Tracking the ACA's Second-Round Progress

Dec. 9, 2014

Topics: Health Care Reform, Exchanges

By Joe Infantino, staff writer 

The stakes are high but the expectations are low -- at least among some stakeholders -- for the Affordable Care Act's second open enrollment period.

Federal officials initially held off on announcing goals for the second open enrollment period. But then the Congressional Budget Office set the bar high for 2015: Six million new enrollees.

Specifically, CBO projected that total enrollment would grow to 13 million in 2015. To meet those expectations, the exchanges would have to retain the 6.7 million enrollees from last year and also add about 6.3 million new people.

HHS announced its prediction just days before the exchanges reopened. HHS Secretary Sylvia Mathews Burwell announced that the department expects 9.1 million to 9.9 million U.S. residents to enroll in coverage during the second round; about 5.9 million of these people will be renewing coverage. That means about four million first-time enrollees in just three months, half the time allotted to the exchanges in the first round.

Challenges Unique to the Second Round

Besides the shorter time period, there are several other challenges unique to the second enrollment period:

  • Current enrollees who received subsidies to help cover premium costs must file new forms with updated tax returns. Individuals could have their financial assistance reduced if they received too much assistance, while the government will owe extra to those who received too little;
  • Consumers who are automatically re-enrolled in their coverage from last year could be surprised by higher prices and receive lower subsidies if they do not shop around for lower-premium plans;
  • Insurers might not be notified when consumers switch to other plans, which could result in some individuals paying double; and
  • The remaining uninsured individuals face higher tax penalties. For 2015, individuals face penalties of $325 or 2% of an individual's income, whichever is higher.

Few Problems So Far

Consumers faced a few problems related to HealthCare.gov during the first few days of enrollment, and some were caused by human error rather than a system glitch. For example, some consumers had trouble logging in to their accounts, resetting passwords and verifying their identities.

As for the state-run exchanges, a few states experienced issues on the first day of enrollment but have since worked to patch them up. For example, Washington state was forced to shut down its website because the site was incorrectly calculating subsidies, but the site was restored by the second day.

While there is a long way to go before the Obama administration can judge the success of the ACA's second enrollment period, AHL wanted to check in on how the exchanges are doing. To keep track of what is happening among the federal and state exchanges, this following list of need-to-know information includes last year's statistics, changes made to the exchanges and their progress during the second round.

To see which states have extended their deadlines for individuals to sign up for coverage that begins Jan. 1, 2015, click here.


Ed. Note: These figures are up to date as of Jan. 22, 2015. Updates to follow.

Federal Exchange

Website: HealthCare.gov
First OEP Results: During the ACA's inaugural open enrollment period, about 6.7 million U.S. residents enrolled in private health plans. HHS originally announced that 7.3 million residents had enrolled in coverage, but that number erroneously included hundreds of thousands of people who selected dental plans rather than medical coverage.

Exchange Updates: For the second enrollment period, HealthCare.gov implemented several updates in an effort to avoid the technical glitches it experienced the first time around. For example, the site uses a new system that is to better detect site traffic overloads. In addition, the Obama administration created a window shopping tool to allow consumers to view plans before the enrollment period began.
Second OEP Progress:
As of Jan. 16, 7,156,691 individuals enrolled in coverage through the federal exchange.

State-Run Exchanges

California

Website: Covered California
First OEP Results: Covered California enrolled 3.4 million previously uninsured residents -- 1.4 million in private coverage and 1.9 million in Medicaid.
Exchange Updates: For the second enrollment period, officials announced that premiums for health plans on the exchange would increase by 4.2% on average, and premiums for plans purchased through the state's small-business exchange would increase by an average of 5.2%. Meanwhile, Covered California hired more than 1,300 exchange assisters to help consumers navigate their coverage options via a phone call, web chat or in-person meeting. Further, enrollment counselors are equipped with additional educational tools -- such as a glossary of health terms, newsletters and webinars -- to help them keep consumers.
Second OEP Progress: As of Jan. 11, 217,146 Californians signed up for private coverage, and an additional 304,394 had been determined to be eligible for coverage. Meanwhile, 466,778 state residents signed up for Medi-Cal, the state's Medicaid program.

Colorado

Website: Connect for Health Colorado
First OEP Results: As of Oct. 31, 2014, more than 146,000 residents enrolled in private coverage through Connect for Health Colorado.
Exchange Updates: For the second open enrollment period, the exchange reached an agreement on a $3.5 million contract with Oracle to improve the usability of its website. For example, the site uses an online avatar to guide consumers through the enrollment process. Meanwhile, the exchange offers 176 individual health plans from 15 insurers.
Second OEP Progress:
By Dec. 31, 2014, more than 151,000 Colorado residents enrolled in in coverage, including 113,864 in private coverage and 35,981 in Medicaid.

