The first number is only slightly higher than last week, but at the time I didn't know if that referred to employees only or their families as well. This article is more specific, so using Covered California's very conservative 1.8x factor for dependents, the actual number of people covered by the SHOP exchange comes to about 711.
As of Jan. 28, 1,612 New Mexico employers had signed up to buy insurance on the SHOP for their employees. A total of 395 employees and their dependents have selected plans on the SHOP.
In addition, as the submitter noted, the numbers aren't huge but the 1,612 employers signing up is extremely promising.
Through January 25, 26,832 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
95,318 Marylanders signed up through the Primary Adult Care (PAC) program were automatically converted to Medicaid coverage effective on January 1, 2014, and now have full Medicaid coverage. As of January 28, an additional 42,302 individuals were newly enrolled in Medicaid effective January 1.
Leigh McGivern, PR & Social Media Manager for CoOportunity Health of Iowa and Nebraska, has done me a huge favor by agreeing to release the Co-Op's on-exchange andoff-exchange (direct) enrollment figures through January 24!
Unfortunately, the on-exchange numbers are both less than the 12/28 totals for either states (there are 2 insurance companies operating on Iowa's exchange and 3 on Nebraska's), so I don't know how much those have gone up since December, but the off-exchange numbers are quite impressive and very telling! I'm not breaking out the age data, but here's the key numbers:
Iowa Off-Exchange QHP Enrollments: 5,325 Individual; 4,694 Small Group; 147 Large Group = 10,166
Nebraska Off-Exchange QHP Enrollments: 7,867 Individual; 8,079 Small Group; 1,833 Large Group = 17,779
Between the two, that's nearly 28,000 more people added to the Private QHP tally.
OK, this is a new one...two updates for the same state only 14 hours apart:
Hot off the press at #RWJFRR - Kentucky official says 195,502 have used Kynect to get coverage (up by 12,000 this week). 44,160 are in QHPs.
That's 760 more QHPs / 12,742 more Medicaid/CHIP enrollees than I had last night. This also brings Kentucky up to over 20% of their absurdly-high "projection" of 220,000 QHPs (or, conversely, 46.4% of the more reasonable "Proportional % of 7 Million" figure).
UPDATE: I should have noted that the actual total number of new Medicaid enrollments for Kentucky is now over 206,000 if you include direct (off-exchange) enrollments.
Some minor updates out of Oregon today: Private QHP enrollments are up to 31,664 from 30,157 a week ago; exchange-based Medicaid enrollments have gone up to 57,858 from 53,018, and Medicaid "Fast Track" direct enrollments are up to 122,869 from 121,190. As noted last week, only the difference in Fast Track enrollments since 12/28 are being listed on the spreadsheet, since the other 120K or so are already included in the CMS report numbers.
Cover Oregon: Private insurance: 31,664 / Oregon Health Plan: 57,858
Oregon Health Authority “Fast Track”: Oregon Health Plan: 122,869
No exact numbers, but roughly 5,600 more private QHPs than the 1/15 official update of 63,407. No new Medicaid/CHIP here, however:
Almost 69,000 people have gotten private health insurance through the exchange that meets new federal mandates, Fontneau said. That's a big uptick from the end of 2013, when just over 50,000 had gotten coverage.
Since this period is evenly split pre- and post- Sec. Sebelius' "3 Million Total" announcement, I'm subtracting a little more than half from the "Not Broken Out Yet" amount and considering the other half to be newly added since then.
The next quote from a Colorado exchange representative is also quite telling:
"As much as we may have overestimated what would happen in October and November, we underestimated what would happen in January," she said.
Arkansas' unusual "Private Medicaid Option" already had 74,000 enrollees at the end of December; it looks like they've added another 5,000 people since then. The other 74K are already included in the "CMS Direct" report columns on the spreadsheet, so I'm only increasing the tally by the new 5K.
More than 79,000 people have enrolled in Arkansas' private option program, and state officials say they expect it to hit 100,000 when the Legislature convenes next month for a session focused primarily on the state's budget.
And voila, with the quarterly earnings conference call for WellPoint Insurance, we have our first clue as to just how many ACA-compliant policies have been sold directly via the insurance companies instead of being run through Healthcare.gov and/or the state-based exchanges: Around 95,000 nationally:
Of the half million new members Wellpoint said that have applied for coverage so far, more than 80 percent came through public exchanges and two-thirds of those were “subsidy eligible.”
Unfortunately, these are pretty rough numbers--"half million" could be as few as around 490,000 or as high as perhaps 520,000, and "more than 80%" could mean anywhere from 81 - 83%, but for the moment I'll assume 81% out of 500,000, which means 19% off-exchange.
Oh, and no, these should not include any of the "1-year extensions of non-compliant/junk accounts" which the Obama administration has been allowing; the article specifies these as new members of WellPoint, not renewals/extensions of existing policies.
According to a report issued last July by the Kaiser Commission on Medicaid and the Uninsured, if all states accepted Medicaid Expansion the number of uninsured would be reduced by an additional ten million people. The comprehensive report noted, however, that 4.9 million of those people were living in states that had refused the expansion and another 1.5 million were in states that had not yet decided.
Why have many governors refused the offer of the federal government to fund 100% of the expansion for three years, and 90% thereafter until 2022? Among other reasons, the governors claim they cannot depend on the promise of federal funding, but they rarely state their main concern: the possibility that a large number of additional regular Medicaid clients will come "out of the woodwork." These are people who could have qualified previously under the regular Medicaid rules but never enrolled, perhaps because they did not know about the system, did not realize they might qualify, or did not know how to find out. As reported by NPR in 2012: "what really has many state leaders worried is something called the 'woodwork effect.' When big parts of the health law go into force in 2014, they worry it will bring out of the woodwork the millions of people who are already eligible for Medicaid but aren't already enrolled."
It appears that many people have indeed been signing up for regular Medicaid because of the publicity about healthcare.gov and the state exchanges, as well as an easier, streamlined enrollment process required by the ACA. Evidence of the woodwork effect can be found in the latest CMS report. For states with Medicaid Expansion, there was an average increase of 14.4% in Medicaid applications Oct-Dec compared to the July-Sept average. For states not expanding Medicaid, there was an average decrease of 10.1% during the same period. This decrease may reflect a typical seasonal pattern, which makes the 14.4% increase in the Expansion states even more remarkable.
States refusing Medicaid Expansion fear the woodwork effect because the federal government pays a much smaller share of the costs of regular Medicaid: from 73 percent in a poor state like Mississippi, for example, to 50 percent for states such as Wyoming, California and Connecticut. When it comes to paying its share of Medicaid costs, the federal government will have to require that states distinguish clearly between regular Medicaid clients and the "non-elderly", non-disabled, childless, low-income adults between the ages of 19-64 who are newly enrolled because of Medicaid Expansion.
Currently, these states (plus DC) are expanding Medicaid:
AZ, AR, CA, CO, DE, HI, IL, IA, KY, MD, MA, MI, MN, MA, NV, NJ, OH, UT, NM, NY, ND, OR, RI, VT, WA, WV
Good Morning! I have some mid-level changes to both spreadsheets this morning which visitors should be aware of:
--On the Private QHP Spreadsheet, I've replaced the very rough percent-based "Total Uninsured" numbers with the raw numbers from the same Kaiser Family Foundation table. Again, this is the same source, I'm just using the raw number view now instead of the percent view. In addition, using percentages were based on the July 2013 census estimates, while the KFF numbers are based on 2011-2012 population totals. Combine this with the percentages being previously rounded off, this resulted in some significant differences in the state numbers.
For example, at the high end, the California number changed from around 7.6 million to only 7.1 million, a half-million difference! Meanwhile, at the low end, Vermont has "dropped" from 57,000 uninsured prior to October 1st to just 47,900…which makes the original CMS projection for Vermont (also 57,000) all the more absurd.
OK, no press release or private/public breakdown yet, but the home page of New York's health exchange website is displaying a total of 351,605, up from 328,796 as of January 20.
Assuming the same 67/33 split that their previous exchange enrollments have followed, that means roughly 15,400 private enrollments and another 7,409 added to Medicaid/CHIP. I'll adjust these numbers as appropriate once a formal press release comes out.
In addition, this is the first update that takes us beyond January 23 (the date of the "3 Million" announcement), so only about half of that 15,400 will be subtracted from the "Not Broken Out Yet" amount. And with that, we've moved onto Week 17.
Washington State just released their latest official update, and as usual, they do a fantastic job of breaking down the numbers in an easy-to-follow manner, especially on the Medicaid/CHIP side.
