START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

April 2014

  • A nice little final-day wrap-up report out of Alaska: 13K on the exchange and another 2,700 off-exchange QHPs. Premera is part of BCBSA, so I can't double-count their off-exchange number, but Moda Health isn't:

    About 13,000 Alaskans signed up for health insurance on healthcare.gov during the open enrollment period that closed March 31st. The two insurers offering plans on the exchange in Alaska shared their enrollment figures today with APRN. Moda Health says it has about 7700 healthcare.gov enrollees in Alaska and the company is still processing some additional sign ups.

    Premera Alaska enrolled 5300 people on the exchange. Before the troubled launch of healthcare.gov, the company had hoped for more customers. But Premera spokesperson Melanie Coon is satisfied with the numbers:

    “I think we readjusted our expectations. We’re very pleased with how enrollment went, based on the slow start to the exchange and… the last minute changes that were made where people could extend.”

  • An hour or so ago, the Republican Staff of the Committee on Energy & Commerce Republican, chaired by Republican Representative Fred Upton, issued a press release which claims that:

    April 15, 2014, only 67 percent of individuals and families that had selected a health plan in the federally facilitated marketplace had paid their first month’s premium and therefore completed the enrollment process. 

    OK, let's unpeel this onion slowly, shall we?

    First of all, the press release makes it very clear that the enrollment data which they're talking about includes all enrollments on the Federal exchange through April 15. Note the following wording (emphasis mine):

  • Rhode Island's ACA Medicaid expansion was at around 65K a couple of weeks ago, so this is a nice small bump:

    Through April 19, 70,243 people had signed up for Medicaid under the Affordable Care Act rollout, according to state figures, with federal dollars paying for about two-thirds of those people and state and federal dollars roughly splitting the cost for the other third, because they were already eligible before Obamacare entered the picture.

  • There may be a few thousand more enrollments to come from Nevada, Colorado and so forth, but today, April 30, is about as definitive a date as we're gonna get for the wrap-up of the first Open Enrollment period under the Patient Protection and Affordable Care Act of 2010, otherwise known as the ACA or Obamacare.

    With that in mind, the time has come for me to officially declare my intentions for this website going forward.

  • My Medicaid spreadsheet currently estimates Illinois at roughly 200K "strict expansion" and another 115K "woodworkers". This article suggests that the woodworker number may be too high, but the "strict expansion" number may be dramatically low:

    For the first time, low-income adults without children are eligible for government health coverage.

     In Illinois, officials expect that'll mean 350,000 new people in Medicaid. And that's not all.

     Julie Hamos, director of the Department of Health Care and Family Services, says the news reports and advertising and community outreach around the Obamacare deadline led to a separate spike.

     "We have 80,000 more than the usual enrollment of people who already were eligible, they just didn't sign up. But because of that activity in the communities, now they're signing up."

  • One More final update from Minnesota...

    Enrollment update, as of end of day on Tuesday, April 29:

    • 206,157 Total Enrollments
    • 112,834 Medical Assistance
    • 50,549 QHP
    • 42,774 Minnesota Care

     

    SHOP: 731 * 1.8 = 1,316

  • The first article is mainly a breakdown of off-exchange QHP enrollments across various Blue Cross companies; normally this would be something of a jackpot for me, but since the BCBSA had already stated that they had over 1.7 million off-exchange enrollments not including March or April, these numbers don't really help out much. What I really need at this point are state-by-state off-exchange QHP numbers (ideally through at least the end of March), and I don't see those coming anytime soon.

    HOWEVER, the article does also give an updated overview of where the "But how many have PAID???" situation stands...or at least, where it stood as of February 1st:

    According to the Blue Cross and Blue Shield Association, between 80% and 85% of people who signed up for a Blues plan through a public exchange are paying their premiums. The percentage is based on a survey of member Blues plans as of Feb. 1. But individual Blues plans say that number is higher.

  • Hawaii's original CMS target was a piddly 9,000 exchange QHPs...believe it or not, they may just barely squeak over that line after all (although my own target for HI was 11,000, which they're almost certainly not gonna pull off...)

    Total through April 26, 2014:

    31,310 Applications completed in the Individual Marketplace
    8,742 Individuals and families enrolled in the Individual Marketplace
    576 Employers applied to SHOP Marketplace
    628 Employees and dependents enrolled via SHOP Marketplace

  • Yes, yes, I know...the "official" open enrollment period "ended" on March 31st, and the "official" extension period ended on April 15th. However, there were a few exceptions to even that, including:

    • The 36 states run by HC.gov: If you submitted a paper application by 4/07, you have until today to complete your enrollment
    • Hawaii, DC and Oregon pushed out their official extension date until today
    • Other states such as CA, CO, CT, KY, MD, MA, MN, NY, RI, VT and WA have already shut down open enrollment, either on 3/31, 4/15 or 4/22

    To my knowledge, after midnight tonight, that leaves only three states with any sort of options left:

    • Nevada has bumped their "started by 3/31" enrollment extension out until May 30.
    • Colorado is allowing people up until May 31st to complete their enrollments, but only if they applied for Medicaid but had their eligibility denied.
    • Massachusetts still has something like 270,000 people stuck in "Limbo Status" who may (?) have until June 30th to have their situations sorted out...not exactly sure what's going on with that, however.

    Aside from that, the following exceptions hold true for every state:

  • Wow! I just updated this yesterday, but that number was from last week...(again, 36.3K of these were bulk-transfers already accounted for):

    Healthy Michigan Plan Enrollment Statistics

    Total Healthy Michigan Plan Beneficiaries: 158,654

    *Statistics as of April 28, 2014 
    *Updated every Monday at 3 p.m.

  • guest post by Esther Ferington

    Recently, I've been puzzling over a question: what is all this "deadline creep" really telling us? Not just about the considerable burden it's placed on Charles Gaba in continuing this website, which is obviously no joke—but also about what's happening as the ACA rolls out. We've been watching deadline creep for at least a month now. And I think it's kind of a big deal.

  • Holy Cats. For a solidly Republican state which didn't expand Medicaid, Idaho has actually kicked some serious ass when it comes to ACA enrollments (then again, they're also one of only two states--New Mexico is the other one--which are planning on moving from HC.gov to their own state-run exchange next year, so perhaps it's not as surprising as all that). In any event, bravo to Idaho!

    Dowd says the Congressional Budget Office wanted to have 40,000 Idahoans sign up through the exchange during the first six-month open-enrollment period. Your Health Idaho exceeded that target by more than 36,000 people.

    ...She doesn’t know how many of the 76,061 sign ups actually paid for their policies. She also doesn’t know how many of Idaho’s roughly 300,000 uninsured people signed up for a plan. She says finding out how many uninsured people sign up for coverage is a priority for Idaho and will be a question on the state’s portal during the next sign up period.

  • In addition to several states bumping their enrollment deadlines out until 4/30, and Nevada going even further by bumping theirs out to the end of May, Native Americans / SHOP / Medicaid not having any enrollment deadline at all and of course the "Qualifying Life Events" factor (marriages, divorces, births, adoptions, etc), it turns out there's Yet Another Group which has been given an extention by when they have to enroll in a QHP or Medicaid plan: Those in the ACA's temporary "High-Risk Pool", who were originally supposed to have enrolled by the end of 2013, then the end of April; they've now been given until the end of June to do so:

    On Thursday, the Obama administration announced another special enrollment period to extend enrollment in the Affordable Care Act's insurance exchanges, this time for people enrolled in the Pre-Existing Condition Insurance Plan, The Hill's "Healthwatch" reports (Viebeck, "Healthwatch," The Hill, 4/24).

  • I know, I really shouldn't give an outfit like this the time of day much less any more exposure than they already have, but I can't help myself. There's an anti-ACA blog called "Uncover Obamacare" (not to be confused with "UnskewObamacare.com") which has "dug up" what they seem to feel is a real "James O'Keefe"-style "hidden camera" moment in the bowels of the Connect for Health Colorado administrative office:

    Patty Fontneau, the Colorado Healthcare Exchange CEO, spoke at a hearing of a Colorado Legislative Review Committee yesterday, discussing the critical need to get young people to sign up for their state ObamaCare exchange. This is a problem that the White House and other states are facing as well. To make the math work for ObamaCare, young healthy people have to sign up to help pay for the old sick people. That’s been a tough challenge so far.

    But don’t worry, Ms. Fontneau has a plan! A creepy, creepy plan: “The Three Ps.” Those three Ps are peer pressure, parental pressure and increased penalties. Because, that sounds like a good idea.

  • Remember all the fuss and bother that the GOP made about how no one would sign up for healthcare under the ACA for various reasons, ranging from the technical problems with the HC.gov website to the law making it "too easy" to get out of doing so (while simultaneously screaming about the mandate itself being "unconstitutional" even though the Supreme Court ruled that it isn't)?

    Well, the former has obviously not been an issue from the enrollment side for months (at least on the Federal side).

    As for the latter, guess what?

    The government left the door wide open for millions of Americans to be excused from the Affordable Care Act’s requirement that most people must carry health insurance or pay a fine, but so far relatively few have asked for such a pardon.

    About 77,000 families and individuals have requested exemptions from the health-care law’s so-called individual mandate, according to internal government documents obtained by The Washington Post. As of April 20, officials had approved tens of thousands of exemption requests and rejected none.

  • Impressive numbers from New Mexico during the extension period:

    Nearly 35,000 New Mexicans had enrolled in health plans through the state and federal insurance exchanges as of April 15, a 32 percent increase from the end of March, the New Mexico Health Insurance Exchange said Friday.

    As of March 31, 24,412 residents had enrolled through the exchanges, and as of April 15, that number had climbed to 34,966, as 8,554 residents took advantage of the extended enrollment period, NMHIX said.

  • Given Oregon's disasterous technical issues, their success in manually processing hundreds of thousands of enrollments is actually quite impressive. In addition, kudos to them for being one of the only sources for dental policies, which has barely been written about by anyone (including myself):

    Medical enrollments through Cover Oregon: 242,618
    Total private medical insurance enrollments through Cover Oregon 1: 70,192                   

    Oregon Health Plan enrollments through Cover Oregon: 172,426

    Dental enrollments: Total private dental insurance enrollments through CoverOregon 1: 14,232                   

    Net enrollments 
    Net private medical 2:  66,052
    Net private dental 2: 13,016

  • Minnesota wrapped up their own "extended-extension" period (they tacked on 1 more week onto the 4/15 extension, ending things on 4/22) with two nice milestones achieved: 50K exchange QHPs and 150K new Medicaid enrollees:

    Combined enrollment in public and private plans now stands at 200,174, MNsure officials said. That includes 50,096 in private plans; 41,403 in MinnesotaCare, a public program  for low to moderate incomes that requires a modest premium contribution; and 108,673 in Medical Assistance, Minnesota’s version of Medicaid.

  • Presented without comment:

    Oregon should pull the plug on the beleaguered Cover Oregon health insurance exchange and switch to the federal exchange, a technological advisory committee recommended Thursday.

    The move is considered almost certain to be adopted by the Cover Oregon board, which meets Friday.

    Changing to the federal exchange would cost about $5 million, while a partial fix to the Oregon exchange would cost more than $78 million based on an estimate from Deloitte, a Cover Oregon consultant.

    OK, I lied; I do have two comments:

    --First, residents of Oregon do still have 3 more days (today, tomorrow and Wednesday) to push their 2014 policy enrollments through the remnants of Cover Oregon, and I'm assuming that the current hobbled-together system will still be in place during the transition period for Qualifying Life Events, Medicaid enrollment and so forth.

  • I haven't updated the graph with this yet, but both the front page "quick stats" block and the spreadsheet now include my rough guesstimate for the final mop-up period from 4/16 - 4/30...I'm guessing an extra 93,000 or so people are being tacked on via stray paper applications, special cases and oddball "super-extension periods" in Nevada, Oregon, DC and Hawaii, etc.

    this should bring the grand total through the end of April up to around 8.14 million, of which I expect AT LEAST 7.5 million to have paid their premiums by late May.

  • Of the pile of submissions and requests which piled up last week, at least a half-dozen were basically the same question: Where the hell is the official March HHS report? Obviously that report from Inside Health Policy claiming that they'd release the report back on the 17th, complete with early April data, was flat-out wrong.

    The irony is, of course, that a) no one has been anticipating this report more than myself (it was supposed to mark the end of this project, after all...although obviously the situation has changed...more on that later); b) I was previously concerned that they'd release the report too early (cutting off the last 2 days of March and only including 3/02 - 3/29); and c) it's actually just as well that they didn't release it last week, since I was in no position to do anything with the data anyway (still on the mend, but I'm at least able to type up a few updates this morning, as you can tell).

  • "Healthy Michigan" is the plan which specifically refers to ACA expansion in MI only (36,307 of these are actually bulk-transfers from an existing program, already listed separately on the spreadsheet):

    Healthy Michigan Plan Enrollment Statistics

    Total Healthy Michigan Plan Beneficiaries: 139,774

    *Statistics as of April 21, 2014 

  • Washington State finally wraps things up with their final numbers, breaking 164K QHPs and keeping their Strict Expansion / Woodworker ratio to the same 2:1 ratio that it's been pretty much the entire enrolllment period:

    The state has previously reported that 147,000 people signed up for private health coverage, but said Wednesday that the total grew to 164,062 as officials finalized applications after the March 31 deadline. Open enrollment began last October.

    Updated enrollment numbers from Oct. 1 to March 31 are included below.

    Qualified Health Plans: 164,062

    Medicaid Newly Eligible Adults: 285,275

    Medicaid Previously Eligible but not Enrolled: 137,930

  • Not that the raw numbers add up to much, but the 603 total lives covered by SHOP policies is mildly interesting, since it was at only 269 as of 3/31:

    30,396 Applications completed in the Individual Marketplace
    8,592 Individuals and families enrolled in the Individual Marketplace
    568 Employers applied to SHOP Marketplace
    603 Employees and dependents enrolled via SHOP Marketplace

  • This article is interesting not so much because of how close I came to the actual situation in Idaho (I had ID woodworkers pegged at around 5,600; the actual number is more like 5K even), but because of how far off Idaho's own official prediction on "woodworkers" was--they were assuming more than 7x that number:

    But even without Idaho expanding its program, experts predicted a surge in Medicaid enrollment. A report prepared for the Idaho Department of Health and Welfare by Milliman Inc. predicted that more than 35,000 people would join Medicaid when they learned they already qualified for it. That was known as the "woodwork" group, for eligible people coming out of the woodwork.

    The report said the cost of new enrollment — aside from the expansion — would total about $14.8 million in this fiscal year, then rise to between $32 million and $45 million per year over the next decade. That's not quite what happened, at least in these early months, Shanahan said.

    "We just haven't seen the large increases we had expected," he said. Only about 35 percent — 5,000 people — of new Medicaid members are from the "woodwork" group, he said.

  • In Pennsylvania, the Medicaid "woodworker" effect has been specified as being roughly 18,000 people...which is actually higher than the 13,000+ that I had estimated for PA up until now:

    Pennsylvania’s Medicaid enrollment is up by more than 18,000 people since the Oct. 1 launch of the Affordable Care Act’s online health plan marketplaces.

