END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Charles Gaba's blog

Things are quickly getting crazy as we go into the home stretch, so I wanted to take a moment to note a few milestones now just in case I get too frazzled to do so properly 3 weeks from now:

Exchange Milestones Reached as of Today:

(Sigh) Don't get me wrong, I'm glad Minnesota is staying on the ball with their updates but really, this is like 8 in the past 9 days or something...anyway, this one includes specific numbers for both categories, no messing with private/public ratios: 33,722 QHPs, 86,932 Medicaid.

Today, MNsure announced more than 120,000 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s health insurance marketplace. With an original goal of enrolling 135,000 Minnesotans, MNsure is on pace to meet or exceed that goal when open enrollment ends on March 31.

“We are averaging about 1,000 new enrollees every day,” said interim CEO Scott Leitz. “We anticipate we will continue, or improve this pace, keeping us on track to meet our original goal of enrolling 135,000 Minnesotans during this open enrollment period.”

The goal of enrolling 135,000 Minnesotans during the 2014 open enrollment period was discussed at the MNsure Board of Directors meeting on October 16, 2013.

No breakout between Private QHPs & Medicaid yet, but KY Governor Steve Beshear just announced that Kentucky has broken the 300K mark, adding an impressive 20,000 new enrollees in the last 6 days:

Congratulations, Kentucky! 300,000 people now enrolled in affordable health care through #kynect. Sign up by March 31 .@kynectky

— Steve Beshear (@GovSteveBeshear) March 13, 2014

Their last update had them at 57,090 QHPs and 223,378 Medicaid/CHIP, 280,468 total, so this is an increase of at least 19,532.

KY has recently shifted towards roughly a 17.5% QHPs / 82.5% Medicaid split. I'll assume a 15/85 with the newest batch for now, which brings the totals to 2,932 QHP / 16,600 Medicaid, for totals of over 60,000 and 240,000 respectively.

Looks like California is fully recovered from their ugly February outage, but they're still not quite up to where I thought they were this week:

#CoveredCA enrollment reaches 923,832 through March 9. 1 million just around the corner!

— Covered California (@CoveredCA) March 13, 2014

In addition, California's NEW Medicaid enrollee numbers continue to skyrocket, up from 877K (exchange) / 652K (bulk transfers/other) at the end of January to a whopping 1.136 Million + 968,500 = 2,104,500 total (!)

The wording of the 1.136M Medicaid number specifies that this is a combination of NEW enrollees as well as "ongoing caseload activity", which sounds to me like people who enrolled a few months earlier but are still having paperwork issues. Either way, it sounds clear to me that these are not "renewals (aka rederminations)".

A beautiful find by new contributor Uncle Toby: Highmark Inc., a major insurer which serves Pennsylvania, West Virginia and Delaware, just did exactly what I've been wanting every insurer to do: They officially announced not just their off-exchange enrollments, but specified the exact date that these run through and the fact that they're all 100% ACA compliant.

As a bonus, they've included specific state-by-state breakdowns as well as a comparison against their on-exchange enrollments. 32% of PA's, 27% of WV's and 29% of Delaware's QHP enrollees to date have been off-exchange. This proves exactly what I've been saying: There are absolutely several million (at a minimum) direct QHPs out there which simply haven't been documented publicly yet.

A couple of days ago, Avalere Health, with whom I've alternately butted heads with and agreed with on all things Medicaid-related, has issued their QHP projection: They're calling for around 5.4 million total. In order to hit that number, the March average would be around 38,600/day.

Avalere is basing their projection primarily on the Medicare Part D enrollment pattern back in 2006. They could very well be correct, but there's also some key differences between that situation and this one (the most obvious one: Medicare enrollments were presumably mainly limited to those over 65, whereas it's the "Young Invincibles" that are the primary target at the moment). However, I'm not going to pooh-pooh their projection either, as there are many similarities between the two as well: Both were/are large, national government healthcare enrollment programs, with a 6-month limited enrollment period, a financial penalty for not enrolling by the deadline and so on.