Private QHP enrollments are up from a total of 149K (73,098 paid, 76,058 unpaid) as of 01/09 to about 168K (86,031 paid, 81,872 unpaid) as of 01/23, a 12.7% increase in 2 weeks.
Medicaid enrollments are up from a total of 198K (134,700 via Medicaid Expansion + 63,070 "Out of the Woodwork" folks who were previously qualified but weren't already enrolled) as of 01/09 to a total of almost 238K (160,587 expansion + 77,144 "woodwork") as of 01/23. This represents a 20% increase.
Between these and the other recent updates, the grand totals now stand at 3.16M Private QHPs and 7.38M Medicaid/CHIP enrollees. It's also important to stress that the Medicaid number does not include renewals of existing Medicaid/CHIP recipients.
I've written about this in passing before, but after repeated requests about the subject, I've decided to devote a full blog entry about the serious problems inherent in the CMS's state-level Private QHP projection numbers.
As far as I can tell, while the national "7 million" private enrollment projection figure issued by the CBO was based on solid analysis of the demographic situation at the time, the state-level CMS projection breakdown is, in many cases, based on little more than educated guesswork.
In general, the enrollment targets provided by state- based Marketplaces are more ambitious than the initial Department enrollment targets for those specific states. As a result, using the publicly available SBM targets without adjusting other states would have raised the projected number of 2014 Marketplace enrollees by 1.4 million; therefore, the Marketplace ramp-up rates for other states were revised downward accordingly to maintain the 7 million total.
Contributor deaconblues provides an interesting Rhode Island update. While the standard Private QHP and Medicaid/CHIP numbers haven't changed from what I already had listed (although the paid QHP number has increased slightly), there's also the addition of 4,311 RIte Care parents automatically enrolled in RI's non-profit Neighborhood Health Plan.
As deaconblue notes, "Rite Care looks like it fully covers the premium for up to 150% FPL and offers premium assistance to those between 150% and 250%...the context implies that all of the 4,311 should be somewhere under QHP - if some of these plans were fully paid by the state, would they have appeared as an asterisked note under the Medicaid Enrollments section?"
I see his point, but at the same time, seeing how it fully covers the cost up to 150% FPL while even the ACA's Medicaid expansion only goes up to 133%, it really sounds like the vast majority of these folks should be categorized on the Medicaid/CHIP side. I'll look into it and may move some or all of these over to the Private QHP side later, but for the moment I'm listing them as "Medicaid/CHIP".
Meanwhile, I've been informed that Washington State only has their SHOP program running in 2 counties, while Maryland's won't be operational until April (SHOP enrollments are open year-round, while individual/family enrollments are only available through 3/31).
As of Jan. 15, 368 people had purchased insurance through New Mexico’s SHOP (Small Business Health Options Program) exchange for small businesses.
...So far, 370 people have enrolled in insurance plans on the SHOP exchange, according to the NMHIX. A total of 1,542 employers have set up accounts on the exchange and they represent 3,962 employees.
Kentucky continues to slowly but steadily increase their tally, hitting 19% of their CMS projection target with 42,000 private QHP enrollees as of last Thursday. The 2,200 new additions have been subtracted from the "Not broken out by state" pool, bringing that total down to 486,500. Again, any new exchange enrollees which are added up through Jan. 23 will be subtracted from this since it fills out the "3 million" total announced by Kathleen Sebelius last week.
Meanwhile, on the Medicaid side, Kentucky added another 12,000 new enrollees, bringing them up to 189,000 when you add the 55K direct additions. It's important to note that according to the CMS reports, these people should all be new to Medicaid, not renewed accounts.
As of Thursday, according to the state, 176,000 Kentuckians have signed up for health insurance.
So far 42,000 have signed up for private insurance, or roughly 14 percent of the total number of uninsured Kentuckians. That compares to 134,000, or 44 percent of those eligible, who have signed up for Medicaid.
Some minor updates buried in the MNsure Board of Directors report; thanks to an anonymous tipster for calling my attention to it. Nothing major, but some small updates to both the Private QHP and Medicaid/CHIP enrollment figures (27,775 and 52,225 respectively). The most noteworthy addition is the 475 SHOP (Small Business marketplace) enrollments noted on page 27 of the report.
The story itself is pretty negative on the SHOP Small Business exchanges--apparently the Federal one (at HC.gov) won't be ready until this fall--but it at least gives the SHOP enrollment number for New York.
Exchanges in larger states aren’t doing much better with their business plans. In New York, about 5,000 employees of small businesses have enrolled in the SHOP exchange, James O’Hare, a spokesman for the state’s Department of Health, said in an e-mail.
...in which we find the third ACA-created SHOP (Small Business Health Options Program) addition of the day. 2,155 employees is a pretty miniscule number (especially for the largest state in the country), but it's something. Note that it says "2,155 employees", which most likely means about double that when you include dependents, but as always, I'm leaving it here unless I find specific sources stating otherwise.
A total of 289 small employers have signed up for coverage through Covered California’s Small Business Health Options Program, better known as SHOP. These employers will provide coverage to a total of 2,155 employees.
If you take a look at the Private QHP spreadsheet you'll see a new column: "Private SHOP Market". This is for enrollees in the ACA's Small Business Health Options Program, basically the small business (fewer than 50 employees) counterpart to the individual/family exchanges getting so much attention.
This is one of those cases where percentages mask the real picture. Yes, Hawaii has seen their Private QHP enrollments increase by an impressive 43% since December 28. However, they only had 2,192 people enrolled in the first place...the actual increase is only 934 people, to 3,126.
Furthermore, those 934 have to be subtracted from the almost half-million "Not Broken Out By State" tally at the top of the spreadsheet, since they came in before 1/24/14.
On the other hand, this also gives the first SHOP (Small Business Exchange) entry for Hawaii...another 307 people.
Hey, a person is a person...
As of Jan. 18 the Connector enrolled 3,126 people, though 13,000 applicants were deemed eligible for tax credits to reduce the cost of coverage. Of the 373 small-business groups that applied, only 75 employers were enrolled with 307 workers selecting plans.
A very nice bump in Oregon's numbers today, especially given their ongoing technical issues. Private QHP enrollments are up from 23,800 as of Jan. 15 to 30,157 as of Jan. 24. However, since yesterday's HHS Dept. announcement of appx. 3 million total enrollments was "as of this week", this doesn't impact the overall total; it simply subtracts about 6,000 from the "Unspecified" number. Expect a lot of this over the next week or two until the enrollment updates "clear" the Week 16 point.
OK, yesterday's update was apparently a bit premature; MD is actually up to over 25K, though they're still under 17% of the CBO projection figure. The Medicaid tally hasn't changed since last week.
Through January 18, 25,177 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
93,514 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of January 14, an additional 29,517 individuals were newly enrolled in Medicaid effective January 1.
In addition, here's the official press release/blog entry at the Health & Human Services website:
Since the beginning of open enrollment, millions of Americans are gaining access to health coverage–many for the very first time—thanks to the Affordable Care Act. The most recent data indicates that approximately 3.0 million people have now enrolled in a private health insurance plan through the Federal and State-based Marketplaces since October 1.
It's also important to note that the press release specifies that this only includes enrollments through the exchanges, and does not include people enrolling directly through the insurance companies themselves. This is a potentially huge number. More to come on this soon (I hope).
The December report released Jan. 21 by Covered California shows that from Oct. 1-Dec. 31 the exchange received 1,107,229 electronic applications for health care coverage through both private plans and Medi-Cal. Multiplying that number by 1.8, "based on an average of 1.8 individuals per application," it was estimated that the number of applications represented 1,993,012 individuals.
The 1.8 factor was not used for "completed applications." From Oct. 1-Dec. 31, there were 771,008 completed applications for health care coverage through Covered California (including Medi-Cal) for 1,456,909 individuals. If the 771,008 completed applications had been multiplied by 1.8, there would have been only 1,387,814 individuals. This indicates that individuals, not households, were counted in the completed applications.
From Oct. 1-Dec. 31, there were 500,108 enrollments in a Covered California health plan (this did not include Medi-Cal). Of the 730,449 individuals who were "determined to be eligible for enrollment in Covered California", more than 2/3 enrolled. Clearly these were enrollments by individuals, not households.