    The state's enrollment bump in the program for low-income families and individuals is small, though it coincides with larger jumps being experienced in other Republican-led states. Supporters of the ACA are crediting the 2010 federal health care overhaul with encouraging more uninsured to examine their health coverage options. Subsequently they discover that they were already eligible for state-funded insurance programs.

    It’s called the “woodwork” effect — people who may have been eligible for Medicaid or related children’s programs all along only learned of their eligibility during the six-month push to sign Americans up for health insurance.

    In other words, they “came out of the woodwork.”

  • Nevada is one of the few states extending their open enrollment beyond the "standard" 4/15 deadline; residents have until 5/30 to complete their enrollments for 2014:

    Update as of 4/19: 45,291 Consumers have selected Qualified Health Plans, 32,365 have paid.

    — Nevada Health Link (@NVHealthLink) April 22, 2014

  • This AR update is noteworthy for being the first enrollment update I've received which actually includes a reference to...myself!

    Through yesterday, almost 45,000 Arkansans have selected plans on the Arkansas Health Insurance Marketplace, the new marketplace created by Obamacare, according to information released today by the Arkansas Insurance Department (see county  by county map above). Open enrollment is now closed, though people who submitted a paper application by April 7 have until the end of the month to enroll and pick a plan. We may also see this number creep up in the next few weeks as the carriers continue to receive data from the feds. 

  • This LA Times story from 4/21 is chock full of good news:

    First, apparently the ACA is such a "socialist, anti-capitalist" enemy of the free market that the private, for-profit insurance companies are just fleeing for the hills. Oh wait, actually...

    Peter Lee, executive director of Covered California, said all 11 current health plans have indicated they plan to return next year. He also said three new plans have submitted letters of intent indicating they may compete on the exchange in 2015.

  • Lots of people (especially myself) have been wondering just how many updates to enrollment data or other QHP/Medicaid/Exchange ACA-related news items there would be after the open enrollment "extension period" ended back on April 15th. After all, the dust should be settling with only the occasional bit of news now, right?

    Well, since I've been out of commission with the shingles all week, this has actually turned into the perfect opportunity to answer this exact question. Take a look at the backlog I'm going to have to work my way through as soon as I'm up to it (this is from just the past 5 days or so):

    Of course, some of these are duplicates and some may not really warrant their own full entry, but you get the picture. Seems like there's gonna be plenty of ACA news to keep this site operational for awhile yet.

    Speaking of which, I'll be addressing my official plans for the future of ACASignups.net sometime next week, as soon as I'm up to extended blog entries...

  • The article claims that these numbers are "through 3/31", but that's obviously an error, since a previous update directly from Kynect made it clear that the QHP number was several thousand lower than that as of early April. Doesn't really matter, however; these are still outstanding results for Kentucky:

    At a Capitol news conference Tuesday, the Democratic governor announced that 413,410 Kentuckians enrolled for health-care coverage through the online insurance marketplace called "Kynect" in its first open-enrollment period, from Oct. 1 through March 31.

    ...He said about 75 percent of the people signing up for health insurance in Kentucky had no previous insurance and that 330,615 people qualified for Medicaid coverage.

    Beshear described it as "deeply satisfying" that 10 percent of the state's population "finally has affordable, quality health insurance that gives them assurance that if they get sick or hurt, they'll get the care and they're not in danger of bankruptcy."

    ...More than one out of every 10 Kentuckians has health insurance through Kynect, Haynes said.

  • LITTLE ROCK - Arkansas officials say nearly 70 percent of those eligible have signed up for health coverage under the state's compromise Medicaid expansion program.

    The Department of Human Services said Monday that 155,567 people have applied and been determined eligible for the state's "private option" program, which uses federal Medicaid funds to purchase private health insurance for the poor. DHS estimates that 225,000 Arkansans qualify for the program that was approved last year as an alternative to the Medicaid expansion envisioned under the federal health care law.

    Hmmm...my own calculations (based on KFF estimates) has Arkansas down as having around 281,000 people "eligible for Medicaid" who aren't currently insured, but that may just mean that the 56K difference are potential  "woodworkers". In any event, this is still huge news.

  • Yes, that's right...ACA Signups is back in action!

    Well...sort of. I'm able to post a couple of updates here and there, but don't expect anything major until next week. The swelling in my right eye has dropped significantly, allowing me to read and type for perhaps 20 minutes at a time, and I'm back on (semi) solid food...thick soups and the like.

    With that in mind, I'm gonna try and cut down on the backlog of updates sent in this week...and you'd be amazed at how much is still going on even after the extension period elapsed 10 days ago...

    I also wanted to thank everyone for the well-wishes and words of support.

    And no, the irony of the situation is not lost on me: I'm taking my brand-new ACA-approved healthcare policy through a thorough workout this month, by subjecting myself to 3 different doctor's appointments (well, technically 4 if you include the dentist, but that's not covered by the policy, of course): Once to my GP, and two more to the Ophthalmologist (once last week to make sure the virus didn't infect my eyeball itself, and a follow-up next week to make sure it didn't seep into the eyeball later in the process).

  • Not that this is particularly surprising after my prior post, but yes, I've been diagnosed with a nasty case of Shingles. That would be bad enough, but making it worse is that it's on my face (usually it's on the torso), meaning that my right eyelid is swollen over, making it very difficult to see, read or type more than a few sentences at a time.

    As a result, I probably won't be able to post any more updates at all for a few days, which will likely mean a bunch of them posted all at once this weekend (or whenever the swelling goes down).

    Please do keep sending updates in, however; I'll just flag them for later reference.

    Thanks, all. Talk to you when I can.

  • ...no reason at all. Really.

    Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again.

    Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.

    You can't catch shingles from someone else who has shingles. But there is a small chance that a person with a shingles rash can spread the virus to another person who hasn't had chickenpox and who hasn't gotten the chickenpox vaccine.

    Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.

  • Well that just figures. Less than 24 hours after the big 8M QHP announcement, I started coming down with...something.

    afyer a miserable Easter weekend (I'm Jewish, so no biggie), Its gotten bad enough that I'm off to the doctor.

    So, between the relative dearth of updates and me being out of commission anyway, expect things to be quiet here for a few days.

    More to come when I'm able. 

  • Earlier in the week I noted that Hawaii's Health Connector website was still vulnerable to the infamous Heartbleed OpenSSL bug. I'm happy to say that it has since been patched.

    This naturally raised the question of whether the main Federal exchange website, Healthcare.gov, was also vulnerable. I checked the site the day that the Heartbleed story went public last Wednesday and it did not show up as being vulnerable. In addition, on that same day Mashable reported that HC.gov was NOT one of the major sites impacted by the bug.

    However, just to be certain (and because, frankly, it's a good idea to reset your password every six months or so anyway), the HHS Dept. has taken the precaution of doing a batch password reset for every account on the site:

  • Latest Vermont Health Connect stats

    • 52,156: Vermonters who used the Vermont Health Connect website, call center or navigators to shop for 2013 health insurance and now have coverage.

    • 24,888: Vermonters who purchased commercial coverage through Vermont Health Connect.

    • 27,268: Vermonters who shopped on Vermont Health Connect but qualified and are now enrolled in Medicaid. Eligibility expanded under the federal Affordable Care Act.

    • 33,549: Vermonters previously covered by the Vermont Health Access Program and Catamount Health who the state enrolled automatically in Medicaid based on income information on record.

  • It seems a bit odd to me that Maryland is issuing a formal press release today when their extension period doesn't end until tonight or tomorrow (why leave a couple days of stragglers?), but whatever; the increase in exchange QHPs from 4/09 to 4/14 was only 1,017, so I guess they figure that it won't be more than a few hundred from 4/15 - 4/18 anyway.

    In any event, they say they aren't issuing any more updates until mid-May, so for all practical purposes, this closes the books on Maryland for now:

    Please note, we will begin reporting on a monthly basis, on the third Friday of each month. Our next report will be May 16, 2014.

    As of April 15, 2014, 262,619 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

    As of April 14, 2014, 66,203 individuals have enrolled in a qualified health plan. 

  • OK, now that we're past the April 15 cut-off period, I can close the books for 2014 enrollments, right?

    Well, no. As I've noted many times before, Medicaid enrollments and SHOP (Small Business) enrollments are year-round; there's no deadline for those.

    OK...but what about Exchange QHPs? Surely those are shut down for the year, right?

    Well, no. Again, as I've noted before, the appx. 5 million Native Americans in the U.S. don't have a deadline, and of course anyone can still enroll or change plans if they have a Qualifying Life Event such as having a baby, getting married/divorced, losing their job, moving to a different state and so on.

    OK...but what about everyone else? April 15th was the deadline, right?

    Well, no. Here's a roundup of the state-by-state deadlines (which have been changing every day, but seem to have finally settled down for real):

  • by Javier Anderson, April 17, 2014

    According to a new policy paper by the UC Berkeley’s Center for Labor Research and Education, it is likely that up to half of California’s Exchange Enrollees will not be enrolled in their current Quality Health Plan’s (or QHP’s) by the end of the first year of the exchanges existence. This is due to a myriad of life factors allowing consumers to drop these plans for other policies afforded to them by their spouses, employers, or other government insurance providers (Medicare, Medicaid, Tricare etc.)

  • Simple and to the point:

    The S.C. Department of Insurance reported Friday that 114,789 individuals selected a plan on the federal exchange through April 15 - up from an 97,000 estimate earlier this month.

  • Today was filled with fantastic news across the board. The only bummer is that the actual HHS report for March (and the first half of April?), with the state-by-state breakdown, was not released today.

    So, you know what? I'm so geeked about the 4/15 total actually breaking the big 8M mark after all that I'm going to attempt to estimate the state-by-state totals for every state which hasn't published their official 4/15 total yet myself.

    This may sound insane, but it's not as difficult as you may think (well, it's not difficult to do; that doesn't mean that I'll be accurate).

    First of all, I can obviously eliminate any state which has already released their data through 4/15. That gets rid of California, Colorado, Connecticut, DC, Minnesota, Nevada, New York and Oregon.

    I can also eliminated Washington State, since they never participated in the expansion period (they may have a few hundred stragglers via "special case-by-case basis" but that should be about it.

  • The wording of the story makes it look like MA's exchange QHP total dropped by over 6K, but in fact they had only reported 12,965 to HHS as of March 1st, so this still represents a slight increase over the last number entered on 4/02 (29,720):

    Unsubsidized enrollment in exchange plans fell to 29,775 April 8, from 36,060 Dec. 1, 2013, when the state had its own, homegrown exchange plan program in place. The exchange is planning to conduct a survey to learn why enrollment fell.

    deaconblues, ever detail-oriented, also made sure to find the subsidized number of QHP enrollees as well: 769

    Add 'em together and you get 30,544.

  • This number out of NC is a bit squirrelly; I'm not updating the actual spreadsheet with it, but it's still worth at least mentioning:

    Overall, Terrell said, the state has received 95,000 Medicaid applications via the federal ACA sign-up, representing 132,000 people, since October 2013. And that number is likely to grow. 

    The number of people added to Medicaid/CHIP in NC thru 3/01 via the HC.gov site was 55,691, so this could potentially be a more than 2.3x increase, but they're noted as applications, so presumably some of them will be denied. Still impressive.

  • Connecticut officially didn't have an extension period, but they did allow late enrollments on a "special case" basis, which apparently amounted to about 5,000 more people:

    A total of 208,301 Connecticut residents enrolled in health care coverage through the Access Health CT online marketplace as of Sunday, the quasi-public agency announced Thursday.

    The numbers reflect those who signed up before the March 31 deadline for open enrollment, plus 5,000 people who attempted to enroll by that date but encountered some difficulty, but were able to enroll over the last two weeks.

    “Over the past two weeks, our team has made follow up calls to each of those individuals to assist them through the enrollment process, and we have now completed all open enrollment applications,” Kevin Counihan, head of the agency created as the state’s response to the federal Affordable Care Act, said in a news release.

    Of the 208,301 enrollees, 78,713 enrolled with a private insurance carrier and 129,588 enrolled in Medicaid. Of the 78,713 residents who enrolled with a private insurance carrier, 78 percent received a tax subsidy and 22 percent did not.

  • Colorado issued a rough update the other day ("over 124K"), but they gave the official 4/15 tally today:

    • Exchange-based Commercial Health Insurance (QHPs): 127,233
    • New Medicaid Enrollees: 178,508

    Oh, by the way: The "over 124K" press release issued on the 14th was a big part of the reason why I downshifted my total projection from the 7.9-8.0M range down to around 7.78M a few days back. I assumed that the only reason they would issue a number press release the day before the deadline would be if the enrollments were tapering off so much that there would only be a handful left to count on the final day.

    Obviously I was wrong; CO managed to add another 3K QHPs on the last day.

  • Oregon continues to plug along, adding an impressive 3.8K more NET QHPs and 7.3K more Medicaid enrollees the past week...not sure if this runs through 4/15 exactly or if it includes yesterday as well (Oregon is one of the states going beyond 4/15), but I'm lining them up at 4/15 for the moment:

    April 17, 2014
    Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

    Medical enrollments through Cover Oregon: 228,795
    Total private medical insurance enrollments through Cover Oregon 1: 67,474                   

    Oregon Health Plan enrollments through Cover Oregon: 161,321

    Net enrollments 
    Net private medical:  63,709

  • Update as of 4/15: 44,468 consumers confirmed Qualified Health Plan selections through Nevada Health Link, 30,176 have paid.

    — Nevada Health Link (@NVHealthLink) April 17, 2014

  • I felt kind of bad for turning FOX News down for their kind offer to have Bill O'Reilly or Sean Hannity scream at me for 10 minutes (Then again, I don't recall which show they wanted me to appear on...perhaps it was FOX & Friends?)

    Fortunately, my friend LOLGOP has provided a gift for me to pass along to them to make up for any hard feelings:

  • And there you have it:

    President Barack Obama announced Thursday that 8 million Americans had enrolled in private health coverage under Obamacare.

    "The bottom line is the share of Americans with health insurance is up," he said from the White House briefing room. "This thing is working."

    In a fact sheet released simultaneously, the White House said 28 percent of those enrollees were ages 18 to 34, the key "young and healthy" population, up from 25 percent at the end of February.

    Details to follow as they're released (where's that HHS report, darn it???)

    One thing to note: The NY Times is reporting that it's 35% "under 35". Presumably the 7% difference between the two numbers are made up of children under 18:

  • So, now that I have the data through at least 3/31 (and in most cases, through mid-April) for all 15 state-run exchanges, I can start to play with the statistics a bit.

    At the end of February (technically March 1st), the 15 state-run exchanges totalled 1,621,239 QHPs. As of 4/15, these add up to at least 2,564,005, or 58.1% higher. There's anywhere from 2-14 days missing from some of these, however (perhaps 30,000 total, for a total of around 2.59 million), so let's call it about a 60% increase since then.

    However, we also know that the total exchnage QHP enrollment figure is a minimum of 7.5 million, and almost certainly closer to 7.9 - 8.1 million. Let's assume the low end: 7.9M total.