After a couple of weeks where the paid QHPs seemed to only be drawing from the existing unpaid enrollments (a sign of new additions drying up), WA seems to be back in gear with 2,740 more paid QHPs, 4,019 more unpaid QHPs and 16,247 new Medicaid/CHIP additions, all since February 27th.

Enrollments Completed:

  • Qualified Health Plans: 109,021
  • Medicaid Newly Eligible Adults: 222,607
  • Medicaid Previously Eligible but not Enrolled: 115,159

In-Process Applications

Qualified Health Plan Applicants – Need to Pay: 82,060

*Note: These numbers reflect enrollments and applications through March 6.

Looks like the 30/70 QHP/Medicaid split that I've been assuming for Minnesota has shifted somewhat; as a result, I actually have to lower the QHP number by a bit compared with the 3-4 mini updates from last week. MN QHPs now stand at 33,362; new Medicaid/CHIP enrollees are at 85,267 as of March 11.

In addition, SHOP (Sm. Biz) enrollees are up a bit from 1,042 to (660 employees x1.8 per household) = 1,188 total individuals covered.

DC itself has an unusual situation: Due to the quirky ACA rule that has Congressional Staffers (some 10,000 of them) enroll via the Small Business SHOP exchange instead of the individual exchange (or that of their home state), DC's SHOP exchange actually has twice as many enrollees as individual QHPs. Anyway, QHPs have gone up 267 in the first week or so of March, while SHOP enrollees have gone up 104. Meanwhile, new Medicaid enrollees are up 506.

As of March 9, 2014, 30,642 people have enrolled through DC Health Link in private health plans or Medicaid: 

 6,516 people enrolled in private health plans through the DC Health Link individual and family marketplace;
 11,383 people gained Medicaid coverage through DC Health Link; and
 12,743 people enrolled through the DC Health Link small business marketplace. 

Eureka! I just received an explanation from the New York Dept. of Health of the mysterious 40,000 QHP enrollment discrepancy between the February HHS report and the New York State of Health press releases--apparently the additional 40K are newly-added enrollees in NY's Child Health Plus program, which is privately operated (and thus not included under Medicaid/CHIP) but is also technically not an official "Qualified Health Plan" by the technical definition.

According to the NY DOH, the higher NYSoH enrollee numbers include both the technical QHPs as well as enrollment in the state's CHild Health Plus program. This program covers kids up to 19 years old, with subsidies given for families up to 400% of the FPL. Therefore, children who fit this criteria get enrolled in Child Health Plus instead of actual QHPs.

They've specifically confirmed that "over 40,000 additional children have been enrolled in Child Health Plus through the Marketplace."

Contributor Steve Ciccarelli brought the following footnote ("Appendix D") from the February HHS report to my attention, which kind-of, sort-of explains the 40,000 QHP enrollment discrepancy between HHS (which gives the 3/01 total as 244,618) and the NY State of Health Exchange, which had the total as appx. 285K as of 3/01:

It is important to note that the SBM enrollment-related data that are reported in this issue brief represent state data that have been reported to CMS through March 7, 2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report. 

I've already corrected for the "different time periods" in order to get the 285K number from the NY exchange for March 1st. The 40,000 difference between them and HHS appears to fall into the "different metric definitions".

Which tells me...exactly nothing. Sigh.

Here's all 50 states, sorted by their achievement of sensible "% of 7M" QHP enrollment goals (as opposed to the CMS's state-by-state projections, which never made much sense).

Two caveats: First, most of the state-based exchanges (blue rows) have an unfair advantage, as their numbers include some post-3/01 data. However, this should still give a good general sense of how the states are doing going into the home stretch. Second, all QHP numbers shown include unpaid enrollments, even for states which have broken them out; this seemed more consistent to me (and yes, I realize the contradiction in going for consistency on that front while still including post-February data on some states, but what the heck).

