State-Based Exchanges Saw Higher Attrition from 2014 to 2015 Than Federally-Facilitated Exchanges

From Avalere Health, April 7, 2015

Exchanges run by the federal government both retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than states that run their own exchanges, according to a new Avalere analysis.

Federally-facilitated exchange states reenrolled 78 percent of their 2014 enrollees in 2015, on average. In state-run exchange states , that percentage drops to 69 percent of 2014 enrollees. California, the state with the highest enrollment in 2014, only retained 65 percent of their 2014 enrollees (Table 1)

NOTE: Hawaii retained only 36.7% of 2014 enrollees, the worst in the nation.

It is unclear why state-based exchanges saw higher year-over-year attrition among their enrollees. One possibility is that state exchanges had more enrollees who over-reported income in 2014. For instance, California shifted about 200,000 exchange enrollees into Medicaid for 2015. However, it is unclear why state-run exchanges would have disproportionately experienced such corrections.

In part, this difference explains some of the discrepancies in 2015 enrollment growth between federally-facilitated and state exchanges. “State-run exchanges lost more ground with enrollment in 2015, making it even harder to achieve annual goals for enrollment growth,” said Elizabeth Carpenter, director at Avalere.

In total, federally-facilitated exchange enrollment in 2015 increased by 61 percent from 2014, rising to 8.8M. By contrast, state-run exchange enrollment only increased by 12 percent, to 2.8M. Large federally-facilitated states like Florida and Texas increased enrollment by 62 percent and 64 percent respectively. Conversely, large enrollment state-run exchanges like California and New York increased enrollment by 1 percent and 10 percent respectively.

NOTE: Hawaii 2015 Enrollment--after non-renewals--grew by 47% over 2014 enrollment--this is the 12th worst result of the 45 states reporting, in spite of 2015 enrollment being 110% of 2014 enrollment, the highest in the nation.

“Federally-facilitated exchange states significantly outperformed their state-run counterparts in 2015.,” said Caroline Pearson, senior vice president at Avalere. “Some of the higher 2015 enrollment may be attributed to initial technological issues with HealthCare.gov that may have depressed 2014 enrollment, however, that alone does not explain why state-run exchanges did so poorly, relative to the federally-facilitated exchange states.”

Methodology

Avalere relied on data from the March ASPE Issue Brief on Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report. To determine the percentages, Avalere used the 2015 enrollment breakouts from the report on the percentage of enrollees who were new or returning enrollees. Then, Avalere used the percentage of returning enrollees to calculate the percentage of 2014 enrollees retained in 2015.