  • I was so caught up in the national tally implications, I forgot to actually devote a proper entry to California itself. There's some additional key numbers to look at here:

    From April 1-15, 205,685 consumers – including a one-day record of more than 50,000 on the final day – completed their applications and selected health plans through the Covered California exchange, bringing the total to 1,395,929 at the end of the historic, first open enrollment period. The total exceeds the base projection for Covered California for the entire six-month enrollment period by more than 815,929.

    As noted earlier, let's assume that "over 50,000" means, say, 50,100. To put this in context, they're saying there were (205,685 - 50,100) = 155,585 QHP enrollments in the first 14 days (about 11,100/day)...followed by 50,100 on the last day. That's 4.5x the rate it had been.

  • Holy Crap on a Stick!

    From April 1-15, 205,685 consumers – including a one-day record of more than 50,000 on the final day – completed their applications and selected health plans through the Covered California exchange, bringing the total to 1,395,929 at the end of the historic, first open enrollment period. The total exceeds the base projection for Covered California for the entire six-month enrollment period by more than 815,929.

    Let's assume that "over 50,000" means, say, 50,100.

    To put this in context, they're saying there were (205,685 - 50,100) = 155,585 QHP enrollments in the first 14 days (about 11,100/day)...followed by 50,100 on the last day. That's 4.5x the rate it had been.

    Until this, I was estimating that the national 4/01 - 4/15 average would be around 45K - 55K/day nationally during the extension period, or around 675K - 825K total, for a grand total of around 7.77- 7.93 million exchange QHPs total. I settled on 7.78M as my "official" projection to be on the cautious side.

  • Just a reminder: Assuming that Inside Health Policy has it right, the official HHS report should be released sometime today and should include about 99% of the exchange QHP enrollment data through 4/15.

    In the past, they've usually released the monthly reports around the 11th or 12th of the following month. In this case they've obviously been delayed because of a) the insanity at the end of March and b) thankfully, they apparently want to squeeze in the first half of April as well (as you know, I was deeply concerned that they might lop off the last 2 days of the month and roll them over to an April report next month, which would cause no end of confusion among sloppy media outlets which can't take a glance at the calendar and do basic math).

    They generally release these reports around 4pm. I know this because there've been at least 2 cases where the conference call with Kathleen Sebelius started up right as I was waiting for my kid to get home from school, so we'll see if that holds true today as well.

  • This is a guest post by Paul Mullen, Consultant Economist, Austin, TX; former Economic Advisor to the UK Minister for Local Government, Minister for Housing & Secretary for the Environment:

    I would love to believe RAND's estimated 8.2 million increase in ESI between September and March but my experience in commissioning similar polls suggests to me that it is not real but due to an unanticipated side effect of the poll methodology.

    We know that there is a pretty large "churn" in insurance status. Some people will gain jobs with insurance, while others lose them. Some people retire, get sick, or die. But one would expect the number gaining and losing employer coverage would be about equal. RAND's 8.2 million increase is the difference between 14.5 million estimated to have gained employer sponsored insurance and 6.3 million estimated to have lost it (with an estimated 102.4 million having employer coverage in both polls).

  • Yesterday I posted a poll asking whether people found the term "woodworker" (used to describe new Medicaid enrollees who were already eligible to be enrolled even without the expansion provisions of the ACA) to be offensive. The thinking is that "woodworker" makes it sound like you're an insect creeping around under the floorboards and so forth; not the prettiest image.

    Anyway, the poll is now closed, and the results are in...out of 505 votes total:

    • 83% felt that I should keep using the term "woodworker" enrollees
    • 10% felt that I should switch to the friendlier-sounding "welcome mat" enrollees
    • 7% felt that I should use some other term

    This led to a robust discussion about what seems to be a pretty minor issue, but apparently means a lot to people. Other suggestions included:

  • I'm debating whether to actually plug this number into the spreadsheet or not. On the one hand, I'm reluctant to do so without hard official numbers being given (this is just a survey, only runs through mid-March and doesn't include kids anyway).

    On the other hand, doing so wouldn't change my total projection of around 7.78 million exchange QHPs; it just reduces the "unsorted" number at the bottom. Plus, I'm almost certain that the March HHS report is going to be released sometime tomorrow (Thursday) anyway, so if I'm wrong, it'll be easy enough to correct it at that point.

  • You may remember Georgia Insurance Commissioner Ralph Hudgens as the jackass who actually bragged about blocking his own constituents from gaining access to healthcare last August:

    “Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”

    After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

  • Washington State is doing a fantastic job of tracking pretty much every data point about health insurance in the state (I already had the 146K number):

    OLYMPIA, Wash. – The individual health insurance market has grown to more than 324,900 people in Washington state, according to updated enrollment information reported by health insurers to the Office of the Insurance Commissioner this week.

    This number includes 178,981 enrolled outside the Exchange and 146,000 enrolled inside the Exchange, Washington Healthplanfinder, as of March 31. The total is expected to increase as late enrollments through the Exchange are processed and reconciled.

    ...Before open enrollment began on Oct. 1, 2013, approximately 278,000 people were enrolled in health plans in Washington state’s individual market. Some 238,000 people received discontinuation notices from their insurers and had to find new coverage by Jan. 1, 2014. Estimates were made earlier this year that 113,000 of those who received notices would qualify for subsidies and 30,000 would qualify for the state’s newly expanded Medicaid program, Apple Health.

  • Avera reported about 8,950 South Dakotans had both enrolled in its plans and paid their first premiums since the enrollment period began in October. Sanford reported 1,443 and DakotaCare 59. The total is 10,450, but the government relaxed the March 31 deadline and some enrollments are still coming in. The insurers also have some applicants who enrolled but didn't complete the purchase by paying their first premiums.

    Avera, in earlier phone surveys, found that 54 percent of enrollments effective in January and February were people without coverage. Avera is studying the issue further and is working with Augustana College to explore what consumers care about most in a decision to buy.

    Read that carefully--54% of the January and February-start policies were previously uninsured. That means people who enrolled between 10/1/13 - 1/15/14. All indications (and logic) are that those who enrolled later than mid-January are more likely to be newly-insured than the earlier enrollees.

  • I can't really use this number in the spreadsheet since it's less than the total for the state, but this is extremely telling news (besides, how often am I gonna get to post a Texas-specific entry?):

    HOUSTON (AP) — More than 177,000 Houston residents have signed up for health insurance through the federal marketplace, far exceeding expectations for the city.

    According to an email obtained by The Associated Press, as of April 5 177,825 Houston residents enrolled for insurance under President Barack Obama's signature law. The email was written by Marjorie McColl Petty, the regional director for the U.S. Department of Health and Human Services in Dallas.

    The expectation had been that 138,000 Houston residents would sign up. Petty told Houston officials the numbers reflect a successful 13-county regional effort.

  • The quotes around "final" are there because DC also announced that they're bumping out the extension period one more time, to April 30th:

    The exchange had 699 people enroll for coverage in the two weeks after open enrollment was originally supposed to close, with 22 percent of those signups coming on Tuesday, the final possible day. That brings the total number of private health coverage enrollments to 10,630, Medicaid signups to 19,217, and small business enrollments to 13,118.

  • A bunch of people have sent me this link to the latest Gallop poll, which is certainly welcome news but isn't exactly unexpected:

    WASHINGTON, D.C. -- The uninsured rate among adults aged 18 and older in the states that have chosen to expand Medicaid and set up their own exchanges in the health insurance marketplace has declined significantly more this year than in the remaining states that have not done so. The uninsured rate, on average, declined 2.5 percentage points in the 21 states (plus the District of Columbia) that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

    So, this is awesome news. Aside from the obvious, though, let's look at the other key stats:

  • Key "final" numbers as of 4/15 (MN is actually allowing another week, through 4/22, for final stragglers):

    QHP: 48,157

    Medicaid: 140,678

    SHOP (from Dashboard) 726 x 1.8 = 1,306

  • This is actually pretty impressive; NY had been averaging around 4,200/day up until yesterday, when they hit 949,428, so this means they racked up another 11,334 in the final day (around 5,600 QHPs and 5,700 Medicaid):

    .@charles_gaba @charlesornstein final NY Enrollment total: 960,762 Medicaid: 525,283 Private: 435,479

    — Dan Goldberg (@DanGoldbergCNY) April 16, 2014

  • OK, this doesn't really change the numbers beyond a couple hundred, but it's encouragingto see that my "15% in Non-Expansion States" rule of thumb for estimating the number of people who fall into the "woodworker" category seems to be pretty accurate, at least in Indiana:

    Even without expanding eligibility for Indiana Medicaid, the program had enrolled 40,577 more Hoosiers as of March than it had in the same month last year.

    More than 15,000 of that year-over-year increase occurred in March alone this year, as a flood of people here and nationally sought coverage before Obamacare would hit them with a tax for going uninsured.

    If you take a look at the Medicaid Spreadsheet, you'll see that I currently have the "woodworker" tally for Indiana at 40,951...only 374 more than the number reported above.

    That 40,951 is 15% of the combined total number of new Medicaid enrollments for Indiana from both the HC.gov website as well as through traditional state Medicaid agency offices (273,005).

  • OK, the various ACA exchanges are just messing with my head now.

    First, Nevada announced that they've extended their enrollment out to May 30 for those who started by March 31st.

    Then Oregon announced that they've extended full open enrollment out to April 30.

    Then I found out that anyone who submitted a paper application by April 7th in any of the 36 states run by HC.gov still have until April 30 to finish.

    Colorado, I've discovered, is allowing people who applied for Medicaid but were denied up until May 31st to finish their enrollment process.

    And, of course, Massachusetts has over 200K "Limbo Status" people who may (theoretically) get squared away as late as June 30.

    Late last night I learned that Hawaii has bumped their extension deadline out to April 30.

  • I said I'd keep the poll for the "woodworker" terminology open until tonight, but until I decide what to do about it I'll be continuing to use that term for consistency.

    This article from Kaiser Health News brings solid numbers for Colorado, but also gives other good info about the Medicaid situation. For instance, they give a simple explanation of where the term comes from...

    Hundreds of thousands of those people were already eligible and could have signed up even before the Affordable Care Act made it much more generous.

    They came “out of the woodwork” to get enrolled, analysts say, thanks to the Affordable Care Act’s individual mandate and publicity around its new marketplaces.

    ...then they give the exact number in Colorado...though only through the end of February...

  • Oh for the love of...(sigh) Look, I'm all for letting as many people as possible enroll in healthcare coverage, but even I admit that I'm getting awfully tired of having to change the final, FINAL deadline dates.

    The Hawaii Health Connector has extended the  initial grace period— which would have ended on Tuesday — given to individuals in need of extra time completing the enrollment application process for health insurance by a couple of weeks to April 30.

    Let's just hope they resolve their Heartbleed issue.

  • Every person counts...up to 8,182 through 4/12:

    Total for the period of Apr. 6, 2014 through Apr. 12, 2014

    Total since October 1, 2013

    29,314 Applications completed in the Individual Marketplace
    8,182 Enrollments in the Individual Marketplace

  • Leigh McGivern of coOportunity Health has helpfully provided their final (well, near-final...through 4/14) tallies for both on- and off-exchange enrollments. The exchange-based numbers aren't really relevant to me since those are reported by HHS, but the off-exchange QHPs and ESI's are vital:

    IOWA

    • Individual/Family members: 18,358 (10,809 on exchange/7,549 off exchange)
    • Small group members: 7,848
    • Large group members: 274

    NEBRASKA

    • Individual/Family members: 30,668 (20,308 on exchange/10,360 off exchange)
    • Small group members: 11,292
    • Large group members: 2,774

    TOTAL ON EXCHANGE IOWA AND NEBRASKA (individuals/families): 31,117

    TOTAL OFF EXCHANGE IOWA AND NEBRASKA (individuals/families): 17,909

    TOTAL BUSINESS (employees and dependents) IOWA AND NEBRASKA: 22,188

    TOTAL BOTH STATES ON AND OFF EXCHANGE (individuals/families/businesses): 71,214

    This represents increases as follows:

  • This doesn't change the actual total number of Rhode Island's Medicaid expansion numbers, but it does specify the ratio between "strict expansion" and the "woodworker" enrollees...66% to 34%. Interestingly, this is virtually identical to the Washington State ratio (again, 67% to 33%).

    This isn't enough to apply to the other expansion states yet, but if it does prove to be the case, that should be helpful in figuring out how accurate my current estimates are. I currently have "strict expansion" at roughly 3.7 million, while "woodworkers" are at 2.05 million. A strict 67/33 ratio would have the "woodworker" number at around 1.82 million...except that the non-expansion states also have some woodworkers as well, which should account for the additional 230K or so.

    Figures obtained from the Chafee administration by WPRI.com show that out of the 64,590 Rhode Islanders who signed up for Medicaid from October through March using the state’s new HealthSource RI marketplace, 34% were eligible before the new law expanded the rules for who could sign up.

  • A few days ago, Michigan's newly-expanded Medicaid tally sat at around 32,000, plus another 54,000 people transferred into the program from an existing state-run one, for a total of about 86,000 people.

    Today that number has grown to over 109K:

    Healthy Michigan Plan Enrollment Statistics

    • Updated every Tuesday at 3 p.m.

    Total Healthy Michigan Plan Beneficiaries (including ABW transition prior to April 1): 109,228

    Total Enrollment in Healthy Michigan Plan after April 1: 72,921

    *Statistics as of April 15, 2014

  • No breakout between Private QHPs & Medicaid/CHIP yet, but NY State of Health just issued this press release:

    ALBANY, NY (April 15, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 1,311,271 New Yorkers have completed their applications and 949,428 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. More than 70 percent of those who have enrolled to date were uninsured at the time of application. The Marketplace is well on its way to meeting or exceeding its enrollment goal of 1.1 million people by the end of 2016.

    This figure is about 16,200 higher than just 4 days ago, meaning NY is averaging around 4K/day. Assuming no final day spike (or drop-off), their final total should come in at around 954,000 people.

    Not gonna update the spreadsheet or graph until I get the actual QHP/Medicaid breakout, however, since those are almost always provided within a few hours of the combined number in NY.

  • I've been shouting from the rooftops about OFF-exchange QHPs for months now (I first added a column for them on January 3rd and had my first significant data update on January 31st), and until recently few in the news media seemed to catch on to the significance of these.

    Until a few weeks ago, I had only officially documented about 560,000 off-exchange QHPs, but guestimated that there were easily 4 million or more out there (I had mused off-handedly back in mid-February that the total could potentially be 7.7 million, but decided to backtrack to "4M or more" out of caution).

  • Nothing major, just another 4,000 people added to NM's Medicaid tally:

    An estimated 107,000 New Mexicans have enrolled in Medicaid since the state expanded the qualifications in October to include low-income adults, state Human Services Department spokesman Matt Kennicott said Monday.

    ...A total of 26,412 New Mexicans had enrolled in health plans through the state insurance exchange by the March 31 enrollment deadline, the state office of the Superintendent of Insurance said in a news release issued recently.

