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ACA QHPs as of 10/13/14: 7.3M Current8.2M PAID / 9.6M Total

Estimated Total, all sources: appx. 28 Million
(7.3M Exchange QHPs, 8.0M Off-Exchange QHPs, 10.8M Medicaid/CHIP, 1-2M assorted)

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Regular readers may recall my thorough debunking of Sharyll Attkisson's ludicrous claim that only 3.4 million people out of the "38 million" who are "eligible for coverage under Obamacare" have actually received healthcare coverage since the law went into effect.

As I noted, these numbers were just a wee bit off. The "3.4 million" is actually more like "11.8 million", and while the "38 million" is actually reasonably close if you're only including those who were a) uninsured last year and b) who qualify for either Medicaid or tax credits via the ACA exchanges (more like 36.4 million), even this is stupid because no one in the Obama administration, HHS, CMS or the CBO ever claimed that all 36.4 million would be insured in the first year of the exchanges.

Some interesting ACA-related news items which aren't really state-specific...

Non-Profits want their status known on exchanges

Research has shown that consumers "do think there is a difference," between for-profit and not-for-profit health plans, says the head of an industry group. But in the final rule on health insurance exchanges, CMS has declined to require that tax-status be disclosed.

Nonprofit health insurance plans continue to dominate customer satisfaction and quality lists, and they want consumers to know about it.

Bruce McPherson, president and CEO of the Alliance for Advancing Nonprofit Health Care, says federal and state health insurance exchanges should do more to make the tax status of health plans readily available to consumers.

And this is kind of important, because at the same time...

Publicly traded insurers take bigger role in Obamacare's second year

COLORADO: Exchange COO joins exodus, new system late

Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.

And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins.

VIRGINIA: Funds to help Va. health care coverage signups

Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance.

Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15.

VERMONT: Federal Law Raises Questions About Who Can Bid For IT Projects That Support The Exchange

A provision of the Affordable Care Act precluding health insurers or companies in the “same controlled group of corporations” as a health insurer from holding exchange contracts raises questions about Optum working on Vermont Health Connect.

Concerns regarding Optum were raised at the federal level by Sens. Orrin Hatch, R-Utah, and Chuck Grassley, R-Iowa, the ranking members of the Finance and Judiciary committees respectively.

IDAHO: Your Health Idaho to launch sign-up system

Basically just an overview of the new Idaho ACA exchange; ID is the only state moving from to their own website for the 2nd year, giving them a unique perspective. Most interesting to me is that they're spinning the "autonomy/states-rights" angle, which was the whole reason for pushing states to set up their own exchanges in the first place:

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

Some fun with numbers.

As I predicted in early September, Part Two of the "OMG!! GAZILLIONS OF POLICIES CANCELLED!!" freakout has commenced with 3 weeks to go before the election. Case in point: Colorado, where the state Insurance Commissioner sent a letter to "state Senate Republicans" yesterday (I'm going to assume that this was in response to their request, as opposed to the Commissioner voluntarily choosing to only inform the Republicans specifically) stating that a total of 22,000 policies are scheduled for cancellation due to non-compliance with ACA provisions:

Over 22,000 Coloradoans have had their health insurance canceled by Obamacare in the past month — and 200,000 are slated to be shut down in 2015, the state insurance department announced Friday.

The Colorado Division of Insurance wrote to state Senate Republicans Friday, notifying them that five more insurance carriers have ended plans for 18,783 more Coloradoans in just the last month. By far, the most canceled plans will come from Humana Insurance Company and Humana Health Plan.

When I last checked in on New Jersey back in June, their Obamacare Medicaid expansion tally was at around 229,000 people. This number has jumped to 343,000, out of around 466,000 NJ residents eligible for the program, or roughly 74%:

The 343,000-person expansion in Medicaid enrollment this year is nearly three quarters of the 466,000-person expansion-eligible population estimate by the Kaiser Family Foundation. But the 161,775 residents who enrolled through the marketplace are equal to just over one quarter of the estimated 628,000 eligible.

The other noteworthy thing here is that according to my own breakdown of the KFF estimates, New Jersey only has around 562,000 uninsured eligible for tax credits via the ACA, not 628K. However, this is mostly moot since those with insurance can also purchase QHPs via the exchange as well if they wish, so it's not really that big of a deal.

As for the 161,775 QHP figure, that dates back to last spring, so no update there.

I'm swamped with my day job at the moment, so I won't be able to do an analysis/breakdown until later, but the August CMS Medicaid/CHIP report has been released, and the major takeaway is that even more people have been enrolled in Medicaid or CHIP programs thanks to the Affordable Care Act than even I had estimated (which is either a good or bad thing depending on your partisan leanings):

The Health Insurance Marketplace, Medicaid, and Children’s Health Insurance Program (CHIP) are critical in ensuring coverage for many individuals. As of August 15, 2014, 7.3 million Americans were enrolled in Marketplace coverage and had paid their premiums. This number represents a snapshot of a point in time, not the cumulative enrollment data from October 2013 through August 2014. 

The other day I noted that Republican Congressman Tom Cotton of Arkansas, currently in a heated battle with U.S. Senator Mark Pryor to take Pryor's seat, is proposing not only stripping healthcare from the 200,000 people in his state who have gained healthcare this year thanks to the Affordable Care Act's Medicaid expanion provision (the "private option" in AR) as well as 40,000 people who are paying for policies via the ACA exchange, but is going even further by pushing for half of the pre-Obamacare Medicaid/CHIP budget to be slashed.

This would effectively result in up to 20% of the state's entire population losing their healthcare coverage...every one of whom is either poor or barely middle-class at best.

Well, that number just went up a bit more:

The massive data dump from this afternoon out of Covered California was mostly excellent news, both for the ACA as well as myself personally:

  • I nailed the total QHP enrollment figures during the off-season almost precisely (99% accurate on the total number, 96% accurate on the daily average)
  • The gross attrition rate has been only 1.6% per month, and the net attrition rate since April is an astonishingly low 1.8% over 6 months, or just 0.3% per month, which is far better than anyone (including myself) had imagined. Basically, people being added are almost entirely cancelling out people dropping coverage.
  • The list of technical improvements, new features, beefed-up staffing and ramped-up outreach efforts for the 2nd open enrollment period included in the press conference was extremely impressive (see the lower half of this entry from earlier today).

HOWEVER, there was one key data point which was quite surprising and disappointing to me: The initial payment rate.