exchanges (357,000 – 232,000 = 125,000). Does that mean that 125,000 persons signed up with Coventry, the only other insurer that offered exchange plans? (and they only offered plans in 37 of 100 of North Carolina’s counties?). I seriously doubt that, and suspect the phrase “actual enrollees” in the BCBS NC release is a subset of what the May 1 HHS release has as a BCBS enrollee. However, I don’t know that for certain and cannot find that Coventry has released data. We need better data.
  • The HHS report leaves open the chance that Coventry managed to sign up a slightly younger group of customers than did BCBS NC if you compare the ages released by BCBS NC and those released by HHS, and assume that most of the 125,000 are not just unpaid BCBS customers. For example, BCBS NC says 25% of its enrollees were ages 18-34, while HHS says the N.C. total is 28%. Similarly, BCBS NC says 29% of its enrollees were age 55+, while HHS says that only 24% of those statewide were in this age group. Either there is a big discrepancy between what constitutes “enrollment” in the BCBS NC report v. the HHS report, or Coventry signed up (1) many more customers than I thought they would, and (2) they are substantially younger than those that BCBS NC managed to attract. I don’t know the correct answer. As always, we need more data….

Biggest question. HHS says 357,000 people signed up as of May 1; BCBS NC says 232,000 were “actual enrollees.” How much of the difference is Coventry sign ups?

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to BCBS NC ACA private plan enrollment through May 1, 2014

  1. Pingback: More on BCBS NC v Coventry enrollments | freeforall

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