    ...An additional 10,000 applications had been submitted by the deadline but remained unprocessed, the statement said.

  • That's right. Thanks to high winds and a mid-April snowfall, I have no electricity today. Expect updates to be few and far between.

    --posted from my iPhone

  • I've been debating whether to post about this since frankly, I'm not entirely sure that I have all the details straight about how this works. If anyone more familiar with this process wants to correct or clarify my description in the comments, please feel free to do so.

    OK, so there's all sorts of hand wringing over how much premium rates will increase for 2015 based on the 2014 risk pool. The CBO issued a report yesterday which projects that in spite of all the fretting, the overall average increase will only be a few percent, which is good news if true (although this will no doubt vary from state to state).

    However, I recently learned a couple of very interesting things about how the ACA works when it comes to pricing oversight and the "risk corridor" program.

    Think Progress has a nice explanation of "risk corridors" (which the GOP hypocritically and wrongly refers to as an "insurance company bailout"):

  • There are many ways of getting a society to “do the right thing”. Many years ago, as I was driving into San Francisco across the Bay Bridge, traffic was at a crawl – except for two lanes labeled Car Pool. Those cars whizzed by and their drivers didn’t even have to stop to pay the road toll. Life can be so unfair to a lonely guy in a BMW or Porsche.

    Above the highway was a billboard advertising, in large letters, the Car Pool Switchboard; its sole function was to hook up people regularly commuting from one place to another at roughly the same time. Saving a few dimes by sharing gas expenses, or even being forgiven a couple of bucks in road toll, may not have seemed like much of an incentive – but getting to work (and home) 20–30 minutes faster each day, most certainly was!

    City of Angels

  • Yesterday I issued a reminder/warning that the March HHS report might stop at 3/29, leaving the last 2 (and by far the busiest) days of the official enrollment period, the 30th-31st to be moved over to the April report.

    If HHS did this, the March report would appear to only include about 6.5M exchange QHPs, since another 600K would be moved to April, along with the additional 700K (give or take) enrollments from 4/01 - 4/15 (and even beyond).

    Fortunately, if this bulletin from Inside Health Policy is true, wiser heads at HHS have prevailed...and then some!

    HHS Eyes April 17 Release Of Latest Enrollment Numbers

  • On top of today's CBO report projecting a $104 Billion savings on the cost of the ACA over the next decade and their projection of 2015 premiums only going up slightly, this is a bit of unexpected news....

    As hundreds of thousands of diabetics get health coverage under the federal law, insurance companies are aggressively targeting this glut of new patients, who are expensive to treat and often lax in taking medications and following their diet.

    Insurers are calling diabetics when they don't pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor's office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines.

    Well I'll be damned. Private, for-profit insurance companies actively assisting their customers in trying to stay healthy.

    Exactly the way that the law was intended to work, I'd say.

  • Hoo, boy...this is gonna cause some heads to explode over at FOX News...

    The most expensive provisions of Obamacare will cost taxpayers about $100 billion less than expected, the Congressional Budget Office said Monday.

    CBO also said it doesn't expect big premium increases next year for insurance plans sold through the health care law's exchanges.

    In its latest analysis, CBO said the law's coverage provisions—a narrow part of the law that includes only certain policies—will cost the government $36 billion this year, which is $5 billion less than CBO's previous estimate. Over the next decade, the provisions will cost about $1.4 trillion—roughly $104 billion less than CBO last estimated.

    But wait, there's more...

    Monday's report also sheds some light on one of the big challenges still to come for Obamacare: next year's premiums. Some critics have warned that premiums could skyrocket next year, based in part on the demographics of the people who signed up for coverage this year.

  • It took me a few minutes to figure out why, at this point, Colorado would issue a formal press release with a "final" number when there's still a day and a half to go. However, I realized that it probably simply means that practically everyone who qualified for the 4/15 extension has already done so by now; presumably they're already over 124K and there's only a few hundred partial applications left anyway, so their final tally will come in somewhere between 124K - 125K, thus allowing them to confidently release the news.

    On the down side, if this "winding down" effect is true in most other states, it also suggests that instead of one final mini-spike, the 4/15 deadline will actually result in a severe drop-off, making the final total more like 7.7M instead of 7.8M, but that's fine as well.

    In any event, CO is up another 3,000 exchange QHPs since last week to over 124K total.

    UPDATE 4/14: From a Denver Post article on the same topic:

    About 500 small employers participated in the Small Business Marketplace, or SHOP, which saw 220 enroll, covering 1,860 employees and family members.

    That's a whopping increase of...90 people. Still, every one counts...

  • (sigh) OK, until this morning I was under the impression that the exchange QHP enrollment rules were:

    • 46 states +DC (36 on the Federally-run exchange, plus another 11 of the state-run exchanges): April 15 as long as you started the process by 3/31
    • Oregon: April 30, no "started by 3/31" requirement
    • Nevada: May 30 with the "started by 3/31" requirement
    • Connecticut & Washington State: No extensions

    I did know that Florida was allowing paper applications received by April 7 to have their enrollments completed by April 30, but I thought that was it.

    Well, if this Motley Fool article is correct, the final numbers could be even a little higher yet:

    The new federal deadline -- a special enrollment period – already allowed registrations delayed by exchange-related problems to be finished as late as April 30 for those who submitted a paper application by April 7. That extension applied to individuals living in states where insurance enrollment under the Affordable Care Act is conducted through the federal exchange.

  • A few days ago I gave a final 4/15 exchange QHP estimate range from between 7.7 - 7.9M, with an outside shot of 8M.

    Today I'm narrowing my projection within that range; unless there's a really big absolute-last-minute spike today and tomorrow (which is conceivable), it's looking like the final tally will end up somewhere between 7.8 - 7.9M. 7.75 - 7.85M I suspect the 8M mark will remain tantilizingly out of reach.

    On the other hand, if I've seriously lowballed here and it does end up around, say, 7.95M, it's just barely possible that a handful of stragglers from Nevada and Oregon (along with paper applications in Florida?) could just barely drag the 4/30 total over the 8M line (Nevada has actually extended their "started by 3/31" policy all the way out until May 30, while Oregon has extended their full enrollment period out to 4/30).

  • Feeling a bit loopy on a rainy Sunday afternoon, so I present the mystery of one of the most significant songs ever released: Young MC's "Bust a Move":

    Your best friend Harry has a brother Larry
    In five days from now he's gonna marry
    He's hoping you can make it there if you can
    'Cause in the ceremony you'll be the best man

    Question: If Larry is the one getting married, why are YOU the best man instead of his own brother? You're HARRY's best friend, not LARRY's.

    For that matter, who waits until 5 days before the ceremony to ask someone to be in their wedding party, especially the best man? That's awfully short notice, barely enough time to get sized for the tux.

    Posit: The brothers had some sort of falling out, perhaps over the bride. If so, that still doesn't explain why he'd ask his brother's best friend to be the best man, unless Larry just wants to rub Harry's nose in it.

    As it happens, a friend of mine figured out the answer. If no one guesses it today, I'll post the answer tomorrow.

  • Earlier today I received the following question via Twitter:

    @charles_gaba off-topic? NJ had coverage 4 adult until age of 30-31? Do they go down to 26 under ACA and if so, did you account for that?

    — Mary Ann James (@ernestine1006) April 13, 2014

    I honestly wasn't sure how to answer this. I had heard that some states already required insurers to allow kids up to 26 to be covered, but wasn't previously aware that NJ (or any other state) went beyond 26...

    @ernestine1006 I have no idea. Didn't know any state required policies to offer higher than 26. Would imagine it works like min. wage...

    — Charles Gaba (@charles_gaba) April 13, 2014

    ...and thanks to the power of Twitter, this was quickly confirmed to be the case:

  • I talked about this a couple of weeks ago, but given that the March HHS report should be released sometime this week (unless it's delayed due to the craziness of the late-March surge), I thought it was important to post again:

    The March HHS Enrollment Report may leave off March 30th and 31st, and therefore leave 600,000 exchange QHP enrollments to be tacked onto the April report instead.

    Every one of the prior 5 HHS reports on ACA enrollments has been tied to the calendar week instead of the calendar month, cutting the tally off on whatever Saturday happens to fall closest to the end of that month:

  • Earlier today a friend of mine (Eclectablog...who, by the way, is also the head of the best blogging team in America, and who could use your help with his quarterly fundraiser at the moment) noted that there was an anti-ACA banner ad from the Koch Bros running at the bottom of this site earlier today.

    His Tweet was intended as snark, of course, but at least a couple of people didn't appear to get the joke, and actually think this means I'm either hypocritical or some sort of 11th Dimensional Chess-playing Double Agent Mole working for the Koch Bros. Not sure how that would work, exactly, but whatever.

  • OK, I actually do have one update today (it's 8:30 at night and my kid is getting ready for bed).

    When I first learned that Washington State's off-exchange total was a whopping 2.2x that of their exchange-based enrollments back on February 20th, I casually noted that if that held true nationally, it would make the off-exchange QHP tally easily 7.7M or higher ...and this was back when the exchange QHPs were only around 3.5M.

    However, I also tried to be cautious in my "official" estimate, keeping it to around 4M or so since I didn't know how many there really were beyond the 300K (later 560K) or so I had documented at the time. After all, other states would likely have a much lower ratio of Off- to On-exchange QHPs; In Wisconsin, for instance, Off-Exchange QHPs were only about 23% as high as exchange-based.

  • Because sometimes you just want to take your kid to the zoo for the day.

  • A few days ago, the much-discussed Rand Corporation healthcare coverage survey was released.

    There's a lot to absorb and discuss in it, but the one number which I found the most puzzling was their estimate of around 3.9 million private QHP enrollments via the ACA exchanges.

    As I noted at the time, this puzzled me because around "mid-March" (the point at which the vast bulk of survey responses had come in), the actual number of exchange QHPs was roughly 1 million higher, around 4.9M.

    The survey itself lists a +/- 1.1 million margin of error for that figure, but it still didn't make much sense to me, since the official HHS report through 3/01 (2 weeks earlier) was already 4.24 million.

    At first, I figured that perhaps they were lopping off about 20% to account for the unpaid enrollments. This would make the 3.9M figure correct, but there was no mention of payments in the survey.

  • Maryland's press releases are getting shorter and more abrupt. With the enrollment period wrapping up and their exchange site still an utter mess (and about to be completely scrapped and replaced), this isn't terribly surprising.

    Still, this is up another 2,184 QHPs and 16,420 Medicaid enrollees in the past week, which isn't too bad, all things considered.

    Through April 9, 2014, 65,186 Marylanders have chosen to enroll in qualified health plans through Maryland Health Connection. As of April 8, 248,495 have gained Medicaid coverage in 2014 and remain active in Medicaid.

    Enrollments in qualified health plans since March 31 include 2,229 enrollments completed with assistance from a dedicated team responding to Marylanders who contacted our 1-800 hotline and other channels to request additional help.

  • This just in from healthcare reporter Dan Goldberg (and others in various formats)...

    .@charles_gaba @charlesornstein NY now enrolled 933,232 Of those, 508,016 have signed up for Medicaid and 425,216 have enrolled in a QHP

    — Dan Goldberg (@DanGoldbergCNY) April 11, 2014

    In addition, there's this from a story at WAMC public radio:

  • I think this is the first Nevada update I've posted which didn't come from the Nevada Health Link's Twitter feed. Technically only 28,208 have actually paid their first premium so far, but another 4,332 have scheduled their payment which is certainly a huge step ahead of having "enrolled but not even arranged for a payment" (and my model has 7% of this total being lopped out for potential non-payment anyway). So, 32,540 it is until further notice.

    And the number of people who enrolled in and paid for a qualified health plan through the exchange hit 28,208 on April 5, up from 25,899 people on March 31. Another 4,332 consumers have scheduled payments.

  • Yesterday, at around the same time that (outgoing) HHS Secretary Kathleen Sebelius confirmed my estimate that ACA exchange QHP enrollments had hit 7.5 million people, Edward Morrissey wrote an article over at Yahoo News claiming that (wait for it) the HHS Dept. was "cooking the books":

    Last week, that [the ACA being here to stay] sounded like wishful thinking. Two new studies released this week prove it. 

    The studies that he uses are the Rand Corp. survey and a study released by Express Scripts regarding prescription drug coverage. I'm not even going to get into the Express Scripts study, because Mr. Morrissey makes so many errors in the Rand section I don't even think it's necessary to continue beyond that:

    While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates. 

  • This is great news, but I have to reduce Ohio's Medicaid total by about 54,000 due to a bit of sloppy double-counting on my part. However, there's another (potential) 120K in the batter's box:

    More than 106,000 Ohioans have signed up for Medicaid under an expansion of the taxpayer funded health program, while thousands of others are waiting to hear whether they are deemed eligible.

    ...Ohio's monthly report on Medicaid caseloads shows that 106,238 residents had enrolled under the extension as of March 31. That's about 29 percent of the roughly 366,000 newly eligible people estimated to sign up by the end of June 2015.

    More than 345,000 people have sought Medicaid coverage through the state's benefit site since Oct. 1. About 65 percent of the applications have been resolved, while roughly 120,000 are still pending. Many of those cases await eligibility determinations by the state's largest counties.

  • Yesterday, contributor Stevef101 noted that Blue Cross of Idaho was bragging about enrolling 45K people via HC.gov...more than the total exchange QHPs for the state through the end of February. Today he further notes that the company has enrolled 70,000 people in new QHPs total during the enrollment period...meaning that 25K of them were done off-exchange.

    Six-thousand people responded to the program, and at last count, 70,000 Idahoans signed up for insurance during the first open enrollment period.

    "All of this publicity, people really starting to talk about what insurance can do for them, really made a big difference in getting people covered," said Zelda Geyer-Sylvia, President and CEO of Blue Cross of Idaho.

    Note that this doesn't change the high-end potential total of 7.8 million from the Rand Corp. study, it just fills in the documented number within that a bit further.

  • OK, I've made one more major update/change to The Graph (I've been meaning to get around to this for awhile): I've split the 2 Medicaid/CHIP categories into a total of 3. The new section is specifically for bulk transfers and other special Medicaid enrollments, including things like:

    • The 650,000 LIHP transferrees in California
    • The 107,000 people auto-transferred from Commonwealth Care in Massachusetts (permanently...this is separate from the 200K+ stuck in temp "limbo" care)
    • The 33,000 transferees from VHAP/Catamount in Vermont
    • The 96,000 transferees from Maryland's PAC program
    • Most recently, the 53,000 people transferred over from Michigan's Medicaid Adult Benefits Waiver program

    It's very important to note that the total number of new ACA-enabled Medicaid enrollees has NOT changed, only the way these are categorized. I've done this purely in the interest of clarity and transparency. In addition to the "bulk transfers", this also includes people who were not previously insured but dont' quite fit into the normal Medicaid enrollment category--for instance:

  • No exact numbers here, but the wording of the article gives the rough breakdown:

    About 3,500 Connecticut residents have enrolled in health insurance through the state’s health care exchange, Access Health CT, since the official open enrollment deadline passed on March 31. That’s in addition to the nearly 200,000 who enrolled by the health care deadline.

