More on BCBS NC v Coventry enrollments

Following up on yesterday’s post on BCBS NC announcing their ACA enrollment as of May 2, 2014 with a chart.

ScreenHunter_01 May. 09 10.21

The dark blue bar furthest left is the percentage of the 357,000 enrollees reported by HHS in a given age band. The golden bar (middle one)  is the 232,000 persons termed actual enrollees by BCBS NC, and the gray bar to the right is the age breakdown of expected enrollees, per BCBS NC. A few points/observations/questions.

  • Most of the discussion about enrollment has been about the age range 18-34 and worries that there would not be enough of these young persons to balance out the older ones. BCBS says that 25% of their enrollees are in this range but they expected 28%. This is a miss. I am unsure of how big a miss it is in actuarial terms.
  • I don’t think I have heard much talk at all about the under 17 age group until this press release, whose main point is driven by under 18 enrollment as compared to expectations. Am I wrong and I missed it? The diddy flying around twitter and in the papers this morning is that BCBS NC expected 50% of their enrollees to be younger than age 34, but that in fact only 32% of them are. The math is correct, but it is mostly driven by a tremendous “miss” in enrollment of children (the 18-34 group about which so much has been written was 25% actual v 28% expected). But, BCBS says in their release that

Our pre-ACA book of business included kids with child-only policies, and many of them were among those who stayed on their pre-ACA plans – which affected the age distribution of our ACA pool.

As I asked yesterday, if most of the miss is kids that stayed on individual purchase policies, is this really a big risk pool problem? I have my doubts, especially because those in this book of business didn’t enter via the enrollment rules of the ACA, but I frame this as a question because I an unsure. I am happy to accept and engage answers from BCBS NC or anyone else.

  • Sticking with the 18-34 age group, if BCBS NC enrolled 25%, but all of N.C. enrollments in this age range is 28%, then the other insurer Coventry had to have done better with this age group that so many talked about all winter and spring. If we use the 85% payment rule (though by May 1, 2014 those enrolling as late as April 18 didn’t have to have paid) then that implies BCBS NC has ~273,000 who have signed up, but 232,000 who have paid (assuming this is their actual enrollee definition). If you assume a similar non payment rate for Coventry, then that implies they have ~84,000 enrollees per the HHS definition, and ~72,000 using the actual enrollee definition. They had to have done *much* better at enrolling the 18-34 demographic than did BCBS NC given the much smaller overall enrollment (3 percentage point difference from a base of 72,000 for Coventry v 232,000 for BCBS).
  • A similar story has to be the case for the age 55+ demographic; Coventry had to have done much better, or there is some tremendous non-random payment of premiums that clusters somehow in the 18-34 and the 55+ age range. I don’t see how this is true.
  • For the less than 18 group, did Coventry get lots more of these customers? Was there a pick up of parents signing up kids on employer provided plans to comply with the mandate instead of buying BCBS NC plans? Exactly what percentage of child only plans that ended up being allowed to be sold were resold? Again, I have heard basically no discussion of this group until the BCBS NC press release. Am I wrong? Here is one of thousands of news stories you can find worrying about age 18-34 enrollment, but not a breath about kids. Is there something very different in N.C. as compared to other states?
  • Final question for now. Where do these people live? Will we ever know geographic distribution of enrollees? Are there big enrollment differences by county in N.C.?

As always, we need more data.

update, 2pm 5/09/14: I talked with Barbara Morales Burke, VP for Health Policy at Blue Cross/Blue Shield of North Carolina. A few points. First, the 232,000 are customers who have paid for their May, 2014 coverage as of May 1, 2014. They had until yesterday to pay for May, 2014 coverage so this number will trickle up. Second, she reiterated that they are not allowed to co-mingle the risk pools of the transitional plans (non qualifying plans allowed to be sold) along with the ACA pools. This is of course true, and will impact 2015 premiums in both pools. But, the true meltdown scenario for an insurer is to pack up and leave a state, and of course that isn’t going to happen as BCBS NC has vast books of business in N.C. outside of the ACA. Third, North Carolina may have more than average “child only” policies than other States because the N.C. State Employee Health Plan does not provide dependent coverage (parents have to pay for premium). Fourth, she does not know if BCBS NC will release enrollment data by county. Such information is very important to target sign ups for next year.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. 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 More on BCBS NC v Coventry enrollments

  1. William Phillips says:

    What is the breakdown by actual plan within BCBS. Has anyone looked at those numbers. Value plan etc.

    I think the generic term is the bronze silver gold and platinum plans.

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