Connecticut:

Website: Access Health CT
First OEP Results: Access Health CT during the first enrollment period enrolled a total of 256,666 residents in private coverage, Medicaid and CHIP. About 53% of enrollees were previously uninsured. Specifically, of the approximately 79,000 enrollees who signed up for private insurance, about 43% were previously uninsured, and more than 60% of enrollees in a public option were uninsured.
Exchange Updates: During the second enrollment period, the state's goal is to enroll an additional 70,000 residents. That effort is being led by a new director: In August 2014, Kevin Counihan, who led the exchange during the first round, was named CEO of HealthCare.gov, the federal health insurance exchange website and replaced by acting CEO Jim Wadleigh. The individual exchange offers 41 plans from four insurers, while three insurers offer 21 plans for small group coverage. Meanwhile, rate changes range from a 24% decrease to a 5% increase.
Second OEP Progress:
As of Jan. 15, Access Health CT enrolled 24,287 Connecticut residents in private coverage and 83,749 in Medicaid.

D.C.

Website: DC Health Link
First OEP Results: As of October 2014, more than 60,000 residents enrolled in coverage through DC Health Link -- 15,110 in private coverage, 14,486 in SHOP and 31,175 in Medicaid.
Exchange Updates: Among the exchange's 185 plans, this year's changes to individual plan premium rates range between a 6.1% decrease and a 7.6% increase. Meanwhile, rates for small group plans range from a 17.2% decrease and a 12.7% increase.
Second OEP Progress: By Dec. 21, 2014, more than 71,500 individuals enrolled in health plans -- including 18,773 people who singed up for private coverage and 37,457 individuals who were determined to be eligible for Medicaid.

Hawaii

Website: Hawaii Health Connector
First OEP Results: The exchange faced software problems that caused its launch to be delayed by two weeks to Oct. 15, 2013, and after a month, the exchange had only enrolled 257 people. As of May 2014, Hawaii Health Connector enrolled 8,592 residents in coverage.
Exchange Updates: As of April, Hawaii had about $100 million in federal funding left for operational costs in 2015, and needed about $15 million to run the exchange this year. Jeffrey Kissel has been named director of the exchange after Carol Andrew --  former executive director of the exchange -- announced that she would resign, making her the first exchange director to leave his or her position since the nationwide launch of the state exchange. This exchange is aiming to enroll 130,000 residents over the next four years.
Second OEP Progress: N/A

Idaho

Website: Your Health Idaho
First OEP Results: Your Health Idaho enrolled 76,061 residents in private coverage last year.
Exchange Updates: During the first round of enrollment, Idaho relied on the federal exchange to allow residents to sign up for coverage. However, the state decided to operate its own exchange during 2015. The exchange now offers 198 plans -- 52 more than last year.
In addition, The exchange is operating under new leadership during the second enrollment period, as Pat Kelly in September was named executive director of the exchange after serving as its interim executive director since July.
Second OEP Progress: By the end of December 2014, 83,383 first-time and returning customers enrolled in private coverage through Your Health Idaho.

Kentucky

Website: Kynect
First OEP Results: As of April 2014, 413,410 residents -- or 20% of all enrollees -- had enrolled in private coverage through Kynect, about 75% of whom were previously uninsured.
Exchange Updates: For the second enrollment period, Kynect has opened a Kynect brick-and-mortar store, doubled the number of insurance agents authorized to sell Kynect plans and created a mobile application, with which consumers can figure out what discounts they qualify for.
Second OEP Progress: During the first 30 days of open enrollment, more than 80,000 individuals enrolled in private coverage, including 9,215 new customers and 75,760 individuals who renewed their coverage.

Maryland

Website: Maryland Health Connection
First OEP Results: As of Nov. 7, 2014, about 463,939 residents enrolled in health plans through Maryland Health Connection -- 82,535 in private coverage and 381,404 in Medicaid.
Exchange Updates: For the second round, Maryland purchased Access Health CT's software to replace its own exchange after experiencing technology problems last year. The updated exchange offers 57 plans from five insurers. The exchange also has hired 350 call center representatives to field questions and troubleshoot problems with consumers.
Second OEP Progress: As Jan. 5, more than 150,000 Maryland residents enrolled in coverage -- about 87,000 in private coverage and nearly 69,000 in Medicaid.

Massachusetts

Website: Massachusetts Health Connector
First OEP Results: As of May 2014, Massachusetts Health Connector had enrolled 31,695 residents in private coverage.
Exchange Updates: Massachusetts in August selected hCentive as its new exchange and is no longer relying on the federal insurance exchange for support. hCentive supports a program called State Wrap that will provide additional premium assistance to consumers. Residents with extended or temporary coverage must complete new applications this round to transition into the new plans.
Second OEP Progress: As of Jan. 15, about 222,721 residents enrolled in private and public coverage.