    Access Health CT CEO Kevin Counihan said there were roughly 10,000 people in the state who wanted to enroll but couldn’t complete the process by deadline for some reason. Those people were told to leave their contact information, and that the state would follow up with them to make sure their enrollment was completed.

    ...Customers to the state marketplace could either buy insurance through one of three private carriers on the exchange, or get covered through Medicaid. The majority of those covered through the exchange — more than 120,000 — were covered under Medicaid.

  • Not an official update, but Idaho was already at 43,861 as of March 1st from all 4 companies operating on the exchange, so over 1,000 more than that total from just 1 of the four companies bodes well for the official total, which will probably come out next week:

    About 45,000 people applied for health-insurance plans from Blue Cross of Idaho through the state's insurance exchange, Your Health Idaho, over the past six months.

    The insurer announced its enrollment numbers Thursday.

    Your Health Idaho is expected to release total enrollment for exchange plans soon. Open enrollment ended March 31.

    Four companies — Blue Cross, SelectHealth, PacificSource and the Regence BlueShield of Idaho sister company BridgeSpan — sold plans on the exchange.

    Additional note: 45K just happens to be my own "fair share of 7M" target for Idaho, so a single insurance company has hit the target. The other three are basically gravy.

  • One of the few updates out of New Jersey, it looks like Chris Christie made one decent decision last year, anyway...

    New Jersey FamilyCare has added over 100,000 people to its rolls, contributing to savings that Gov. Chris Christie has already anticipated in his proposed budget.

    In just the first three months of this year, 102,268 state residents were added to the rolls of FamilyCare, which includes recipients of two federally supported programs – Medicaid and the Children’s Health Insurance Program (CHIP).

  • Through April 6, 41,402 Arkansans have purchased plans on the Arkansas Health Insurance Marketplace, the new marketplace created by Obamacare, according to information released yesterday by the Arkansas Insurance Department (see county  by county map above). As in the rest of the country, Arkansas saw a surge in enrollment recently, with more than 7,800 people signing up in the last two weeks. But while national enrollment in the marketplaces across the country hit initial projections, Arkansas will fall well short. 

    ...This does not include enrollment in the private option, the state's policy for Medicaid expansion which purchases plans on the Marketplace for folks that make less than 138 percent of the federal poverty level 

  • Oregon continues to slog it's way through enrollments in spite of their technical problems...

    April 10, 2014
    Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

    Medical enrollments through Cover Oregon: 217,413
    Total private medical insurance enrollments through Cover Oregon 1: 63,325 

    Oregon Health Plan enrollments through Cover Oregon: 154,088

    Net private medical:  59,923

  • This just in...Kentucky's tally is now up to nearly 80K exchange QHPs and 323K Medicaid enrollees:

    BREAKING: 402,407 Kentuckians are enrolled in @kynectky. 322,827 in Medicaid, 79,580 have purchased private insurance. #ACA #kyga14

    — Joe Sonka (@joesonka) April 10, 2014

    Still ~75% of @kynect enrollees previously did not have insurance. That's over 300,000 Kentuckians who now have health coverage due to #ACA

    — Joe Sonka (@joesonka) April 10, 2014

  • The numbers are small, but the percentages are impressive: Delaware's 3/31 tally is in:

    DOVER – Delaware ended its first enrollment period for the nation's new Obamacare health plans with 11,335 people enrolled – about 3,000 more than federal goals for the state.

    Another 3,411 people gained coverage through the state's expanded Medicaid coverage, which extended eligibility to 138 percent of the federal poverty level.

  • According to L.A. Times reporter Chad Terhune, CoveredCA has confirmed enrolling another 70,000 people in private QHPs in the first 9 days of the extension period. They had 1,221,727 as of 3/31, so that brings their total to 1.29 million as of last night:

    #CoveredCA added 70,000 (on top of 1.2M) who picked a plan in the 9 days of the "grace period" since March 31 to April 15. @charles_gaba

    — Health Access CA (@healthaccess) April 10, 2014

    #CoveredCA exchange: 70K more enrolled since 3-31 deadline after extending sign-ups to 4-15, adding to 1.2M already in #ACA

    — Chad Terhune (@chadterhune) April 10, 2014

  • Yeah, I know, I keep bouncing around on this; first I thought 8M was feasible, then I backtracked. However, let's do some simple math.

    • Obviously it wasn't exactly 7.1M on the nose at midnight on 3/31. Let's assume an overage of, say, 20K at a minimum.
    • It's also safe to assume that it was slightly over 7.5M as of midnight last night; let's say 20K there as well.
    • That means that in the first 9 days, QHP enrollments averaged 500K / 9 = 55.5K per day
    • I'd say a final weekend mini-surge is also likely for those who wait until the absolute last possible moment, which should cancel out what I'm assuming is a natural dropoff throughout the week. So...figure something like 30K/day today and tomorrow, then back up to 60K/day for the last 4 days. That's 300K added to the existing 7.52K, or 7.82M.

    So, as my final projection for 4/15, I'm going with: Somewhere between 7.7M - 7.9M, with an outside chance of squeaking by the 8M mark after all (wishful thinking?)

  • Me, last night: Hey, Guess What? I think we just hit 7.5M QHPs.

    HHS Secretary Kathleen Sebelius, moments ago: 

    Health and Human Services Secretary Kathleen Sebelius says 7.5 million Americans have now signed up for health coverage under President Barack Obama's health care law.

    That's a 400,000 increase from the 7.1 million that Obama announced last week at the end of the law's open enrollment period. The figure exceeded expectations, a surprise election-year success for the law after a disastrous roll-out.

    Sebelius disclosed the new figure during a hearing Thursday before the Senate Finance Committee.

  • Assuming that my "back of the envelope" estimates on extension-period exchange QHP enrollment are accurate, the ACA has just crossed several important milestones, including:

    • 7.5 Million exchange-based private QHP enrollments (total)
    • 7.0 Million exchange-based private QHP enrollments (paid or will pay within a month of their policies actually kicking in)
    • 20 Million documented enrollments total (ie, including all types--individual QHPs, on exchange, off-exchange, Medicaid, woodworkers, sub26ers, etc...but not including the 13.9 million undocumented, non-specific additional off-exchange QHPs and ESIs suggested by the RAND Corp. study)

    Note that I've modified The Graph a bit more tonight, separating out the ESIs (Employer-Supplied Insurance) into a 4th category (this includes the tiny number of SHOP enrollments, but mostly the controverisal 8.2M ESI estimate noted by the RAND study).

  • Last night I posted that Washington State, which officially is not offering any sort of extension period, actually is allowing late enrollments on a special, case-by-case basis.

    Then, earlier today, I learned that Hawaii (which I never really read an official policy on one way or the other, but which I thought was not extending enrollments) actually is doing so for up to potentially 1,100 people or so (192 to date).

    Now it appears that Connecticut, which had been very explicit about their "no extension" policy...apparently is allowing up to 10,000 people to (potentially) sneak in under the wire after all:

    Connecticut’s health insurance exchange ended its first open enrollment period with 197,878 people signed up for health care coverage, including 5,917 who enrolled Monday.

  • Yesterday I posted an update for Michigan's just-started Medicaid expansion. Officially the number was about 32K, but there was a reference to "tens of thousands more" transferred over from an existing state-run healthcare program (similar to the 650K LIHP transfers in CA, the 107K transferred from Commonwealth Care in MA and so on).

    Today, it turns out that "tens of thousands" actually meant a whopping 53,700 people:

    Since April 1, Michigan has received 54,479 applications and enrolled 32,071 Michiganders into the Healthy Michigan Plan. The difference represents those with applications that are pending confirmation, others who were eligible but enrolled in different Medicaid programs or have applications in progress or have been denied. Prior to April 1, MDCH transitioned the previous Medicaid Adult Benefits Waiver population into the program with coverage beginning on April 1. These enrollment activities combined mean that Michigan has already enrolled 85,761 residents into the new program.

    85,761 - 32,071 = 53,690 "bulk transfers".

  • CO had the official exchange QHP tally as 118,628 as of 3/31, so this means they've added another 2,343 to that total over the past week. The Medicaid number hasn't been updated:

    Connect for Health Colorado reports that nearly 280,000 state residents gained coverage during the six-month enrollment period, including 120,971 who signed up for private insurance plans as of Monday and 158,521 who enrolled in the expanded Medicaid program as of April 1. In an interview last fall, Patty Fontneau, CEO of the non-profit organization running the exchange, had estimated that 125,000 to 140,000 Coloradans would sign up for insurance through the exchange during its first year.

  • So, a lot of people, including myself, have talked quite a bit about the people who had their pre-2014 insurance policies cancelled due to them not being compliant with one or more of the requirements of the Patient Protection & Affordable Care Act (one of the few times I've used the full name, I might add). And yes, those people absolutely do exist; I know, because (as I've noted many times before), I was one of them. My wife and I received one of those "scary" cancellation notices last fall (nothing scary about it...just a simple note saying, "Your current policy isn't compliant with the law, so it'll end as of 12/31/13...we invite you to replace it with a new policy which is compliant with the law."

  • Whoops...apparently I was wrong about Hawaii not joining in with most other states on the "finish by 4/15 if you started by 3/31" bandwagon. Thanks to deaconblues for the catch:

    Total since October 1, 2013

    28,374 Applications completed in the Individual Marketplace
     7,788 QHP Enrollments in the Individual Marketplace
    557 Employers applied to SHOP Marketplace
    269 QHP Enrollments from the SHOP Marketplace

  • 4 different people brought Minnesota's latest update to my attention...their exchange QHPs are up another 651 from 47,046 since 3/31, while their Medicaid tally is up another 5,655 from 128,005:

    ST.PAUL, Minn. – Today, MNsure announced 181,357 Minnesotans have enrolled in quality, affordable coverage through MNsure, the state’s health insurance marketplace. The growing numbers come from continued processing of “in line” applications, as well as Medical Assistance and MinnesotaCare enrollments.

    ...To date, MNsure has enrolled 47,697 Minnesotans in a Qualified Health Plan, 37,050 in MinnesotaCare and 96,610 in Medical Assistance.

  • Until today, I had The Graph broken into 7 distinct categories:

    1. Exchange-Based Individual QHPs (Paid or To Be Paid Soon)
    2. Exchange-Based Individual QHPs (Unpaid or May Not Pay)
    3. OFF-Exchange Individual QHPs
    4. Exchange-Based SHOP (Sm. Biz) QHPs
    5. Medicaid/CHIP (Strict Expansion)
    6. Medicaid/CHIP (Woodworkers)
    7. Sub26ers (Low Est. / High Est.)

    Yesterday, however, the release of the RAND Corp. Survey made me realize that I was handling the 3rd category (OFF-Exchange Individual QHPs) the wrong way.

    You see, in the rare cases where I had access to the off-exchange enrollments for a particular company, I mushed their individual and group policies together. The numbers weren't huge--only about 34,000 people--but the potential numbers, as the RAND survey indicated, could potentially be massive.

  • This is great news for two reasons...not only has the Michigan Medicaid expansion already shot up another 5K in just the past day or two, but at least 20,000 ("tens of thousands") more people have been added to the Medicaid tally due to bulk transfers (similar to the 650K LIHP transfers in CA, 107K Commonwealth Care transfers in MA and so on):

    The Healthy Michigan program has received nearly 55,000 applications since April first. 32,000 Michiganders have already had their applications approved. And tens of thousands more have been moved into the expanded Medicaid program from a different state health assistance program.

  • Thanks to deaconblues for all three of these items:

    Avalere Health, with whom I've both clashed and agreed with on ACA-enabled Medicaid enrollments in the past, is projecting as high as a net gain of 4.3M Medicaid enrollees through the end of March:

    700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.

    However, March and April figures could bring more dramatic increases if outreach and enrollment efforts targeting the end of exchange open enrollment translate into new Medicaid enrollees. Specifically, if Medicaid sign-ups follow a similar pattern as exchanges, new Medicaid enrollees could reach 4.3 million by the end of March. In addition, recent figures released by CMS do not account for individuals assessed eligible for Medicaid through HealthCare.gov who have yet to be determined eligible by states.

  • For anyone interested, I'm scheduled to appear on the Craig Fahle Show tomorrow (Tuesday) morning at around 10:00am. The show is broadcast from WDET, 101.9 FM in Detroit. No idea what the rebroadcast schedule is but I assume it'll be available as a podcast archive at some point.

    Meanwhile, my appearance on Left Jab Radio on Sunday night, complete with my son bursting into the room in the middle of the broadcast, is now available via their website. My segment kicks in around 14:45 in and lasts about 20 minutes, I think.

    Finally, I've been hesitant about posting this publicly since there may be copyright issues involved (I'll take it down if necessary), but this strikes me as a reasonable/fair use situation (besides, I tried contacting the producer and no one ever got back to me); my apperance on America Tonight from about 2 weeks ago is now available via YouTube:

  • Urban, Gallup, and RAND all say the number of uninsured is declining since the ACA went into effect. Now we can debate why and by how much.

    — Larry Levitt (@larry_levitt) April 8, 2014

    Everything else is secondary. Larry Levitt of the Kaiser Family Foundation wins the day.

    Having said that, I'm still not understanding this "3.9 million now covered" number, however, when the number covered thru "mid-March" was actually around 4.9 million:

    By our estimate, 3.9 million people are now covered through the state and federal marketplaces. This number is lower than current estimates of marketplace enrollment through the end of March from the Department of Health and Human Services (DHHS), perhaps because some of the HROS data were collected in early March. All HROS data collection reported here ended on March 28, and therefore missed the last three days of the open enrollment period, during which time there was a surge in enrollment.

    As noted earlier, the only way 3.9M makes sense to me is if they assumed an 80% Paid rate, which would have been about right at that time.

  • At last, the big RAND Survey that everyone was freaking out about (and in some cases, completely misinterpreting) has actually been released!

    The key numbers:

    Using a survey fielded by the RAND American Life Panel, we estimate a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.

    The net result, according to RAND? An overall drop in the adult uninsured rate from 20.5% to 15.8%, or around 9.3M people nationally.

    Put another way, the survey estimates that the share of uninsured American adults has dropped over the measured period from 20.5 percent to 15.8 percent. Among those gaining coverage, most enrolled through employer-sponsored coverage or Medicaid.

    Assuming the RAND study is accurate (and most people from both sides of the aisle seem to think it's a pretty solid source), we may finally have an answer to the question "How many of them were UNINSURED???" Answer? Around 36%...of the first 3.9 million enrolled! That's right: Their study doesn't even include the 3.2 million more people who enrolled in individual QHPs via the exchanges after the survey concluded!

  • This is really just a cleaned-up version of my earlier NM update from this morning, but it's worth having an official source now:

    The New Mexico Health Insurance Exchange (NMHIX) reported a total of 26,412 New Mexicans had enrolled in qualified health plans as of March 31, 2014, according to the Office of the Superintendent of Insurance. This figure represents a 76 percent growth rate from the 15,012 enrollments confirmed at the end of February 2014.