OK, in some ways this is gonna make my previous Medicaid analysis (which was confirmed by the CMS a few days later) seem like kid's play, but in other ways it'll actually be far easier to follow. Not only have I prepared multiple screen shots of the spreadsheet involved so you can see exactly what numbers changed and why, but there's far less guesswork on my part as to which cells to keep or eliminate. All of the relevant reports, along with the actual spreadsheet itself (with all 6 worksheets) are linked to at the end of this screed.
You see, while my 6.3M figure from several days ago does match the 6.3M total that CMS announced yesterday, there are still some anomalies, because my 6.3M includes some additional data that's been released since the end of December, while their 6.3M includes the December "direct ernrollment" data for all 50 states that I didn't have access to. There are some additional factors to sort out, and I decided to start from scratch to figure out what they were. What I found surprised me.
If you review page 3 of the latest CMS report (which includes Medicaid/CHIP enrollments through December), you can see that they've added a small but important new paragraph at the bottom:
9 The following states have included renewals in their application data: Nevada, New Mexico, Ohio, and Pennsylvania. These states have included renewals in their determination data: District of Columbia, Iowa, Maryland, Michigan, Missouri, Nevada, North Dakota, New Mexico, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Virginia and Wyoming. Some of these renewals are conducted without the individual submitting a new application, using information already in the system that the individual is asked to verify.
Well, now, this certainly answers a burning question, doesn't it?
If those 14 states (+DC) do include Medicaid/CHIP renewals (aka redeterminations) in their data, then that means, by definition, that the other 36 states don't include renewals.
Yes, this is self-serving and smug. I really don't care at the moment:
Enrollment in Medicaid spiked in December, aided by Obamacare exchanges and an expansion of the government-run health coverage program for the poor in 25 states...
By the end of December, more than 6.3 million people were determined to be eligible for Medicaid or CHIP, the program covering children, through state-run agencies and state-based Obamacare exchanges, according to a Centers for Medicare & Medicaid Services report released Wednesday.
That tally does not include the 750,000 or so people who were determined eligible in Medicaid through the federally-run Obamacare exchange HealthCare.gov.
Adding the two enrollment numbers together equals more than 7 million Medicaid-eligible determinations. But some of the determinations made by HealthCare.gov may be duplicative of state-based decisions.
As it happens, if you look at the Medicaid/CHIP spreadsheet, I deliberately left out about 620,000 Medicaid enrollees from the total because I suspected they would otherwise be double-counted.
When I posted my big Medicaid/CHIP spreadsheet overhaul, I was understandably concerned that I missed something major--that there had to be some factor lost in the messy, semi-overlapping reports from HHS and CMS that would account for big swaths of the 1.7 million "extra" Medicaid enrollments that I've "found" (in reality, those 1.7 million have been gradually accruing ever since the beginning of October, I just wasn't able to pin them down into a tangible format on the spreadsheet & graph until now). As a case in point, after the overhaul, I have California sitting at 1.214 million new additions to Medicaid/CHIP programs.
Today a friend provided a link to a story out of the Fresno Bee from 4 days ago, in which the Cailifornia Dept. of Health Care Services reveals that enrollments in Medi-Cal (CA's implementation of Medicaid) have gone up from 8 million people last year up to about 9.2 million as of now...a difference of about 1.2 million.
I'm not saying that there aren't flaws in my methodology; no doubt there are, but this certainly helps set my mind more at ease.
Ka-Pow! This is the most eagerly-awaited enrollment update we've had in weeks. California has finally let the dust settle on their Christmas-week craziness and have released new, comprehensive enrollment data for both Private QHPs as well as Medicaid/CHIP, and the numbers are impressive indeed: After closing out 2013 with just over a half a million private enrollments (about 1,300 more trickled in in the final 3 days of the year), the first half of January has proven that, while the completely expected post-December drop-off did happen, enrollments are still proceeding at a very healthy pace, as over 125,000 more people enrolled in the first 15 days of the month, more than a 25% increase since New Year's Eve. Broken out, that comes to over 8,300 per day for California alone.
It's also worth noting that with this update, the total Private QHP enrollment figure has now broken the 2.5 million mark.
Meanwhile, Medicaid enrollments have also continued to show a similar 25% gain, up from around 460,000 (or 472,000...see today's Medicaid Spreadsheet update) up to 584,000.
A few days ago I posted an exclusive analysis of the ACA Medicaid/CHIP enrollment data as provided by the official HHS report released on 1/13, the CMS report released on 12/20, as well as the other various sources for ACA-related Medicaid/CHIP enrollment that I've already been posting/linking to since I started this site.
My general conclusion was that the actual grand total number of Medicaid/CHIP enrollments since October 1st, 2013 is actually far higher than the 3.9 million cited by the Obama administration (which was based on the 12/20 CMS report) or even the 4.5 - 4.6 million that both I and Glenn Kessler at the Washington Post have agreed are more accurate up until now.
Last week I took an uncharacteristic gamble by not trusting my instincts about the off-hand "7,000/day in January" comment made by the Deputy Director of NY State of Health; her claim seemed quite a bit off-base compared with the official press release a few days earlier, but I decided that she must know the numbers better than I did, so I went with it.
Today, the newest official numbers were released, and as it happens, I should have trusted my instincts--while the totals are still impressively higher than the prior numbers, they're still lower than the "7K/day" number indicated. In any event, NY is up to 222K private QHPs and about 107K Medicaid/CHIP, which still pushes them above 100% of their CMS projection for the enrollment period.
The newest figures show that as of 9 a.m. Monday, 587,486 people had completed their applications on the insurance exchange and 328,796 went on to enroll in some sort of coverage.
Well, this is a nice bit of good Medicaid-related news after the recent setback: It looks like after dragging their heels, Arizona authorities finally started processing new Medicaid applications, resulting in the number of enrollments skyrocketing. They're now up to over 98,000 from about 40,000 as of December 28th.
As of January 10, 2014, 98,203 adults have been approved for AHCCCS health insurance coverage: 96,834 are childless adults between 0-100% FPL and 1,369 are adults in the new category frin 100-133% FPL.
Very slight number bumps; 800 private QHPs and about 1,300 more Medicaid, but an update is an update.
To date, [acting Cover Oregon directory Bruce] Goldberg said, 65,932 people have enrolled in health insurance through the marketplace. About 23,800 of those are enrolled in commercial health plans. There are almost 30,000 people who have been approved to select their plan but have chosen not to move on in the process, Goldberg said.
The latest Colorado update is significant not just because of the solid numbers (private QHP enrollments up 20% from 12/31 through 01/15, to 63,407; Medicaid/CHIP enrollments up 17.6% to 101,730), but also because the second report devoted to Medicaid expansion specifically states that the 101K does not include redeterminations (ie, renewals of existing Medicaid recipients).
Also note that these Medicaid applications may include more than one person each.
Colorado is now at about 69% of their CMS projection number with 59% of the enrollment period passed.
And from the Medicaid Expansion Report:
**These are new applications for Medicaid or Child Health Plan Plus (CHP+) and do not include redeterminations. An application can include multiple individuals.
Maryland's private QHP enrollments went up about 10% in the first part of January, to 22,512, but the Medicaid numbers are confusing. According to the HHS report, as of 12/28 Maryland had 43,065 people enrolled in Medicaid via the exchange, but this update from the Maryland Health Connection states the number as only 29,517. However, they did also enroll a couple thousand more people via the automatic Primary Adult Care program, which cancels out some of this loss.
I'm not positive what to make of the 60,000 number, but the footnote certainly makes it look like this may be the true number of new Medicaid enrollees after separating out Medicaid renewals. This appears to account for the drop of 13,548, and suggests that (not including the PAC transfers), roughly 32% of all Medicaid enrollees were renewals. Assuming this is the case, these have now been separated out, and like Washington State, Maryland's Medicaid numbers should now be "clean" going forward (I think).
Not much to say here, just steady improvement. Kentucky's Private QHP Enrollments have gone up from 33,289 to 39,771, a 19% increase since January 2nd. Medicaid Enrollments are up from 100,359 to 122,328, a 22% increase. Kentucky is now up to 18% of their absurdly high CMS projection level.
122,328 have enrolled in Medicaid and
39,771 have enrolled in a qualified health plan (QHP).
Nearly 44% of the enrollees in Medicaid or qualified health plans are under 35 years old.
Last night I posted an exclusive analysis of the ACA Medicaid/CHIP enrollment numbers (supported by, if not actually confirmed by an official at the Centers for Medicare & Medicaid Services) which concluded that rather than the 3.9 million that the HHS and Obama administration have been touting, or even the 4.5 million or so that has been on the ACA Signups spreadsheet for the past week or so, that the actual number could be closer to 6.4 million.