Minnesota

Website: MNsure
First OEP Results: As November 2014, 369,118 Minnesotans had enrolled in coverage through MNsure, 55,813 of whom enrolled in private coverage. As a result, the state's uninsured population decreased by 180,500 residents -- or 40.6% -- from 445,000 -- 8.2% of the state population -- to about 264,500 -- 4.9% of the population.
Exchange Updates: For the second enrollment period, five insurers are offering plans on the MNsure exchange. Meanwhile, IBM has installed new software on the state's exchange website that allows consumers to automatically renew coverage or make changes to coverage due to life events.
Second OEP Progress: As of Dec. 31, 2014, more than 68,000 residents enrolled in coverage, including about 31,159 individuals who selected a private health plan.

Nevada

Website: Silver State Health Insurance Exchange/Nevada
First OEP Results: As of June 2014, 36,827 residents had enrolled in private coverage through the Silver State Health Insurance Exchange, while 159,093 Medicaid applications had been submitted.
Exchange Updates: During the second enrollment period, Nevada's exchange will be federally supported, but it will still be considered a state exchange. The website directs consumers to the necessary portals to purchase coverage. For example, the new website uses a pre-screener tool that determines what plans residents are eligible for and then directs them to either HealthCare.gov or to Access Nevada for Medicaid and Nevada Check Up (CHIP).
Second OEP Progress: N/A

New York

Website: New York State of Health
First OEP Results: As of June 2014, a total of 960,762 residents enrolled in coverage through New York State of Health -- 370,604 in private coverage, 525,283 in Medicaid and 64,875 in CHIP.
Eighty-one percent of all enrollees were previously uninsured. Specifically, 63% of private coverage enrollees were previously uninsured and 93% of Medicaid enrollees had been uninsured, meaning New York State of Health enrolled 233,480 and 488,513 previously uninsured residents in private coverage and Medicaid, respectively.
Exchange Updates: For the second enrollment period, 19 different carriers offer health plans through the individual exchange, while 11 carriers offer coverage on the SHOP exchange.
Second OEP Progress: As of Dec. 12, 2014, more than 154,562 first-time customers enrolled in private coverage.

Rhode Island

Website: HealthSource RI
First OEP Results: Between Oct. 1, 2013, and March 31, 2014, 27,961 residents had enrolled in private coverage through HealthSource RI, while 64,590 residents had enrolled in Medicaid.
Exchange Updates: During the second enrollment period, the exchange is offering 20 plans from three insurers on the individual market, down from 28 plans offered last year. Monthly premium rates range from $99 to $898, depending on the metal tier and the insurer. Meanwhile, the state's SHOP exchange also will offer 20 plans from the same three employers. Monthly premiums range from $144 to $1,255.
Second OEP Progress: As of Dec. 23, 2014, about 2,522 first-time costumers enrolled in coverage, while 9,825 individuals renewed coverage.

Utah

Website: Avenue H
First OEP Results: Utah last year operated a hybrid exchange in which it maintained oversight of its small business exchange, while federal government ran its individual exchange. By May 2014, 84,601 residents enrolled in private coverage through HealthCare.gov, while 11,572 residents received coverage through Avenue H, the state's SHOP exchange.
Exchange Updates: Utah will continue to rely on the federal exchange for the second open enrollment period.
Second OEP Progress: N/A

Vermont

Website: Vermont Health Connect
First OEP Results: As of May 2014, 38,048 residents had selected private health plans through Vermont Health Connect.
Exchange Updates: While the exchange's website was not fully functional for the first open enrollment period -- for example, consumers could not pay for their plans through the system -- Vermont Health Connect decided not to transition to the federal insurance exchange. Instead, it replaced its former contractor -- CGI -- with Optum.
Lawrence Miller, chief health care reform, said that maintaining the state-run exchange would benefit consumers, because transitioning to the federal exchange would have caused Vermonters to lose out on state-funded premium assistance. However, officials have asked consumers who already have coverage to not use the website during the second enrollment period to lower site traffic.
Second OEP Progress: As of Dec. 30, 2014, more than 27,000 individuals enrolled in private coverage, including 6,881 first-time customers and 23,356 individuals who renewed their health plans.

Washington

Website: Washington Health Benefit Exchange
First OEP Results: As of September 2014, the Washing Health Benefit Exchange had enrolled 699,911 residents in health plans -- 147,888 in private coverage and 552,017 in Medicaid.
Exchange Updates: For the second open enrollment period, 10 insurers offer 90 plans in the individual exchange, up from eight insurers and 46 plans last year. The average rate increase is 1.9%. Further, the state's SHOP exchange in its first year offers 23 plans from two insures. Meanwhile, About 100,000 of the private coverage enrollees from last year are eligible for auto-renewal of their plans.
Second OEP Progress: As of Dec. 22, 2014, more than 92,000  residents enrolled in private coverage, including 22,710 first-time customers.