    In addition, as noted this morning, NM reports 11K OFF-exchange individual QHPs and another 13,500 off-exchange SHOP QHPs! The 11K are part of the alleged "9M" RAND QHPs, not sure how to handle the 13.5K SHOP QHPs, not that it makes much of a difference vs. 9M...

  • Oregon's Medicaid figure hasn't changed, but the exchange QHP tally is now up to an unspecific 59K (assuming this is as of yesterday):

    Cruse said he became a full-fledged enrollee on a Moda plan in February. He’s now one of 59,000 people in Oregon who enrolled in private insurance after successfully navigating through the often cumbersome Cover Oregon process. Another 140,000 enrolled through the site on the Oregon Health Plan. 

    UPDATE: OK, scratch that. Looks like this article was quoting the 58,833 "total" QHP figure from the most recent official press release instead of the "net" figure which was exactly 3K less: 55,833.

    Leaving this up since it's already posted but sorry about the mixup.

  • Now that my home state of Michigan has finally joined the Medicaid expansion program, the numbers are starting to come out, and are pretty impressive right out of the gate:

    The Department of Community Health says that as of 12 a.m. Monday, roughly 27,000 individuals had been enrolled in Healthy Michigan, which is intended to provide health insurance for hundreds of thousands more low-income adults.

  • Ah, at last...the Federal exchange state data is starting to trickle in now...

    Nearly 100,000 South Carolinians enrolled in a health insurance policy on HealthCare.govbetween Oct. 1 and March 31, the director of the state's insurance department said Monday.

    But only some of those 97,387 individuals - about 57 percent - have paid their first month's premium, Director Ray Farmer said.

    The number of people actually enrolled may go up or down through May 1 - the deadline by which that first payment must be made.

    Data released Monday by the S.C. Department of Insurance shows a sharp increase in Obamacare enrollment in South Carolina during the second half of March. Approximately 30,000 people in this state signed up for a plan during the last two weeks of open enrollment.

    It's nice to be able to plug in SC's data, but the "How many have PAID???" thing is more amusing. 31% of the enrollees don't have their policy start until May 1st, so it's only 69% who you would even expect to have paid yet. Presumably the bulk of the 11% in between will pay over the next few weeks, and the 31% May-starts will start paying in increasing numbers as well.

  • I was recently contacted by someone representing one insurance company who wanted me to attempt to find out specialized enrollment data about one of their competitors.

    I don't blame them for giving this a shot; the insurance industry is, no doubt, a highly competitive business.

    However, get this straight: If you want inside info on one of your competitors, go elsewhere. If your competitor happens to provide enrollment data for me, the odds are that it will be published publicly, which means that you'll will be able to view it by simply visiting the website just like anyone else.

    As a courtesy, I am not going to identify either the person/company who made the request (nor the company they were trying to get information about).

    However, I cannot guarantee that I won't do so if this happens again.

    That is all.

  • In the past 2 days, there have been two very flattering profile pieces published about ACASignups.net and myself. Both are pretty in-depth and involve interviews with others as well as myself, and they're both very well-written, but I do feel a need to clear up a few things:

    1. I don’t “hate” being compared to Nate Silver; It’s incredibly flattering. I just think it’s a bit of an insult to HIM. That isn't false modesty...I really don't know anything about "probability distribution" or "loglinear regression" (in fact, I had to look those terms up just now).

    2. I didn’t expect HHS to release the full, 30-page report every week, I just figured they'd release the top-line numbers (X in QHPs, Y in Medicaid or whatever) on a weekly basis (and hope they decide to do so the next time around).

    3. I didn’t know that Aaron Strauss was a data consultant or that he was in charge of the Analyst Institute; I figured he was a regular schmoe like myself.

  • The 3 largest states with their own exchanges are California, New York and Washington State. WA did not allow an extension period, so that leaves CA & NY...the latter of which has just issued it's first post-3/11 update:

    N.Y. latest breakdown Medicaid: 486,689 Private: 421,883 @charlesornstein @charles_gaba

    — Dan Goldberg (@DanGoldbergCNY) April 7, 2014

    OK, NY was at 453,386 Medicaid and 412,101 QHPs as of 3/31, so this means they've added 9,782 QHPs and 33,303 Medicaid enrollees in the 6 days since then.

    That's 1,630 QHPs per day, which is actually very close (97%) to the 1,683/day that they averaged back in February.

    IF that's typical nationally (and that's a huge if), then that would suggest around 32K/day or around half a million total by 4/15...which is right at the low end of my new, lowered projection of 7.6M.

  • OK, so I may have gotten people's hopes up a bit too much with the 8M by 4/15 thing. Still, 7.6M or higher would still be awesome, and the two reports which were sent my way this AM should more than make up for my lowered projection.

    First up is this from the Motley Fool, regarding hospital readmission rates, especially among Medicare recipients:

    After hovering around 19% for years, hospital readmission rates began dropping beginning in 2012 and continued to do so into 2013. (The above chart reflects data through August of last year.) The national rate appears to still be falling considerably this year based on the latest data from the Centers for Medicare and Medicaid Services, or CMS. 

    Readmissions cost U.S. taxpayers a pretty penny. The federal government estimated that hospital readmissions for just Medicare patients has historically added up to $26 billion annually -- $17 billion of which could be avoided. 

  • (Sigh) See, this is why, when I said "I'm not gonna do the prediction thing this time" I should have stuck with that.

    Dan Pfeiffer's statement about "200K this week" on Meet the Press yesterday (which was down about 1/3 from what I was figuring) got me thinking about the contrast between his statement and Peter Lee's (head of CoverCA) statement about CA having around 250K potential QHP enrollees in the queue.

    It just occurred to me this morning that while my assumption about the number of applications is probably correct, my assumption about the number of individuals covered by those applications could be way too high...because that assumes that each application includes my standard 1.8x multiplier for spouses & kids in the household.

  • I don't have Sirius XM myself, but if anyone does, I'm scheduled to be a guest on "Left Jab" this evening, sometime between 7pm - 9pm. It's apparently on Channel 127.

    I assume it'll be available as a podcast afterwards...

    UPDATE: Nothing like having your kid banging on the door and shouting at you while you're on a live radio broadcast (sigh)...

    Anyway, for anyone interested, the podcast of the show should be available around 9:30pm Eastern or so.

  • This is more of an updated/simplified version of my post from a couple of days ago. As I said, I'm not going to set up an elaborate spreadsheet and try to micromanage the projection data for the next 10 days the way I did during the regular enrollment period. Instead, I'm just going with a lazier, more general estimate: Based partly on the California data given by Peter Lee (500K partly done applications in under the 3/31 wire, half of which are likely Medicaid-bound), I'm figuring that total exchange QHP enrollments gonna end up somewhere around 900K total, for a nice round 8M by the end of April 15th. Perhaps a little higher (1M even?).*

    As always, I'll be more than happy to be proven wrong, as long as I've undershot the mark :)

    This breaks down to around 60K per day x 15 days, which is what I'll be tacking onto the Spreadsheet & Graph until the actual total comes out.

  • Oh for heaven's sake. Having grudgingly given up on the general "But how many have PAID????" argument (answer: around 85%, plus another 8% or so who will pay by the time they actually receive the bill or shortly after it's, you know, actually due), and having conceded some ground on the "But how many were UNINSURED???" argument (answer: At least 33% of the first 6 million, more likely a good 40% or more when the additional 1.1M+ are added in, and possibly even as high as 49% by some right-winger's own admission...see below), at least one Forbes writer openly opposed to the ACA is now moving onto the next tactic: Combining the remnants of these two arguments, Voltron-like, into a new talking point:

    "OK, most people have paid, and a high percentage of the total may be newly insured after all...but how many of those who are newly insured have paid???"

    That's right, this is where they're trying to move the goal posts.

  • Hmmmmm...not sure what to make of this update out of KUNM in New Mexico. NM only had 18,691 exchange QHPs as of 3/15, so 51.4K would be absolutely insane (a 2.75x increase). It looks like they've mixed the SHOP enrollees into the mix, which means it's not quite that crazy--take those out and the QHPs are down to 37,400, or a "mere" doubling of the existing total. So...I guess that makes sense.

    HOWEVER, this causes bigger questions, because the only data I've had for New Mexico's SHOP exchange was a mere 524 as of March 18th. How the hell did they manage to enroll 28 times as many people in the next 13 days???

  • Simple and to the point (it's Twitter, after all). Also, 95% paid. Looking more and more like my 93% rule of thumb may actually be overly conservative (pun intended):

    Updated @MNsure enrollment numbers: 47,046 QHPs, 35,603 in MinnesotaCare and 92,402 in MA. Total of 175,051.

    — MNsure (@MNsure) April 4, 2014

  • I don't usually write this all out, but given the interest in the site these days, I figured I would give a play-by-play of the process of breaking down the CMS reports by state, using the February CMS report just released an hour or so ago.

    First, skip to Pages 12-16, where you can see the grand total for February (which, unlike the HHS reports, covers February 1-28 itself, none of this "Saturday closest to the end of the month" business):

    • Expansion States Subtotal: 1,303,676
    • Non-Expansion States Subtotal: 945,444
    • Total: 2,249,120

    Hmmm...that looks like a lot less than 3 million to me. The main reason for the missing 750K is because some of the new enrollments ran through the ACA exchanges (HC.gov/etc) while others went through traditional means (walking in the door of a state Medicaid agency office, etc). Furthermore, some of the states overlap--they're reported on both reports, which means I have to be careful not to double-count:

  • Unfortunately I don't have a link to the actual report yet; Politico just did one of their "Breaking News" things for now. Apparnetly it's slightly below 3M Medicaid/CHIP enrollments in February, for a total of 11.7M since October 1st. HOWEVER, not all of these are new (some are renewals), and others may be part of the "baseline churn" so it's not a simple matter of tacking on 3M to the total.

    Watch this post for updates once I actually hunt down the PDF of the report itself...

    Remember, this is for Februarynot March. The March CMS report probably won't be out until the first week of May, and possibly even later (I'm assuming it'll be even more of a PITA to compile, given the craziness at the end of March...)

    Meanwhile, the HHS report for March, which is the one which will confirm/clarify the big 7.1M exchange QHP figure (along with the other half of the Medicaid data) should be out sometime next week...although again, it might be delayed due to the March rush.

    UPDATE: OK, I have a copy of the report now!

  • Sean Parnell sent me a clarification of the 64.6M Medicaid number out of Rhode Island from the OHHS in Rhode Island (which did seem a bit high to me, but surge and all...)

    New Medicaid enrollment figures through March 31, 2014

    Medicaid enrollment:  64,590 (through HealthSource RI from October 1, 2013 through March 31, 2014)

    Of that number, 42,320, or 65.5 percent, represent adults in Medicaid’s new eligibility group, adults 19-64 without dependent children who were not previously eligible for Medicaid but became eligible on January 1, 2014.    The new eligibility group is authorized under the Affordable Care Act’s Medicaid expansion and is financed with 100 percent federal dollars for its first three years, 2014-2017.

    The other roughly one-third represents those enrolling who were eligible for Medicaid under previously existing rules.

    Unfortunately they don't specify how many of the remaining 22.5K are renewals vs. "woodworkers". I'm going to go with about half (11K, or around 17% of the 65K total) unless I receive further clarification one way or the other. This reduces the current "woodworker" estimate of 16.6K by about 5,600.

  • OK, this one is actually semi-legitimate, depending on your perspective.

    According to Glenn Kessler of the WaPo, when the CBO crunches the numbers next year to see how many 2014 ACA Exchange QHPs actually did qualify as being counted towards their 7M (then 6M) projection, they're actually going to have to slice up every single person enrolled into 12ths.

    That is to say, if your policy started coverage in January and was paid for straight through until the end of the year, you'll be counted as one "CBO person", but if it didn't start coverage until, say, April 1st, you'd only be counted for 9 months, making you 3/4 of a "person" in CBO terms.

    Needless to say, not only does this complicate matters considerably, it also means that when the CBO releases their full-year 2014 report next year (January? February?), it may look something like the following:

  • A lot of people have asked me if I plan on doing a 4/15 QHP projection. Honestly, I'm a little burnt out at the moment and need some chill time on the prognosticating thing. However, if this news is any guide, it could be huge:

    Now topping more than 3 million, the number of Californians who have enrolled in a private health care plan or in Medi-Cal through the state's health insurance exchange will likely rise by about 500,000 people who started but did not finish their applications by Monday's midnight deadline, exchange officials said Thursday.

    At a news conference, Peter Lee, executive director of the Covered California exchange, told reporters that of the half-million individuals who had started their applications in the last week of March, at least 20,000 had finished their applications by Tuesday.

    Now, I'm assuming that "finished their applications" in this case actually means "enrolled", because 500K / 15 days = 33,333 per day if they plan on squeezing that many in under the new 4/15 wire.

  • Now that we're past the official Open Enrollment period, I've overhauled The Graph with some major changes & updates. These include:

    • By popular request and much pondering (see comments at bottom of link), I am no longer subtracting the 3.7M Cancelled Policies from the grand total. However, these are still clearly and prominently noted in the yellow box.
    • As promised, I have lowered the "Sub-26er" bottom-end estimate again, from a low of 2.2M to 1.6M. I'm done mucking around with this until further notice.
    • With the official announcement of a whopping 1.7M OFF-exchange QHP enrollments from the BCBS Association, I have increased the documented off-exchange total to 2.17M on the graph, causing a noticable spike at the end (obviously these weren't all enrolled in today, but I can't really back-date these so they're all added at once).
    • Note that I've also deleted all of the state-specific BCBS off-exchange QHPs since the 1.7M total noted above supercedes all of them.
    • Since the 9M total off-exchange figure credited to the Rand Survey was a very rough estimate (see update at bottom of link), I've added an "up to" caveat (and the 6.83M balance isn't on the graph itself anyway).
    • I've replaced the 7M arrow with 6M and 7M lines to reduce the clutter.
    • Finally, the most controversial change is probably the removal of the "documented unpaid" exchange QHPs (as well as the "estimated additional" QHPs; instead, I've simplified things greatly by separating the total Exchange QHP number into 2 areas: 93% estimated PAID (or will pay soon) and 7% UNPAID (or may not pay).
      I'll be happy to revise this 93 / 7 ratio one way or the other as more data comes in, but for now, based on all the partial "Paid/Unpaid" data I've seen to date, that seems to be fairly accurate.
  • About 5 different people have sent me a link to this new study by the Urban Institute, which concludes that the total number of uninsured adults in the U.S. has been reduced by around 5. million people since last fall.

    They're pretty clear about the time period: it runs from just before the exchanges launched until...well, actually, until early March (more on this below):

    The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014.

    The results? According to this study, it's a net reduction of 5.4M uninsured:

  • As deaconblues reminds me, the 29K is in addition to the 720 subsidized enrollees that they've managed to get through their messed-up system.

    Massachusetts will not meet its goal of moving more than 200,000 people into insurance plans that comply with the federal law by the end of June. It has managed to enroll about 29,000 residents in unsubsidized coverage, 138,000 in temporary coverage, and another 114,000 in extended coverage since the October launch of its new website, with a significant number applying on paper, said a Connector spokesman Thursday.