I should also note as an aside that after I pointed his error out in my entry last night, Glenn Kessler at the Washington Post Fact Checker changed his incorrect "750K" number for Oct/Nov HC.gov enrollments to 270K; I had noted that you have to include December to hit the 750K figure. I don't know whether he corrected it based on my story or not, but I'll assume he did for my own ego's sake :)
Two quick 'n simple updates: Oregon's "direct" Medicaid enrollments are up another 3,000, while the 86,000 total enrollments in Connecticut now have precise numbers (instead of ones based on percentages the other day). This knocks their private tally down by 880 while increasing the Medicaid number by the same amount.
More than three months after it was supposed to launch, Cover Oregon's website still can't enroll anyone from start to finish. Using a backup process that requires workers to process applications by hand, the state has managed to enroll 65,000 people in health coverage, about 23,000 of them in private insurance and the rest in the Oregon Health Plan, the state's version of Medicaid.
Another 118,000 have enrolled in Medicaid through a separate process that bypasses the exchange.
Access Health CT has signed up more than 86,001 customers by the end of Wednesday, which includes 43,840 people in private plans and 42,161 who learned they are income eligible for government-funded Medicaid.
For those who just want the capsule version, here it is:
The official ACA Medicaid/CHIP enrollment number that the HHS Dept. has been touting up until now has been 3.9 Million. The number that I've been claiming on the spreadsheet is currently around 4.5 Million. However, based on a very detailed analysis of the first 3 HHS reports, as well as the 2 CMS reports issued last fall, I've concluded that the actual grand total of Medicaid/CHIP enrollments since the ACA exchanges launched on October 1st is actually even higher, possibly as many as 6.4 Million. While they can't officially confirm my numbers and some caveats apply (described below), a CMS official did review my work and concluded that "the methodology appears to be accurate".
Now, before everyone starts freaking out about this claim--and it's an admittedly major one--I want to make two VERY important caveats:
...and, just like that, we're back up above the 10M grand total mark again. Connecticut's private QHP enrollment tally just increased from 40,000 to 44,720, cancelling out the 3,702 that we just "lost" from Nevada a few moments ago. Medicaid/CHIP enrollments also went up by several thousand.
As of Thursday morning, Access Health CT had enrolled a total of 86,000 people, said Kevin Counihan, the marketplace's chief executive. He said about 500 to 1,000 enrollees are being added a day. That means the marketplace, also called an exchange, is on track to meet or exceed its goal of enrolling 100,000 people once the open enrollment period ends on March 31, he said.
Of those 86,000 people, Counihan said 52 percent signed up for private coverage and 48 percent for government-funded Medicaid.
These 3 updates push the Private QHP enrollment tally up to about 2.4 million; add about 4.5 million Medicaid/CHIP enrollments and 3.1 million "sub-26'ers" added to their parents plan thanks to the ACA, and you hit just over 10 million total.
A few days ago the New York exchange released an oddly-worded press release which mixed some numbers through December 24 with other numbers through January 12. My reading of it at the time was that the state had added roughly 53,000 (private QHP + Medicaid/CHIP combined) since 12/30.
However, today, the Deputy Director of the NY exchange stated that they've been enrolling "about 7,000 per day" total in January...which adds up to 98,000 if you assume that runs through yesterday, the 14th. Even subtracting the extra 2 days, this means her number is 31,000 higher than yesterday's press release, but I'm not about to argue with the Deputy Director of the exchange, so another 98K it is. Assuming this breaks down roughly 72% Private QHP to 28% Medicaid/CHIP (as prior numbers have in NY), that comes to about 70.6K private and 27.4K public.
In addition, this pushes New York over the top in terms of their original CMS projection of 218,000 private QHP enrollments by March 31st. They should easily double that number by the end of the enrollment period, and could potentially hit 2.5x at this rate.
I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).
As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.
Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.
As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.
Qualified Health Plans: 73,098
Medicaid Newly Eligible Adults: 134,700
Medicaid Previously Eligible but not Enrolled: 63,070
Qualified Health Plan Applicants – Need to Pay 76,058
Some slightly updated numbers out of Oregon today, revealed during a conference call with the director of the beleaguered Cover Oregon exchange. Private enrollments are up from 20K to 23K, and exchange-based Medicaid enrollments up from 39,711 to about 42,000.
In addition, some info on the method of the 115,000 "direct transfers" to Medicaid off of the exchange: Apparently they used food stamp income information to do so, which is pretty clever if you think about it.
More than 65k enrolled so far through exchange, he says, 23k in private plans
As we recall, HealthCare.gov and most state insurance exchanges moved their enrollment deadline for January 2014 coverage, first from 12/15 to 12/23, then to 12/28 or as close to the New Year as possible.
That, however, will not be the case for February coverage. That deadline is firm – and it is today.
Thus the number of enrollment days in January will be roughly half that of December. Or to put it in an amusing way: January is almost half a month shorter than December. We must bear this in mind when examining any statistics of how many people have ACA-compliant insurance on February 1st, not drawing overly hasty conclusions about the declining enrollment rate.
Yesterday, HHS extended its coverage of people in the Federal High-Risk Pool. The new deadline is March 15th, coinciding with the deadline for the ACA’s open enrollment. This adjustment will help ensure a smoother transition for patients with pre-existing conditions.
Already, more than 55,000 of the 85,000 people that were in the PCIP programs per October 1st have enrolled in other healthcare plans. This is a reduction of at least 65 %. According to HHS, less than 30,000 people now remain in the federal high-risk pool.
Since it was launched in late 2010, the PCIP program, has provided coverage for a total of 135,000 people with serious pre-existing conditions who would otherwise have unable to obtain insurance.
There is an 8 % difference between the genders: 54 % of those who have selected a Marketplace plan are women, while men account for only 46 %. Men are in the majority in only two states: Connecticut (54 %) and Hawaii (51 %), whereas the District of Columbia was evenly split per 12/28.
It’s also worth noting that in the District of Columbia, so-called “young invincibles” (enrollees between 18–34 years of age) account for 44 %, while in Massachusetts HHS pegs the portion to be 31 %. Nationally, people 34 years of age or younger account for 30 % of the enrollment, and 18–34 year olds account for just over 24 %.
I've already noted that the State-Level CMS Projection Numbers are, for 40 out of the 50 states (plus DC), not particularly well-arrived at. However, for good or for bad, those are the numbers that the states are "supposed" to be striving for, so let's take a look at how they're doing.
With the official 12/28 HHS numbers in hand plus more recent updates for 13 states, here's where things stand purely on a "% of CMS projection attained" basis.
This is important to understand in cases like Kentucky, which has actually been operating quite successfully but which shows up as performing "poorly" due purely to the absurdly high "projection number" that it was assigned in the first place.
The official HHS ACA Exchange Medicaid enrollment figure for Illinois released earlier today was 82,286. However, contributor sulthernao noted that the actual number of people enrolled in Medicaid under the ACA in Illinois is at least 53,714 higher. As he/she put it:
Illinois is a partnership state for Medicaid enrollment, has used SNAP autoenrollment, and early expansion experiment in Cook County. For this reason, the numbers reported by the Federal Government (ASPE) are a severe underestimate of the enrollment. People who apply directly through the state's website may not be counted.
I realize that this probably has no connection to the "mystery" 1.24 million Medicaid/CHIP enrollments that I just wrote about an hour or so ago, but it's been a very long day and I'm extremely tired, so until I hear a better explanation for those 1.24M, I'm lopping the 53K difference out of that "unspecified" total at the bottom of the spreadsheet.
OK, the Medicaid situation is, to put it mildly...confusing. For most of the states I simply swapped out whatever numbers were there from the November report for the Dec. 28 total. However, there are easily a dozen states which either have one-time bulk automatic transfers from an existing state-run program (such as the 630,000 transferred from California's LIHP program, which was itself created in preparation for the ACA's Medicaid Expansion program); earlier mass enrollments in Medicaid which were quietly put through via other ACA elements long before the actual Exchanges launched (see DC and Minnesota); "special" cases such as Arkansas' unique "private Medicaid option" program; or simply updated numbers which have been released since 12/28.
Even with all of this, there's still roughly 1.24 million "unspecified" Medicaid/CHIP enrollments which are necessary to make up the other "3.9 million" figure which the HHS Dept. has been touting since around December 20th. I am simply unable to determine exactly what these "unspecified" enrollments are, since the "normal" Exchange-based Medicaid/CHIP numbers only add up to about 1.58 million.