Anyway, as you can see, the state exchanges are definitiely in the lead:

--Vermont is crushing everyone else, with more than 300% of their fair share of the 7 million figure enrolled

--Washington, Connecticut, DC, Rhode Island and California, all state-based exchanges are all also above their "7M CBO" projections

--4 more states are also overperforming (that is, above the 89% mark; the enrollment period is 89% of the way through as of today): Idaho, New York, Maine and Michigan

--Interestingly, even though the Massachusetts and Oregon exchange websites are still complete messes, both states are actually "peforming" quite well now in terms of actual enrollments based on their reasonable percentage of the total uninsured nationally. In both cases, the states wisely made the decision to pour a ton of resources into manually processing enrollments instead of focusing purely on fixing the websites. While neither should be cheering, this tactic does seem to be acting as a pretty effective workaround.

--Meanwhile, the other 3 troubled websites, Hawaii, Nevada and Maryland, are indeed in the lower half of the list...but amazingly, Hawaii (with arguably the worst-running exchange) is above the other two, based purely on their extremely low uninsured population to begin with.

--Finally, bringing up the rear are mostly the usual suspects: Wyoming, Iowa, South Dakota, Louisiana, Texas, West Virginia, Oklahoma and Alaska. The only surprise (to me) here is to see New Mexico coming in dead last; as far as I know, NM's political climate should be fairly ACA-friendly, but so be it.

The February HHS Report included some especially confusing numbers out of the two largest state-run exchanges, California and New York, as both seemed shockingly low given how successful they both seemed to be doing in the first half of the month.

In the case of California, they were kicking serious ass in the first half of February, averaging around 7,200 QHP enrollments per day. Unfortunately, a few days later the CoveredCA exchange was hit with a very nasty technical problem which brought things to a standstill for not the 3 days that I thought, but 5 days. Result? The daily average dropped from 7,200/day in the first half to only 2,800/day for the second half of the month:

Enrollment in Obamacare coverage slowed last month in California, hurt by a recent website outage.

New federal data show 868,936 Californians signed up for health insurance in the state's exchange through March 1.

OK, now that I've resolved the 290K discrepancy from the HHS report (short answer: they corrected the report sometime yesterday, but the total hasn't changed), and have confirmed that someone from HHS/CMS is checking on the 40K New York QHP discrepancy, I've finally been able to update both The Spreadsheets (QHP and Medicaid) and The Graph with the latest data. Here's where things stand as of the morning of March 12th:

PRIVATE QHP ENROLLMENTS:

  • Exchange-based, Paid or Unpaid for Legitimate Reasons Only: 3.91 Million
  • Exchange-based, Including Unpaid Enrollments: 4.45 Million
    (this is the figure used to measure against the CBO 6M/7M projections)
  • Off-Exchange/Direct (Known): 461K
  • SHOP (Sm. Business Exchanges): 69K
  • Grand Total, QHP Enrollments: 4.98 Million

NEW MEDICAID/CHIP ENROLLMENTS:

Do me a favor. Go to the February HHS Report right now, scroll down to pages 21 & 22, and enter the numbers in Column 5. Go ahead, I'll wait.

Done? OK, according to the HHS Dept., when you tally up all of the Medicaid/CHIP determinations in Column 5 from both pages, according to the report, the grand total are supposed to be 4,377,932.

The subtotals (2,706,404 for the State-Based Marketplaces and 1,378,871 for the Federal Marketplace) all tally up correctly.

However, when you add the two together, guess what?

2,706,404 + 1,378,871 does not equal 4,377,932

In fact, if you add those two together you get 4,085,275, over 290,000 less.

What's the deal?

UPDATE: Just received the following responses via Twitter:

@charles_gaba We updated the 2.7M number to be 2,999,061.

— Aaron Albright (@AaronKAlbright) March 12, 2014

@charles_gaba the report online was updated yesterday i believe: http://t.co/hi7225xDjl

— Aaron Albright (@AaronKAlbright) March 12, 2014

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