  • Presented without comment (and again, I'm NOT endorsing eHealth, but they're obviously going to come up in conversation a lot since they're essentially a private version of HC.gov without the subsidy factor):

    First, don’t believe polemicists who argue that 70% or more of buying policies at HealthCare.gov had insurance already, as Republicans claim, in an interpretation of a McKinsey & Co. study that Politifact ruled “false.” Even at eHealth, which has almost no subsidy-eligible customers so far, 51% of clients this year were previously uninsured, up from 34% in late 2013, Lauer said.

    With 83% of the people using HealthCare.gov and the state exchanges eligible for subsidies, it’s highly unlikely that they’re going to skew more heavily toward the being previously-insured than eHealth’s crowd.

  • Oregon appears to be purging their old unpaid enrollments, for cleaner totals (along with the dental enrollments, which even I haven't really talked about)...I'm assuming this is through yesterday. Note that the Medicaid number doesn't include an additional 128K enrolled via their "Fast Track" program from earlier:

    April 3, 2014 Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

    • Medical enrollments through Cover Oregon: 200,165
    • Total private medical insurance enrollments through Cover Oregon 1: 58,833                      
    • Oregon Health Plan enrollments through Cover Oregon: 141,332
    • Total private dental insurance enrollments through CoverOregon 1: 12,066                       

    Net enrollments 

    • Net private medical:  55,833
    • Net private dental: 11,208

    Background: With three months of open enrollment completed, Cover Oregon is expanding the enrollment report beyond what is required by the federal Center for Consumer Information & Insurance Oversight to include net private insurance enrollments and also dental enrollments. 

  • Hawaii makes a correction by separating out their SHOP enrollees...

    Connector Updates for March 31, 2014

    • Total since October 1, 2013:
    • 24,176 Applications completed in the Individual Marketplace
    • 7,596 QHP Enrollments in the Individual Marketplace
    • 1,280 attestation forms filled out
    • 544 Employers applied to SHOP Marketplace
    • 265 QHP Enrollments from the SHOP Marketplace
  • OK, this is why CoveredCA was holding off on announcing their numbers: Peter Lee had to testify before Congress today anyway:

    Enrollment in Covered California private health insurance plans hit 1,221,727 through March 31. In fact, March was the highest single month of enrollment, with more than 416,000 people signing up for a health insurance plan.

    ...Medi-Cal enrolled approximately 1.9 million people through the end of March, including 1.1 million through the Covered California portal and county offices, approximately 650,000 former Low Income Health Program (LIHP) members who were transitioned to Medi-Cal by the California Department of Health Care Services (DHCS) and 180,000 individuals who applied through the state’s Express Lane program.

    In addition...

  • And there we have it: Glenn Kessler of the Washington Post reports that BCBSA (the family of Blue Cross companies, as well as Anthem, Regeant, etc) confirms 1.7 million ACA-compliant QHPs sold OFF-exchangenationally from October 1st through March 1st (that's right, the rest of March isn't included; for comparison, March made up 40%of the exchange QHP total for the open enrollment period):

    Newsy: BlueCrossBlueShield companies sold 1.7 million ACA-compliant policies OFF-exchange between 10/1-3/1. #obamacare

    — Glenn Kessler (@GlennKesslerWP) April 3, 2014

    @charles_gaba @Cripipper no link. I had been asking for the data and I got it the old fashioned way--a phone call.

    — Glenn Kessler (@GlennKesslerWP) April 3, 2014

  • Since I'm shifting the "Paid/Unpaid" tally to a simplified "93% Paid or Will Pay Within a Reasonable Time" model, I'm no longer distinguishing the paid/unpaid factor for states which do so (although I am still listing them when released by the states):

    Enrollment data (Oct. 1, 2013 through March 31, 2014)

    Total HealthSource RI enrollments (including those who have not yet paid): 27,961

    Paid enrollments: 21,097

    Medicaid enrollments (per EOHHS): 64,590

    Small employer applications initiated: 1,319

    Small employer enrollment: 175 (based on their submitted census, these employers represent 700 covered employees and 1,110 covered lives)

    Small employers who enrolled in Full Employee Choice: 103

    • Thru 4/02: QHPs: 63,002
    • Thru 4/02: Medicaid: 232,075 (295,077 - 63,002, includes one-time PAC transfers)

    O’Malley points out that despite the problems, Maryland exceeded its overall enrollment goal of 260,000. As of Tuesday night, that number had hit 295,077. It includes people who have enrolled in private plans (which has dramatically lagged expectations) and Medicaid (which has exceeded expectations).

    ...Sharfstein said in late February that a more accurate projection is 75,000 to 100,000 private enrollees.

    As of Tuesday evening, there were 63,002, with hundreds or thousands more expected to finish their applications in coming weeks.

  • As a follow-up to my follow-up last night, HuffPo healthcare reporter Jeffrey Young tweets:

    About 3/4 of the 28K @HealthSourceRI enrollees had paid a premium as of 3/31. People who signed up after 3/23 have until 4/23 to pay.

    — Jeffrey Young (@JeffYoung) April 3, 2014

    @asymmetricinfo And the paid rate through 3/8 was 83%, including people whose bills were due later.

    — Jeffrey Young (@JeffYoung) April 3, 2014

    Interim CEO of @MNsure, Scott Leitz, to tell U.S. House subcommittee that 95% of its 47,000 enrollees have paid, and the rate will rise.

    — Jeffrey Young (@JeffYoung) April 3, 2014

  • OK, looks like I completely misunderstood the Vermont figures from a few days ago; half of them were supposed to go on the Medicaid side after all. From a source at the Vermont Health Connector:

    In the meantime, I can provide the enrollment figures: 48,150 are fully enrolled in a plan through Vermont Health Connect; 25,930 of those enrolled in Medicaid or Dr. Dynasaur, our CHIP program.

    Doesn't impact the overall national total, but it does change the dynamic for Vermont to something...rational (prior to this it looked like they had hit a whopping 585% of their year 1 target!

    This means 22,220 QHPs and 25,930 Medicaid.

  • The Hawaii Health Connector has enrolled 7,861 individuals as of the March 31 deadline, with another 24,176 who completed applications for coverage through the state-run online health insurance exchange. 

    ...It is important to note there are only about 50,000 uninsured people in Hawaii who are not deemed Medicaid eligible, which makes Hawaii’s market small compared to other states.

    ...Kayla Rosenfeld, spokeswoman for the state Department of Human Services, told PBN on Wednesday that since Oct. 1 — when the department launched its new online eligibility system KOLEA— net Medicaid enrollment in Hawaii has increased by 46,605, which is close to the expected increase of 48,000.

  • Van Pelt highlights the more than 300,000 "enrolled in health care coverage since October thanks to Cover Oregon ... and the Oregon Health Authority."

    That figure includes:

    • 55,000 people enrolled in private plans using the backup manual processing system set up to cope with the exchange's technology issues.
    • more than 120,000 people enrolled into Oregon Health Plan after the exchange forwarded their information to the state for processing, a workaround for the exchange's broken Medicaid interface.
    • 125,000 people enrolled directly into the Oregon Health Plan using a streamlined system set up to bypass Cover Oregon.
  • OK, this just adds to the confusion over the "extension periods"...not only is Kentucky joining the "you have until 4/15 if you started by 3/31" brigade, but it appears that they're also allowing people to start the application/enrollment process between 4/4 - 4/11 as well:

    Gov. Steve Beshear announced Tuesday that the state will extend its deadline. People will be able to file for health insurance from April 4 to April 11.

    The official deadline had been midnight March 31. Gwenda Bond, spokeswoman for the Cabinet for Health and Family Services, said 21,000 people signed up over the weekend, including 12,000 people who signed up Monday. The deadline affected only those signing up for private health insurance, because those eligible for Medicaid can apply at any time.

    Because of the high demand, Bond said, state officials decided to add additional days for enrollment or a "special enrollment period." The days between the March 31 deadline and the special enrollment period will allow for some tweaks to the technical system to allow for the extension, she said.

    Huh. Good for them, but if that's the case, why not just bump this out to 4/15 and be done with it? Weird.

  • Up from 1,300...

    So far, 198 companies have bought SHOP policies for 1,770 covered lives — both their employees and their employees’ dependents, Sugden said. That's less than a large state like California, but ahead of other states that have not even been able to launch their small-business exchange, he said.

    ...The SHOP is attracting about 40 new companies per month right now, a number that will continue to rise because companies can continue to buy policies throughout the year, he said.

  • Why the heck Nevada couldn't have posted the 3/31 total instead of tacking on 4/1, I have no idea, but what the hell; it's starting to look like I'll have to wait for the HHS report in order to get the precise monthly figure anyway (assuming they don't move the 30th & 31st over to April's report, that is...)

    Update as of 4/1: 41,823 Nevadans confirm Qualified Health Plan Selections through http://t.co/k2YKIcssBl. 25,899 paid to date.

    — Nevada Health Link (@NVHealthLink) April 3, 2014

  • Regular followers may recall that a couple of weeks ago, in response to a Glenn Kessler "Fact Checker" article, I ended up converting the "Sub26er" tally from a solid 3.1 million figure (the number touted by Pres. Obama and the HHS Dept. for months) to a "range" setup, similar to the other enrollment figures.

    Kessler's argument was essentially that the quarterly reports comparing the number of 19-25-year-olds on their parent's plans between 2010 and 2013 fluctuated greatly from one quarter to another, and that therefore instead of taking one particular quarter and measuring it against another (which is where the 3.1M figure came from), it would be more rational to take the averages for the full years and compare those against each other. Based on this, he came up with a range of 2.2M - 2.8M, instead of 3.1M solid.

  • Over the past month or so, several researchers, reporters and other data nerds have inquired about whether I'd be willing to open up the QHP and Medicaid spreadsheet permissions to let people export them to Excel. It was always my intent to do this once the 3/31 deadline was past. However, a few things complicate this.

  • OK, now that we're over the hump of the 3/31 "official" open enrollment deadline, it's time to take a look at the "But how many have PAID???" fuss again.

    I've been trying to decide whether my "90% either Paid or Unpaid for Legitimate Reasons" rule of thumb seems valid, or whether I should bump it up...or down.

    An article up in today's National Journal states that according to the Blue Cross Blue Shield Association, their Paid Enrollee figure is around 80 - 85%...for policies from October, November, December and the first half of January.

    On the one hand, this is significant for two reasons: First, because the BCBSA is huge; I don't know their collective marketshare, but it's big (they include Anthem/WellPoint, the various Blue Cross companies such as Highmark, Regence and so forth). I dunno...maybe 30% or more of the market in total?

    Secondly, according to the article, this specifically refers to policy premiums which are well past-due. That is, policies which started either January or February 1st. This does not apparently include more recent enrollments (those from late January, February or March):

  • A few weeks back (upon my request) I was sent updated enrollment data (both on- and off-exchange) from CoOportunity Health, which operates in Iowa and Nebraska.

    Earlier today (upon my semi-request...that is, I had asked about it a couple of weeks ago but kind of forgot about it), I was sent a press release for Blue Cross Blue Shield of Michigan, which included their ACA Open Enrollment data breakdown (well, most of it...I had to have them clarify the rest).

    A few minutes ago, without any doing on my part, eHealth Insurance (which I've written about a couple of times for off-exchange data, and which is actually a broker, not an insurance company themselves) tweeted out a link to one of my stories about them.

  • A lot of good info here, mostly about off-exchange enrollments, but also about the "Paid/Unpaid" question:

    That total breaks down as 27,968 individuals who used HealthSource RI to sign up for plans from Blue Cross or Neighborhood Health Plan of Rhode Island, along with 11,271 who bypassed HealthSource and boughtObamacare-compliant policies directly from Blue Cross, the two organizations told WPRI.com.

    Those 11,271 direct-purchasers are important to Blue Cross because they will be combined with those who bought through HealthSource RI to make up the insurer’s 2014 risk pool for individual insurance. The size and shape of the risk pool is crucial to determining how much premiums will cost.

    ...Roughly four in five of those who bought insurance through HealthSource by March 8 had paid their first premiums at that point.

  • OK, this hasn't become an issue yet, and perhaps I'm deluded about my importance by thinking that it might, but I figured it would be a good idea to post it "on the record" just in case it ever does.

    I am a not a professional journalist. I don't work for the AP, Reuters or any other media organization. I wasn't even a "freelance journalist" prior to this project, unless you count my rants over at dKos as journalism (in a few cases they might have approached it). I'm a web developer and a blogger. Yes, I've received some donations (thank you again to everyone who has helped out!), but that's a voluntary, unofficial sort of thing. This is where the whole "blogger/journalist" fuzziness comes into play.

    I am also not a lawyer, so I have no idea what, if any, legal obligations I'm under when it comes to "disclosing sources" or "keeping confidences". I haven't signed any nondisclosure agreements with anyone, nor do I plan to. I found this primer on the issue from Slate, way back in 1999, and it doesn't help me much.

  • So, I just received a press release from Blue Cross Blue Shield of Michigan (BCBSM), which includes a bunch of data covering the full open enrollment period.

    The key part for me is this:

    DETROIT, April 2, 2014 – At the close of the six-month ACA Marketplace open enrollment period, Blue Cross Blue Shield of Michigan and its HMO subsidiary, Blue Care Network, were selected by more than 300,000 Michigan consumers.

    ...BCBSM will report final, confirmed numbers later this month once all enrollments are processed and tabulated by the federal government.  The results announced today are initial figures based on reporting by the federal government and BCBSM’s records:

    • 180,000 members enrolled with BCBSM and BCN “on-Marketplace,” meaning through Healthcare.gov.
    • 53,000 members enrolled “off-Marketplace,” meaning directly through the companies.

    However, this is a bit confusing, because there aren't any other enrollment numbers listed. 180K + 53K = 233K. If the total is over 300K, where are the other 67K?

    In addition, this doesn't make any sense either:

  • OK, I don't mean to sound full of myself, and it's a fine article, but it's a bit amusing to see the reporter refer to "politicians and policy makers" as being the only ones who have "largely overlooked" off-exchange enrollments.

    Millions of newly insured people are hiding in plain sight.

    They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions.

    Politicians and policy makers have focused on the number of people who signed up through the exchanges — at nearly seven million and counting a day after the March 31 deadline — but they have largely overlooked the group that did not use the exchanges, even though it could have a major impact on the program’s financial success in the years ahead.

    This leads to the main point of this entry.

  • Well this one came out of nowhere...it doesn't seem to be an April Fool's joke. It makes little sense, however...why would FL's be extend to 4/30 when the other 35 Federal-Exchange-run states are all cut off at 4/15? And what's with the April 7th "paper" application bit? Weirdness.

    The open enrollment period for health insurance coverage for Floridians under the Affordable Care Act is extended through April 30 for people whose paper applications are received by April 7.

  • The QHP number (80K) looks about right, but that 67K Medicaid number bears no connection whatsoever to the existing number (91,115). On the other hand, AZ has some sort of unusual situation going on with their Medicaid program anyway, so I'll leave that one alone for now.