In short, as best as I can figure, it breaks down as:
Whew! OK, after plugging in the numbers from the December HHS report (which actually only runs through 12/28, which is important to keep in mind), I now have the spreadsheet as up to date as it can be. There are 12 states which have released more up-to-date enrollment figures since 12/28. When you add these more recent numbers to the 2.153 million in the HHS report (which, again, only covers through 12/28), you get the following total: 2,347,097
Now, some of this may be questionable, which is why it's clearly italicized on the spreadsheet. Specifically, there's 72,178 enrollees in Washington State who hadn't made their first payment as of January 2nd, and another 1,999 who haven't paid yet in Rhode Island. Finally, there's the confusing case of 22,000 people in Massachusetts who have apparently been approved but are just waiting on some paperwork processing to be completed; in the meantime, they've been put on some sort of temporary state-financed healthcare plan until this is resolved.
According to the official December HHS report, the total number of exchange-based private enrollments was 2,153,421 as of 12/28.
ACASignups.net was, therefore, appx. 99.2% accurate (ok, knock 0.2% off for the missing 3 days of data...call it 99% even).
I have no idea why the HHS report doesn't include the last 3 days of the year; perhaps a lack of personnel during the holidays? Will post something about this if/when I find out what the deal was there.
OK, I've plugged the numbers into the spreadsheet, but since most people's browsers won't be wide enough to view it, here's the state-by-state breakdown; remember, these numbers are only through 12/28:
Rhode Island becomes the 2nd (or possibly 3rd, depending on how New York's final tally turns out) state to break through the CMS's private enrollment projection, hitting 12,300 when employees enrolled via the Small Business exchange are included (and yes, these count. They're still people who didn't have insurance prior to the ACA, who do now thanks to a part of the ACA).
This moves RI up from an 80% paid rate as of New Year's Eve to an 83% paid rate as of January 8th. The rest will have to wait until February for coverage at this point.
Nearly 2,000 people of the 11,770 who signed up for health insurance through HealthSource RI did not pay their premiums by the Jan. 8 deadline...
The numbers show that 23 percent of enrollees are age 18 to 34, and 56 percent are 45 or older. Also, 54 percent are female. These numbers are based on the figure of the 11,770 who selected a plan by Jan 4....
Some 75 small businesses have enrolled, with coverage for a total of 530 people.
A friend who wishes to remain anonymous provides a bit more info on the MinnesotaCare program discussed earlier.
The program seems similar to California's Low Income Health Program. The LIHP wasn't part of Medicaid, but it was set up with federal funds in preparation for Medicaid Expansion. However, Minnesota Care predates the ACA. It began in 1992. Part of its funding comes from federal Medicaid funds:
"MinnesotaCare is a publicly subsidized health care program for residents who do not have access to affordable health care coverage. It is funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid funds and enrollee premiums.
Most enrollees pay a monthly premium based on family size and income. Children under 21, some military families, and families with an enrolled American Indian do not pay a monthly premium.
Still waiting for clarification of the distinction between private enrollments and Medicaid/CHIP expansion on the new additions, but assuming they're a similar ratio to the prior enrollments, it should be roughly 38,500 private and 14,500 Medicaid/CHIP. If that ratio is close, this means that New York has essentially reached their March 31st private enrollment projection of 218,000 (give or take a few thousand).
Bonus: It was also revealed during NY State Senate testimony today that a whopping 40% [Ed: 30%, thanks to DwightKSchrute for the correction] of enrollees are under 35, and another 16% are between 34-44. This should go a long way towards quieting the ""young invincibles" aren't signing up!" ACA attack point.
A regular site visitor has sent me some in-depth information about the public healthcare program situation in Minnesota, which is evidently quite a bit more complicated than most other states. I've put together this information into what I hope is a cohesive whole, with my response below. Anyone who's more familiar with the Minnesota situation can feel free to correct or clarify any of this if you'd like.
"Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans."
Several thousand more than 26,000 should be counted as exchange sign-ups rather than Medicaid signups. Minnesota has a sort of in-between basic health plan called MinnesotaCare. It covers people between 133% and 200% (I think?) of poverty. It is not Medicaid (which is called Medical Assistance in Minnesota) and therefore not part of the ACA Medicaid expansion, but it is a public plan. So, when the StarTribune refers to "public plans," they are lumping Medicaid and MinnesotaCare together. The state has cleared this up before in reporting on Minnesota's enrollment numbers in the New York Times. MinnPost reported on this correction back in November.
As a follow-up to Friday's news that Idaho has hit around 20,000 private enrollments comes this story about the status of those enrollments from the actual insurance companies' perspective. While the major thrust of the article is the unusually long payment deadline extensions that have become necessary due to the technical and paperwork confusion caused by the Federal HC.gov exchange, as contributor Witgren notes, there's two important points which are quite telling.
First, in Idaho, at least, it appears that at least 75% of those 20K people have made their first payment. While you can certainly spin this as being "25% are deadbeats" if you want to, this certainly goes a long way towards disproving that the "OMG!! NOBODY IS ACTUALLY PAYING!!!" meme that the ACA opposition has been shouting about.
Secondly, it appears that, according to the insurance companies themselves, having a large percentage of new policy purchasers not make their payment until the last possible moment is standard for the industry as a whole, and has been for a very long time.
Right after last night's South Dakota update we have their sister state to the North. ND was at just 265 private enrollments as of 11/30, so this represents a four-fold increase as of January 7. I've subtracted 800 from the "unspecified" pool at the bottom of the spreadsheet to compensate.
Meanwhile, their Medicaid expansion has gone from 1,001 up to around 1,700.
As of the first week of January, when coverage started through plans under the Affordable Care Act, 977 members had signed up with Blue Cross Blue Shield of North Dakota, the state’s dominant insurer.
The Sanford Health Plan enrolled 92 in North Dakota through the new marketplace exchange.
By contrast, enrollment in North Dakota under expanded Medicaid eligibility stands at about 1,700 in the first week of January....
In North Dakota, estimates of new Medicaid enrollees under the expanded eligibility have ranged from an increase of 20,000 to 32,000.
A 42% increase from South Dakota since 12/23 is pretty good by itself. However, this number only covers 2 of the 3 insurance companies participating in the exchange. I have no idea what sort of market share the 3rd company has in SD, so I can't speculate as to how many more enrollments they have to add to the total.
I've also subtracted a the corresponding 1,000 difference from the "unspecified" Federal pool at the bottom of the spreadsheet to compensate.
As of Jan. 1, about 3,550 people in South Dakota had signed up through the federal marketplace website from Avera and Sanford, with about 2,700 from Avera and about 850 from Sanford. DakotaCare figures weren’t available.
Who would have thought that it would be Idaho, of all states, that would mark the first significant milestone since hitting the 2.1 million mark a around Christmas? In any event, the spokeswoman for Your Health Idaho announced that ID has shot up from just 1,730 private enrollments at the end of November to a whopping 20,000 people "in time for January 1st". Since the final January deadline for Federal exchange states was Christmas Eve, I assume this means that an additional 18,270 people enrolled from 12/01 - 12/24, increasing Idaho's total 11-fold.
Of course, most of those 18K new people will probably have to be taken out of the HHS's non-specific "1 million" enrollments which haven't been officially broken out by state, but even after doing so, the total number of private enrollments now still sits at just over the 2.2 million mark.
At the same time, since Idaho's CBO projection for 3/31/14 was only 40,000 people to begin with, this means that just like that, they've jumped up to 50% of their target.
Maryland added another 2,093 people to the private exhange rolls from 12/28 - 01/04, a 11% increase. The Medicaid situation is a bit more confusing: Actual enrollments increased from 19,578 to 26,500 (a 35% increase), but the prior week's tally had it at 43,065. It turns out that about 20,000 or so of the Medicaid applications need to be double-checked for duplicates, so they can't be counted yet, making it look like a huge drop by comparison. Sorry about that, folks.
As of Jan. 4, just over 20,350 people had enrolled in private insurance plans on the Maryland health exchange, up 2,100 from the week before, according to a weekly report by exchange officials. The pace of enrollment slowed from recent weeks.
...About 26,500 people had enrolled through the exchange in Medicaid, the federal-state health program for the poor, according to the latest numbers, up some 7,000 from the previous week. Tens of thousands more have been found eligible, but officials say many might be duplicate applications.
"Churning" describes the process by which an estimated nine million people move off Medicaid every year when their income increases, perhaps because of a seasonal job, and then move back when their income drops. Usually, people churning out of Medicaid have remained without health care coverage until they re-enroll again.
Now, because of the Affordable Care Act, people who leave a Medicaid managed care plan may temporarily qualify for subsidized insurance through the exchanges, but they may experience gaps in coverage or have to change health plans or doctors as they move back and forth. The director of the National Association of Medicaid Directors, quoted in a Kaiser Health News article, explains the challenge:
Well, that just figures. Right after I post a screed whining about the lack of big numbers since New Year's--in which I specifically call out the DC Health Link for not releasing any data since mid-November--what happens? Whammo: Private enrollments have skyrocketed from 1,115 on Nov. 15 to 15,613, a whopping 14x increase. They also released the first Medicaid expansion figure at all, since neither the HHS nor anyone else has had a number for that since the exchanges lauched on October 1st: 4,677 people.
Amusingly, it looks like the majority of enrollments (up to 10,000 of the 12,000 small business enrollments) were from Congressional staffers who were, ironically, required to do so due to a clause insisted upon by Congressional Republicans.
The top line talking point: More than 20,000 people have secured medical coverage.
But nearly 60 percent, or 11,967, enrolled through the small business side of the exchange, which is designed for companies with fewer than 50 workers but also — via the Republican amendment and Obama administration rules — Congress.
After the massive spike in enrollments seen in mid- to late December, regular site visitors might be a bit disappointed at the relative dearth of increases since New Year's. There have actually been quite a few updates, including several impressive percentage increases, but the actual numbers involved have been relatively small compared to the massive jumps seen just a few weeks ago. In short, you're probably wondering why the total number of private enrollments which shot up to 2.1 million in late December only seems to have gone up about 80,000 more since then.
There are three reasons for this:
First, obviously there was a tremendous sense of urgency for people to enroll in time for January 1st coverage. A drop-off after Christmas has long been expected, although this has been a bit fuzzy as the actual enrollment deadline bounced around, from 12/15 to 12/23, then 12/24 (for most states), then 12/27 or 12/31 for a handful, and finally as late as 01/06/14 for Oregon.
Ironically, even though the article itself is primarily about Medicaid expansion in Nevada (from a newspaper in Georgia), I can't actually use the Medicaid numbers provided since they're fuzzy. It does, however, give slightly higher numbers for private enrollments in NV.
It also mentions 23,000 dental plans, which I'm not even covering. In other news, the spreadsheet includes minor corrections to both Colorado (private enrollment typo had it off by 10) and Minnesota (I had MN down as 26,001 based on "just over 26,000", this article specifies it as being exactly 26,011...or an increase of 10, although that also means decreasing the MN Medicaid number by 10 as well).
Another report presented later Thursday to the board overseeing Nevada's insurance exchange shows 17,946 people who shopped for private insurance through the online portal have confirmed plan selections. Of those, 10,776 have paid the premiums. About 23,000 have chosen stand-alone dental coverage.
It looks like the exchanges are starting to become more sensitive to the distinction between paid and unpaid enrollments; Delaware is the 5th state exchange to start separating these numbers out (or perhaps the media is just starting to do so based on the numbers released). In any event, depending on how you look at it, Delaware's private enrollments have gone up either 44% or 400% since the 793 enrolled as of December 12, and Medicaid enrollees have gone up 3.7x the 1,822 that it stood at as of 11/30.
Delaware officials reported Thursday that 1,145 people have enrolled in the state’s new health insurance exchange and paid their first premiums under the federal health care reform law.
The 1,145 paid enrollees are among 3,183 people who, as of Jan. 3, had chosen one of the health care plans offered on the exchange, suggesting that most of those who have chosen plans have not yet paid for coverage.
CGI, which has been responsible for development, failed to deliver a working website. Worse than that: after three months, there is still no indication that CGI has the competency required to fix the website.
We’re seeing many types of outreach efforts to reach the uninsured. Navigators are doing their utmost (at least in states where their work is not being obstructed), and many church groups are addressing their congregations. Nevada has mounted a concerted door-to-door effort. Here are the results, as reported by Allison Bell.
Exchange managers want the canvassers to reach 450,800 people who seem likely to need individual or family health insurance. Mi Familia Vota says it made 53,052 total attempts from Nov. 1 through Dec. 31. The organization’s workers talked to people in 7,935 homes, or 18 percent of the homes in the target area, and generated 661 enrollment appointment leads. The canvassers found 8,377 households were inaccessible, and no one was home in 33,875. In 5,596, the residents already had health coverage. In 806 of the homes, residents refused to talk to the canvassers.
About half of those who applied for coverage effective Jan 1 were turned away because their applications were not fully filled out, state officials have said. Instead, they'll be processed for insurance effective Feb. 1.
If Oracle had delivered a working website to Cover Oregon, then online applicants would immediately have received feedback that they needed to fill in more information. Clearly this is an added source of frustration for Oregonians who had every reason to think that their paper application was complete and in order.
On the other hand, this speaks to a huge potential. If Cover Oregon can assist those 20,000 applicants quickly, that alone should double the state’s enrollment numbers! Who knows – with dedication and luck, Cover Oregon might well achieve that before the end of January.
No new private enrollment numbers, but Rhode Island's Medicaid expansion jumped from 6,627 at the end of November to 19,941 as of yesterday. For some reason the article claims a "quadrupling" from 5,280, but the official HHS number for 11/30 is 6,627, so I'm not sure what that's about (they also claim the quadrupling was "in December" even though the same number shows up as being "through Wednesday" which was January 8th).
In any event, a nice Medicaid bump (or a horrific one, depending on your POV) for Rhode Island.
The number of Medicaid enrollments through HealthSource RI totaled 19,941 as of Wednesday, with an additional 1,500 sign-ups pending, David Burnett, chief of government and public affairs at the R.I. Executive Office of Health & Human Services, revealed Wednesday in response to a request from WPRI.com.
The number of Medicaid sign-ups on HealthSource RI roughly quadrupled in December, jumping from 5,280 to 19,941, amid a drumbeat of publicity about deadlines to get coverage under President Obama's new health law.
The prior MA update was extremely confusing; this one is more straightforward but is still pretty fuzzy. As far as I can tell, Massachusetts increased their private enrollments by 24% from Dec. 30 to Jan. 7...but that only brings them up from 3,759 to 4,676. There's another 22,000 or so enrollments in semi-limbo which appear to be approved but not fully processed due to the technical problems they continue to have.
The Republican/MassLive.com previously reported that as of Dec. 30, only 497 people were enrolled in permanent subsidized health insurance plans. The state was providing temporary insurance for another 22,000 new enrollees while it worked to process their applications. The state had extended coverage for existing customers of its Commonwealth Care plans through March 31.
Lefferts said that as of Jan. 7, 4,676 people enrolled in both subsidized and unsubsidized plans through the Health Connector, up from 3,759 as of Dec. 30. He did not have a breakdown of how many of those were subsidized. Individuals whose plans are not subsidized have until Friday to pay their premiums, so that number is likely to tick up.
Pretty slim pickings here on the private enrollment front (up just 141 assuming "slightly more than 26K" = 26,001), but the Medicaid number is up 9.6% to 45,981.
Despite MNsure's problems, so far 71,982 people have signed up for insurance coverage through the exchange. According to newly released demographic details, 53 percent are women and the median age is 48. The largest number signed up for mid-level "silver" plans — about 35 percent of total enrollees. Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans.
Some interesting numbers out of Washington State. While private enrollments are only up 6% over 12/23 (143,383 vs. 135,078; the % paid as of 01/02 has increased from 48% to 52%), the Medicaid numbers are quite different, due to changes in how they're being reported.
Previously, "Newly Eligible" and "Previously Eligible" were lumped in together with "Redeterminations" (ie, people who were already on Medicaid prior to ACA expansion and are simply renewing their accounts). However, WA is the only state (so far) to list "redeterminations" separately, so I've left those out this week. With all the concern and confusion about how many ACA enrollees are "new" to having healthcare coverage, this seems like a wise move. Of course, this also means that the Medicaid total is actually somewhat lower than I had it previously, even with the additional new enrollees since 12/23.
As a result, the total Medicaid number for WA is now 177,065 vs. the previous 194,398, a "drop" of 17,333. The new number is lower, but more accurate reflection of the actual impact of the ACA on Medicaid...in 1 state. Hopefully other states (and the HHS) will start separating out "redeterminations" going forward as well, if possible.