    As of March 1, the enrollments were behind projections, with just about 58,000 enrolled. But Plese said she’s seen unofficial figure that show the number rose to about 80,000 by mid-March.

    Another 67,000 who used the federal site had been determined to be eligible for Medicaid.

  • And now we enter the Bonus Round!

    That's right, Medicaid Expansion finally came to Michigan starting today, April 1st, 2014:

    Enrollment began Tuesday for Healthy Michigan, which extends Medicaid eligibility to adults making up to 133 percent of the federal poverty level, or about $16,000 for an individual and $33,000 for a family of four.

    By 4 p.m. Tuesday, 11,848 applications had been received, and 4,152 had been automatically approved, according to the Department of Community Health. The state expects 320,000 residents to sign up in the first 12 months. The number could grow as high as 470,000 over time.

    I actually have Michigan down as having up to 500,000 people qualifying for expansion, but whatever. I'm not entering this into the spreadsheet or anything yet; I really want to lock down the March numbers before I start up with the April ones. However, it was at least worth mentioning, especially since this is my home state and all... :)

  • OK, in addition to the appx. 7.041 million enrollments on the Federal exchange (HC.gov), I've brought CO, CT, DC, HI, KY, MD, MN, NY, RI and WA completely up to date, with all QHP data through midnight on 3/31 (some of the Medicaid/CHIP data is still missing, but that's a lesser concern at the moment).

    However, I'm still missing the following exchange QHP data:

    • California: 22 hours (that's right...the current tally runs thru 2am on 3/31)
    • Massachusetts: 3 days (current is thru 3/28)
    • Nevada: 2 days (current is thru 3/29)
    • Oregon: 3 days (current is thru 3/28)
    • Vermont: 1 day (current is thru 3/30)

    I can't tell you how frustrating it is to be this close to full data while still missing it.

    So, how much is actually missing? Well, if these states were running at their prior average March daily rate, it would be

    • CA: 11,754
    • MA: 512 x 3 = 1,536
    • NV: 427 x 2 = 854
    • OR: 502 x 3 = 1,506
    • VT: 775
    • Total: 16,425

    However, this obviously doesn't apply since the final weekend and especially yesterday were insane.

  • Without the final day's numbers, this update is both helpful and frustrating, because it's so close yet so far away. The QHP number is actually somewhat lower than I had thought a few days ago (not that I'm complaining; HC.gov more than took up the slack, and CA was going nuts on the final day anyway...which is why I'm so anxious to get the data from the 31st):

    Consumer interest in Covered California has been strong, with 1,209,791 Californians signing up as of 2 a.m. March 31. From March 24 through 2 a.m. March 31, 155,988 individuals signed up for coverage. During the same week, 389,840 accounts were started — including 123,787 on Saturday and Sunday, as consumers hurried to meet the deadline.

    “We’ve set records on accounts created five of the past six days,” Lee said.

  • Maryland's exchange may be a mess, but this article gives solid, no-nonsense totals: 60K QHPs and 232K Medicaid through 3/31.

    Sharfstein provided updated enrollment numbers on Tuesday. He said the state enrolled 60,003 people into private health plans. The state initially hoped to have 150,000 enrolled in private plans. O’Malley has tried to offset the disappointing private plan enrollments by highlighting a higher numbers of Medicaid enrollments through the federal Affordable Care Act. Sharfstein said Tuesday that 232,025 have been enrolled in Medicaid. The state’s goal of total enrollments was 260,000.

  • Excellent find by contributor deaconblues; HighMark is one of the few major insurance companies which has been very open about their off-exchange QHP enrollments. This press release contains some great updates for 3 different states, including a total exchange QHP update for West Virginia (since HighMark is the only insurance company operating on the exchange there anyway):

    Highmark's total enrollment* for individuals who have purchased Affordable Care Act-compliant plans both on the federal marketplace exchange and through Highmark directly:

    Pennsylvania: 148,003 total with 104,324 on-exchange and 43,679 off-exchange
    West Virginia: 20,131 total with 14,839 on-exchange and 5,292 off-exchange
    Delaware: 13,010 total with 9,187 on-exchange and 3,823 off-exchange

    Through both on- and off-exchange purchases, Highmark had a noteworthy percentage of new members, which are likely those who were previously uninsured or had insurance with a competitor.

    Pennsylvania: 53 percent new members
    West Virginia: 63 percent new members
    Delaware: 67 percent new members

  • Not exactly a glowing review of Hawaii's performance, but the final 3/31 number is higher than before, anyway (I'm going with 7,990 as "under 8,000" for now)...no Medicaid news here, however:

    April 01--As of Monday, the deadline for signing up for Obamacare coverage, fewer than 8,000 Hawaii residents had successfully enrolled, among the lowest in the nation.

    ...The Connector said it had 22,000 apply as of March 22. Those who applied but did not finish the process have the opportunity to complete their applications even though the deadline has passed.

    ...Kataria said there are more than 11,000 Connector applicants being held up because of the problem with DHS.

    ...DHS said it only agreed to collect information necessary to make a Medicaid determination and isn't required to collect additional data for the Connector.

  • OK, the kind folks at KynectKY have helpfully cleared up their final 3/31 numbers:

    Kynectky Here is what I have. This is as of 7:00AM 04-01-14.Total QHP Enrollments: 77,044; Total MCO Enrollments: 294,221.

    UPDATE: I've been so busy plugging these numbers into the spreadsheet that I haven't had a chance to see what the true impact is...and in Kentucky, it's nothing short of amazing:

    Obamacare has cut Kentucky's uninsured population by more than 40 percent, signing up roughly 360,000 residents since enrollment opened up on Oct. 1, according to the Louisville Courier-Journal.

    Some 75 percent of them -- 270,000 -- were previously uninsured. That means Kentucky's uninsured population of 640,000 has come down by 42 percent.

    UPDATE: (sigh) OK, another very slight update:

  • Washington State gives the official 3/31 total (except for Medicaid, which is still missing a few days):

    Enrollments Completed

    Qualified Health Plans: 146,497

    Medicaid Newly Eligible Adults (through March 27): 268,367

    Medicaid Previously Eligible but not Enrolled (through March 27): 135,485

    Medicaid Redeterminations (Previously Covered - through March 27): 408,086

    Total: 958,435

    *Note: These numbers reflect enrollments and applications through March 31.

  • Connecticut reports their 3/31 totals...just shy of their 200K upgraded goal, but still very impressive:

    A total of 197,878 residents secured a policy through the system, including 76,597 with a private carrier and 121,281 in Medicaid. Since open enrollment began last October, Access Health CT logged 801,509 unique website visitors. 

  • New York joins the 3/31 Final club ("9am" appears to include enrollments through midnight the night before, which makes sense...takes awhile to fully process/etc...) 

    Just out from @NYStateofHealth: As of 9 a.m. today, Total enrollments: 865,487 Medicaid: 453,386 Private: 412,101 cc @charles_gaba

    — Charles Ornstein (@charlesornstein) April 1, 2014

  • So far, I've entered the final 3/31 Exchange QHP data for Colorado, the District of Columbia, Minnesota and Rhode Island. I also have inexact final numbers for Kentucky.

    I still need to update the final numbers for California, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, New York, Oregon, Vermont and Washington State.

    I'm sure all of these will come in later today or so. In the meantime, I'm taking a few minutes to actually breathe :)

  • Wow, a personal response from the KynectKY Facebook Page:

    Kynectky Charles Gaba Total QHP Enrollments = 73,080; Total MCO Enrollments = 286,222.

    I don't think this is the final 3/31 total, however, since this adds up to 359,302, which was posted as of around 4pm yesterday.

    However, they've also just announced another 12K "processed through 8:30am today", so I'm not sure whether those are counted as part of the 3/31 total or not. I'm going to assume that they were entered last night and just took a few hours to actually process fully...therefore they count towards the 3/31 tally (unless they clarify otherwise), using a 20/80 ratio of 2,400 QHPs to 9,600 Medicaid:

  • No final numbers or Medicaid, but it's something for the moment:

    According to preliminary numbers, approximately 140,000 people had purchased insurance plans through the state by the end of the weekend, said Michael Marchand spokesman for the Washington Healthplanfinder exchange. That’s a bump of about 9,000 people over four days.

  • The third state-based exchange (well...technically not a state) to release their 3/31 total is the District of Columbia. Fortunately, they specifically separate out the SHOP numbers:

    The DC Health Benefit Exchange Authority today released new data showing strong enrollment activity through DCHealthLink.com as of March 31st.  Since the marketplace opened for business on October 1, DC Health Link has enrolled 40,234 people. This includes District residents who enrolled in private health plans and in Medicaid, as well as people with coverage through their employers.  In the final week alone, more than 2,000 people enrolled through the individual and family marketplace -- accounting for over 21% of all individual enrollments in private coverage. 

    Enrollment

    As of March 31, 2014, 40,234 people have enrolled through DC Health Link in private health plans or Medicaid:

     9,838 people enrolled in private health plans through the DC Health Link individual and family marketplace;
     17,489 people were determined eligible for Medicaid coverage through DC Health Link; and
     12,907 people enrolled through the DC Health Link small business marketplace.

  • The headlines are all buzzing with the announcement of the official grand total of exchange-based QHPs as of midnight yesterday: 7,041,000:

    How many people have signed up for private coverage under Obamacare? 7,041,000, White House Press Secretary Jay Carney announced Tuesday afternoon.

    But wait, what's this?

    That number is likely to rise: It does not include the Monday sign-ups in the 14 states operating their own marketplaces. In addition, the enrollment deadline was relaxed for people having trouble completing the process, so some people could still sign up in the next two weeks.

    Yup, just as I suspected this morning:

    IF I'm interpreting Mr. Park's words correctly, he's saying that the grand total of exchange QHPs was brought over the 7 million mark even without including the state exchange enrollments for the day.

    So, how many more did the 15 state exchanges (well, 14 + DC) bring in?

  • Here comes state exchange number 2...Minnesota!

    ST. PAUL, Minn.—MNsure successfully enrolled 169,251 Minnesotans into comprehensive, affordable health insurance plans as of midnight on March 31, bringing the 2014 open enrollment period to a close, MNsure announced today.

    “More than 169,000 Minnesotans have enrolled for health coverage through MNsure, blowing past our projection of 135,000 in October,” said MNsure’s interim CEO, Scott Leitz. “I am extremely proud of the MNsure staff who worked tirelessly, often sacrificing time with family over the last year to get Minnesotans enrolled in coverage. Our mission every day has been to make health insurance coverage possible for those Minnesotans who are uninsured and underinsured, including those who have been denied coverage up to now due to pre-existing conditions. Though the rollout of MNsure has not been perfect, we have worked hard to make critical improvements—which we will continue to do through the spring and summer, leading up to our next open enrollment period in November.”

    To date, MNsure has enrolled 47,046 Minnesotans in a Qualified Health Plan, 34,219 in MinnesotaCare and 87,986 in Medical Assistance.

  • Here we go...Rhode Island is the first state-based exchange out of the gate with an (unofficial, but specific) final tally of 3/31 QHP enrollments: Nearly 28,000 by midnight yesterday.

    HealthSource RI spokeswoman Dara Chadwick said 27,968 individuals signed up for private plans through the new marketplace between Oct. 1 and the 11:59 p.m. deadline for 2014 enrollment, 1,840 of whom signed up Monday. The number is expected to rise as those who encountered technical difficulties or weren’t able to speak to a representative on Monday finish getting processed.

    There's no update on the Medicaid number since March 8th, unfortunately, but this still locks down at least one key number. More to come, no doubt...

  • Holy smokes.

    From April Ryan, whose "HHS major scoop" batting average is now two out of three (at least since I started following her, anyway):

    At 12:01 AM, White House Chief Technology Officer Todd Park acknowledged to QSSI, the Columbia, Maryland firm tasked with fixing Healthcare.gov that the ACA enrollments have surpassed the 7 million mark.

    OK, that's pretty cool, but what's with the "holy smokes"? Well, when you listen to the audio clip of the countdown/7M announcement (and do so at the link...it's pretty cool), Todd Park states the following (emphasis mine):

  • Good Morning.

    "Outstanding Numbers" has two meanings: The first, of course, is that in spite of everything--the terrible website launch of HC.gov and some of the state sites; the still-terrible status of some of the state sites even now; the actively-hostile opposition and obstructive actions in certain states, the negative spin on every development by some in the news media--in spite of all of this, over 7 million people nationwide enrolled in private, ACA-compliant healthcare plans between 12:01am on 10/1/13 and 11:59pm on 3/31/14...slightly surpassing the original CBO projection for that period.

    There's the usual discussions about "But how many have PAID???", "But how many were ALREADY INSURED???", "How many were YOUNG???" and "What METAL LEVEL did they get???" etc etc etc. All of these are reasonable questions for actuaries, accountants and so forth to ask, and the answers will indeed help shape our understanding of what the overall economic and health impact of the law will be.

    For the moment, however, none of that matters. This is an outstanding number any way you slice it.

    • 7.08 Million Exchange-based QHPs (estimate)
    • + 71,000 SHOP QHPs
    • + 9.0 Million total OFF-Exchange QHPs (estimate from the Rand Corp.)
    • + 4.71 Million New "Strict Expansion" Medicaid enrollees
    • + 1.80 Million New "Woodworker" Medicaid enrollees (estimate)
    • + 3.10 Million 19-26 Year Olds on their Parent's Plans (estimate)
    • - 3.70 Million Cancelled Non-Compliant Policies
      (see? I told you I'd subtract these once I knew the total number of off-exchange QHPs!)

    = appx. 22.1 Million People (at the high end) or 14.6 Million (at the low end)

    Of course, you can quibble about how many of the 9 million off-exchange QHPs were previously uninsured, or how many of the cancelled plans were swapped out with QHPs from the exchanges vs the off-exchange amount. You can quibble about whether the "sub26ers" should be 3.1 million or only 2.5 million. You can argue bout whether "woodworkers" should "count" or not (as if a massive outreach campaign which encourages previously-eligible people to enroll in a program they qualify for isn't an accomplishment to be proud of). You can argue about whether unpaid QHPs should be counted (yet) or not.

    The bottom line is this: No matter how you slice it, this is a ton of people receiving decent healthcare coverage who either a) didn't have anything before or b) can no longer be dropped, denied or bankrupted by coverage that was scattershot, piecemeal or shoddy.

  • Given the Wyoming Sen. John Barrasso's accusation that the Obama administration is "cooking the books"
    and the epic meltdown that Sean Hannity had earlier today, this came to mind...

  • More great news: Specific numbers out of New York, and apparently the 826K figure included about 6K more QHPs than I thought (and 6K fewere on Medicaid, of course):

    Since the state website launched on Oct. 1, 826,812 people had signed up for coverage as of 9 a.m. Monday, with 436,304 qualifying for Medicaid and 390,508 obtaining private insurance, she said.

    In addition, while I thought the extra 14K total was between 9am and this evening, according to this article 826K was actually the 9am figure, meaning an even higher eventual total. Doesn't really matter at this point, I suppose; the final numbers will all come out soon...