The problems with the Obama Administration’s rollout of HealthCare.gov are reminiscent of the troubled rollout of the Medicare Part D expansion under President George W. Bush. In a candid interview with Kaiser Health News, former Health and Human Services Secretary Michael O. Leavitt offers telling details of their technical problems – and the Bush Administration’s solution.
…people were walking up to the pharmacy counter to get their drugs and their name wasn’t in the computer. Ultimately, we had to say, ‘give them their drugs, and we’ll work it out later.’ Then we spent 15 or 18 months working it out later. It was an expensive proposition and less than ideal. But it allowed the limited number of people who were having problems with the system to have their human needs met.”
By contrast, the Obama Administration has spent just over three months working out glitches of HealthCare.gov, which was launched on October 1st, 2013. Perhaps after 15–18 months have passed, we can do a more complete comparison with President George W. Bush’s rollout of Medicare Part D?
We have our 3rd Oregon update this week today; they're now up to 20,000 private enrollments as of Monday, plus another 35,000 Medicaid expansion additions. Add this to the 114,500 automatic enrollments via the Oregon Health Authority, and that brings their total Medicaid tally to 149,500.
In total, about 170,000 people have new health insurance beginning this month under new funding and rules of the Affordable Care Act. A majority of them are Oregon Health Plan enrollees, a program for low-income residents...
Monday was the last day for Oregonians to finalize their commercial plan selections on Cover Oregon. Of the 55,000, about 20,000 new enrollees purchased private plans. About 35,000 enrolled in Oregon Health Plan through Cover Oregon, and the majority of the new OHP enrollees signed up directly through Oregon Health Authority.
The Nevada ACA exchange, which apparently only uses Twitter for press releases, just announced that private enrollments have gone up from 12,745 as of 12/23 to 17,673 as of January 4th, a 38% increase.
They're also one of only 3 states to specify paid vs. unpaid status so far; they've gone from 49% paid as of 12/23 to 60% paid (10,647) as of 1/4.
Update as of 1/4: 915,977 unique individuals visited Nevada Health Link. 17,673 consumers confirmed QHP selections, 10,547 have paid.
The final December tally for Rhode Island is in, and also gives a clearer picture of the "But how many have PAID???" talking point. As of New Year's Eve, 11,305 people had enrolled in a plan, of which 2,300 still hadn't paid as of 2 days ago. That means that at least 80% of RI private exchange enrollees are paid in full. No new Medicaid numbers in the article.
Depending on your POV, this also means that Rhode Island has also now hit either 94% (if you're counting unpaid enrollments) or 75% (if you're not) of their 12,000 CBO projection for 3/31/14. See this story for additional discussion.
Monday night, HealthSource RI, the Obamacare marketplace in Rhode Island, sent emails to 2,300 people who had not paid as of Jan. 5 to tell them they had until 4 p.m. on Jan. 8 to pay the first month's premium, and their plans will still be effective retroactive to Jan. 1.
HealthSource RI reported Monday that 11,305 people selected plans as of the Dec. 31 deadline, but not all had paid.
Yesterday, Theda Skocpol of Harvard University cited the data at this site in a brief about state progress in implenting the Affordable Care Act posted at the Scholars Strategy Network website. This brief--particularly the accompanying visual graph--was in turn cited in articles posted at both Talking Points Memo and Mother Jones. The gist of both the brief as well as these articles is that the states which have been cooperating with the ACA have been far more successful in enrolling people in both private insurance plans as well as publicly-funded plans such as Medicaid, SCHIP and related state-run programs.
It is well known, and highly embarrassing, that Oregon has yet to enroll a single person in a new insurance plan online. Since the 1st of October, Cover Oregon has had to do it all by hand, based on paper applications.
That, of course stands in stark contrast to today’s situation. In the course of three months, Cover Oregon has managed to enroll just 18,000 people in private insurance plans – and towering piles of applications are still awaiting the attention of their stressed case workers.
Connecticut, the first state to exceed their March 31 enrollment deadline back on December 23rd, continues to keep their momentum up, adding at least another 12,000 people to their rolls since the 12/23 deadline for January coverage. The article doesn't distinguish between private plans and Medicaid expansion, so I've broken it out roughtly 55/45 for now to match their previous numbers.
This brings CT up to nearly 41,000 private enrollments and over 33,000 added to Medicaid/CHIP.
Many state residents are aware that enrollment is still open, as Counihan said enrollment through Access Health CT has remained strong over the past week or so.
"We're still doing a thousand a day," Counihan said. "I would have thought that, after Dec. 23, things would have really dipped."
For California, we presently have data through the December 23rd. However, at the last minute, California extended its deadline to 12/27. This means that we are still waiting for four days of enrollment data! Keep in mind that just prior to the deadline, California was seeing 20,000 private plan enrollments daily.
It that rate continued unabated, we could be looking at as much as 80,000 signups beyond the 428,000 already registered. During the three days December 20–22nd more than 77,000 Californians enrolled in private plans. Granted, this is speculation – we won’t know until Covered California releases its figures.
The Vermont numbers have been alternately impressive and confusing at the same time. The wording of a prior article from 12/12 made it sound like the 45,000 (at the time) people were split between private enrollments and Medicaid expansion, but also made reference to 29,200 people being enrolled "directly via their employer". At the time, I wasn't sure what to do with that number, so I ignored it. However, the more recent article again references the same 29,200 people; after comparing the 2 articles, it seems pretty clear to me that these would fall under the category of "direct" or "off-exchange" enrollees (although they also might fit under "small business exchange enrollments", which is a category I haven't even added yet). Add this to the 22,800 private exchange enrollments and you have 52K total.
In a December 23rd interview with the Des Moines Register, CoOportunity Health (1 of 2 companies participating in IA's ACA exchange (and 1 of 3 participating in NE) said they had enrolled 2,577 people in private plans in Iowa via the HC.gov exchange as of 12/20. However, they also mentioned a total of 8,583 enrollments state-wide as of 12/20, meaning another 6,006 people were enrolled directly through the company, bypassing the exchange completely.
I contacted Leigh McGivern, the PR representative for CoOportunity Health, who informed me that CoOportunity operates in Nebraska as well, and gave me more recent and detailed numbers for both states: 3,468 exchange-based enrollments (not sure if this is people or households) in Iowa, and another 7,362 exchange-based enrollments in Nebraska.
(Note: The spreadsheet numbers for IA & NE were actually updated with this data a couple of weeks ago, but it took me this long to get around to writing up the explanation)
In a December 23rd interview with the Des Moines Register, CoOportunity Health (1 of 2 companies participating in IA's ACA exchange (and 1 of 3 participating in NE) said they had enrolled 2,577 people in private plans via the HC.gov exchange as of 12/20. However, they also mentioned a total of 8,583 enrollments state-wide as of 12/20, meaning another 6,006 people were enrolled directly through the company, bypassing the exchange completely.
I contacted Leigh McGivern, the PR representative for CoOportunity Health, who informed me that CoOportunity operates in Nebraska as well, and gave me more recent and detailed numbers for both states: 3,468 exchange-based enrollments (not sure if this is people or households) in Iowa, and another 7,362 exchange-based enrollments in Nebraska.
One key question that I ask myself is this: For which states are we still waiting for data that may change the number of insured as of January 1st 2014? And how much of a change is possible? The various states offered different extensions. From the spreadsheet, we see that the California data is current only through 12/23. Likewise Washington, Connecticut and Nevada. We can also expect to see a significant movement in Vermont (current data is only through 12/11 plus one additional day).
Given this, I will be very surprised if we don’t add at least another 100,000 enrollments to the total, surpassing 2.25 million private plan signups.
Fourteen states and the District of Columbia have been operating their own exchanges, with varying degrees of success. At the end of 2013, the best 12 of these account for more than 950,000 enrollments in private insurance plans. In the table, the states are rated by performance, as measured by fulfillment of their enrollment targets.
One more update in Oregon, and it's a substantial one despite their severe technical issues: The Oregonian reports a 22% increase in state signups , from the previous totals of 14,700 private and 32,000 Medicaid enrollments. Journalist Nick Budnick, who has written numerous articles on the Oregon health exchange’s non-functioning website, also confirms the correctness of the additional Medicaid figure.
The final tally on enrollment through Oregon's health exchange by Jan. 1 topped 50,000, according to Cover Oregon. More than 18,000 people enrolled in commercial or private insurance, according to Cover Oregon spokesman Michael Cox, while more than 32,000 people enrolled in the Medicaid-funded Oregon Health Plan.
...The exchange's enrollment figure does not include more than 100,000 people who were enrolled in the Oregon Health Plan using a streamlined process set up by the state to bypass Cover Oregon.
It was just brought to my attention that there's a story in today's L.A. Times that mentions my name and this site several times. Given that the site has received quite an uptick in traffic and attention the past week or so, I just wanted to welcome new visitors, ask you to please read the FAQ and also stress a few additional points:
No, I don't guarantee that my numbers are accurate. I'm fairly confident of them, but my data is only as good as that of my sources, which are a variety of local & national news media websites as well as official state & federal government reports/media releases. If their data is wrong, mine will be as well, though I do the best I can to double-check any numbers which seem suspicious.
A few of the spreadsheet cells are color-coded; scroll to the bottom of the page for explanations of those.
Other numbers are italicized; those are either verified as being unpaid or are otherwise questionable (Massachusetts has a pretty messed-up situation at the moment).
Numbers that don't have any source link mean that they come from the official monthly HHS Dept. report (whcih currently only runs through 11/30/13).
At the right side of the spreadsheet is a "Notes" column; I'm currently in the process of changing this to direct links to the corresponding blog entries about that state. This will help simplify the spreadsheet as well as allowing me to go into detailed explanations for the entries.
Massachusetts is a mess. I've been debating how to handle this; for private enrollments, it looks like I need to combine 497 subsidized, 3,262 unsubsidized (the previous number) and 22K temporary plans, which are apparently qualified/approved but haven't been processed yet. This adds up to 25,759 total, but the article refers to a lower number of 24,256. Given the confusion, I'm using that as the total and listing it below the other number in italics, which I normally use for "unpaid" enrollments. This brings the new tally to 3,759 fully enrolled and 20,497 "semi-enrolled"...I think.
The Medicaid number is more straightforward: 130K transferred automatically from a state-run public health program over to Medicaid proper.
As of Dec. 30, only 497 people had successfully enrolled in new subsidized health plans throughMassachusetts' health connector.
State officials have put another 22,000 people on temporary insurance plans, paid for by the state, while the connector processes coverage applications.
After last week's confusing numbers, Minnesota is back on track with private exchange enrollments increasing by 6,440 over a week earlier, or 33%. Enrollment in MinnesotaCare and Medical Assistance went up to 15,997 and 25,948 respectively.
MNsure got through the first round of customer sign-ups, which had a Dec. 31 deadline. On Friday the agency reported that 67,805 Minnesotans had used the site to enroll in a health plan by year’s end. Some 25,860 consumers bought an individual plan on the commercial market, with the rest eligible for one of the publicly subsidized programs.MNsure said that 14,600 people signed up in the last four days of December, a last-minute burst that Leitz described as “an encouraging sign.”
Kentucky's enrollment continues to quietly but steadily increase, with private exchange enrollments up 5% over Christmas Eve (from 31,672 to 33,289) and Medicaid expansion up 7% (from 84,480 to 90,254). Ironically, for all the praise they receive for their exchange running so smoothly, KY is actually still only at about 15% of their CBO goal, mainly because it was set absurdly high in the first place (220,000, or slightly higher than New York which has a population 4.5x as large).
Maryland's latest tally has just been released. They went from 11,715 private enrollments on 12/21 to 18,257 as of 12/28, a whopping 55% increase in the final enrollment week. They also added another 13,000 people to Medicaid either via the exchange or transfers from the MD Primary Adult Care program.
Through December 28, 18,257 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
91,570 Marylanders signed up through the Primary Adult Care (PAC) program to be automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. Separately, through December 28, 43,065 Marylanders have been found eligible for a Medicaid program through Maryland Health Connection. As of January 1, 19,578 of those individuals were enrolled in Medicaid, and we expect many more of those found eligible to be enrolled in the coming weeks, with coverage retroactive to January 1.
There's no specific breakdown given between private and public accounts, but the previous numbers were 14K and 24K, so I'm assuming the extra 2,000 are broken out in a similar 37/63 ratio. The article also reaffirms the 100,000 enrollments in the publicly-funded Oregon Health Plan.
The website still has not enrolled anyone, though roughly 40,000 have enrolled using the exchange's paper applications, and more than 100,000 have enrolled in the Oregon Health Plan using a system set up by the state in August to bypass the exchange.
It looks like my previous source for Colorado's Medicaid Expansion tally (114,192) was mistaking applications for actual enrollments. This number has been reduced by 27,760 as of 12/31/13.
In addition, in a previous entry I mentioned a study by the Commonwealth Fund from earlier this year which claimed that the correct number of "Under 26'ers" on their parent's plans thanks to the ACA is actually closer to 7.8 million instead of the 3.1 million figure that I've been using. However, I've been reluctant to switch to that figure since a) it's much larger and b) the HHS itself is only using the 3.1 million number. Today I found out why this is the case; contributor jdld provided a link to this report on the HHS website which states:
Colorado has increased their private total enrollment from 42,771 on Christmas Eve to 52,773 as of New Year's Eve.
Not too much to add here. This is significant not just because of the hard number, which is impressive and pushes CO ahead of their CBO enrollment schedule (92K by 3/31/14; they're 57% of the way there while the period is only 50.5% over), but because of the implication--the state extended their January enrollment deadline to 12/27, and managed to increase their tally by more than 23% in that last week. If this trend held true for other late-enrollment states, it could mean some nice last-minute mini-spikes.
On Christmas Day I posted "New ACA Attack: "But how many have actually PAID???" in which I pointed out that unless there prove to be significant technical issues preventing large numbers of premium payments from going through, this is pretty weak tea in terms of being an anti-ACA talking point...or at least it won't have any teeth to speak of until after January 10th, the date which most insurance companies have agreed to extend their January payment deadlines out to.
However, in the interest of completeness, I did point out that in at least one case (Washington State), the enrollment numbers are indeed broken out between paid and unpaid; specifically, 65,000 out of 134,000 total enrollments had been paid, or 48.5%. The next day, Nevada's numbers came out and once again, 49% (6,219 out of 12,740) were paid. So the short answer I gave at the time was "almost half of enrollees have paid."
In 2012, more than 50 million Americans lacked any form of health insurance. The Affordable Care Act was enacted into law in order to reduce that number. This website aims to give an accurate picture of how much.
In April this year, after the six-month open enrollment period has ended, it will be interesting to examine the statistics. Foremost among those numbers, in the minds of political pundits, will be how many Americans enrolled in private health plans? We will then know whether we reached, surpassed or fell short of the 7,066,000 enrollments projected by the Congressional Budget Office – long since elevated to a “target” rather than the projection it was.
How many more people are insured?
As we start this new year, at least 2.1 million people will be covered by new private plans, roughly 30 % of CBO’s first-year projection. However, this is by no means the only key figure. More than 4 million people are embraced by the Medicaid expansion. In addition, an estimated 3.1 young adults are now insured though their parents’ health plans. That adds up to 9.2 million people, which is a respectable start and should significantly reduce the number of uninsured. However, it must be underscored that many complex factors make it impossible to quantify that reduction, at least for the time being.
On top of that are an unknown number of people who have purchased ACA-compliant insurance plan off-exchange, i.e. directly from the insurance company. There are strong indications that total is significant – and we’ll return to that issue.
Mississippi:Private up to 2,000 from 802(h/t Steve Mullinax, aka rsmpdx)
Transcript from Jeffrey Hess of Mississippi Public Radio, NPR Audio:
Only two insurance companies are offering plans in Mississippi, and they only overlap in four of the state’s 82 counties. However, those two companies appear to be betting that the web site problems and skepticism about the exchange in general are passing. One of the two companies, Humana, launched a late-December ad campaign to drive more people to the site, says spokesman Mitch Lubitz. “There’s been a ramp-up as the HealthCare.gov web site has gotten easier to use and there have been other options for people to go on and get information and enroll.” Mississipi’s Insurance Commissioner Mike Chaney says the improvements to the enrollment process are good, but he’s still skeptical they’ll be able to get enough people signed up this year. “From zero to ten, I’d give it a confidence level of about a three.” Hess: “That’s still not very good.” Chaney: “That’s not, but it’s better than where I was, a one, a week before last. “Chaney says the unofficial count is around two thousand people enrolled, but he says if the confidence trend continues upward, his confidence will rise to a five.”
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I have a dozen or so submitted updates to check into, so hopefully I'll have a lot to add tomorrow, but otherwise I'm spending a quiet New Year's Day curled up in front of James & the Giant Peach and Hugo with my family.