Charles Gaba's blog

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Dear (outgoing Director) Kathleen Sebelius, (presumptive incoming Director) Sylvia Burwell, and whomever is in charge in between:

Your office is not supposed to be a political one. I, however, have the luxury of not being restricted by that fact. I'm a proud, unapologetically progressive Democrat. While I certainly have my issues with President Obama and the ACA, in general I think that it's an excellent start towards an eventual goal of a single payer healthcare system. While I'm still disapointed as to why they didn't simply drop the "65" age requirement from Medicare (perhaps phasing it in 5 years at a time...60, 55, 50 and so on, with an accompanying funding mechanism), or at the very least add a Public Option to compete with the private corporations, I do understand that the political realities at the time presumably didn't allow for either one.

I received some disturbing news this morning which, if true, will piss me off to no end.

Supposedly, now that the open enrollment (and extension) period is over, the HHS Dept. has decided NOT to issue any further monthly ACA exchange enrollment reports going forward.

I don't know if this only means that they're mothballing the reports from now through November (when the 2nd open enrollment period starts up again), which would be bad enough, or if they mean permanently (which would be far worse).

I should stress that I have not confirmed this yet; if this information is incorrect, disregard everything below.

Assuming this news is accurate, however, HHS has lost their mind and will deserve every bit of criticism that they receive over it.

I've said many times before that the only reason that I started this website in the first place is because neither the HHS Dept. nor the major news media outlets seemed to be willing (or able?) to post accurate exchange enrollment data on a timely basis (and by "timely", I mean daily or weekly, not monthly, which is just too damned long in the modern political/media world).

First Oregon told Oracle to go pound sand after paying the company hundreds of millions of dollars for a useless website; now Nevada has officially done the same thing to Xerox:

The Silver State Health Insurance Exchange board voted unanimously Tuesday to end its relationship with Xerox, the vendor contracted in 2012 to build the exchange’s Nevada Health Link website.

In place of Xerox, the exchange will adopt the federal Healthcare.gov exchange’s eligibility and enrollment functions for the sign-up period that begins Nov. 15, though it will keep its status and funding as a state-controlled system. The exchange will also issue a request for proposals to evaluate replacement systems in coming years. A new platform could come from a state with a functional marketplace, or from a vendor with a similar, proven program.

Unlike Massachusetts, which is taking a dual-path approach (they're scrambling to replace their own crappy site with a new one while simultaneously preparing to move over to HC.gov just in case the first plan doesn't pan out in time), Nevada is sort of doing the opposite: They're moving over to HC.gov this year, but reserving the right to try a do-over on their own exchange for 2016 and beyond.

Interestingly, even though we're well past even the extended QHP enrollment period, Hawaii continues to have new enrollments trickle in. I'm not sure if these are clerical corrections from before 4/30 or if these are "Qualifying Life Events", but either way they just added another 111 people to the tally (plus a whopping 5 more people in their SHOP enrollments).

Total since October 1, 2013

32,086 Applications completed in the Individual Marketplace
9,397 Individuals and families enrolled in the Individual Marketplace
604 Employers applied to SHOP Marketplace
636 Employees and dependents enrolled via SHOP Marketplace

In addition, Hawaii's exchange just became a slightly better value, dropping from $23,899 per person enrolled down to $23,617 per person. So, there's that, I guess...

Wyoming's QHP enrollments didn't add up to much (understandable given that the entire state only has 576,000 people), but the state insurance commissioner states that around 92% of those who did enroll have paid up so far:

Nearly 12,000 people in Wyoming have enrolled in a plan on the federal marketplace created by the Affordable Care Act, according to the latest data announced Monday at a legislative committee meeting.

About 11,000 of them have begun paying their premiums, Wyoming Insurance Commissioner Tom Hirsig told members of the Joint Labor, Health and Social Services Committee at Casper College.

“I’m surprised, frankly, that there’s this many,” Hirsig said. “I was thinking 7,000 or 8,000.”

The actual number of exchange QHPs in Wyoming is 11,970, so yep, 11K would be about 92% of that.

(To clarify the last statement: Contributor Esther F. also gives a link to another story which clarifies that the "7-8K" quote refers to how many people he thought would enroll, not how many he figured would pay):

Michigan continues to quietly enroll thousands and thousands of people in ACA-expanded Medicaid, having already reached 81% of the 320K first-year goal in just 7 weeks (or, alternately, 52% of the total eligible for expanded Medicaid state-wide):

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 259,007

*Statistics as of May 19, 2014 

OK, due to my unexpectedly-far-longer-lasting bout of shingles, I've gotten a bit backed up with my ACA news the past few weeks, but I did want to address the "cost per enrollee" story which popped up a week or so ago:

Sometimes there really are economies of scale. And the nation’s health insurance exchanges may be a case in point.

As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report.  It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.

The article (and others like it) goes on to break out the individual state exchange costs. Some do better than others, of course, and Hawaii comes in dead last (in part simply because their uninsured population is so small to begin with). While it's certainly interesting to see which ones were the most efficient and which were the least, there's a big part of me which keeps asking "why is anyone surprised by this?"

In spite of all the hand-wringing that people have had about the insurance company premium rates for the 2nd year of the exchanges (this is the main reason for all the freaking out about how many "young invincibles" there would be, etc etc), the truth is...the new premium levels appear to be all over the place:

May 15--A first-glance snapshot of the lowest premium rates being proposed for individual health-insurance plans to be sold in the Washington Healthplanfinder exchange marketplace reveals spirited competition and more choices for consumers.

These rates are not yet approved, and it's likely the number of plans requested will decline, according to the Office of the Insurance Commissioner.

That office is now reviewing rate changes the companies requested.

Changes proposed by companies asking to sell plans on Healthplanfinder ranged from a nearly 7 percent decrease in one case to an increase of more than 11 percent in others.

If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:

Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.

...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.

They may have flushed a couple hundred million dollars down the drain on their website, but that just makes Oregon's manual QHP processing achievement all the more impressive. Over 6 weeks after the official enrollment period ended, and over 2 weeks after their extension period wrapped up, Oregon continues to push their QHP and Medicaid enrollment totals up:

Medical enrollments through Cover Oregon: 280,334
Total private medical insurance enrollments through Cover Oregon 1: 81,358                

Oregon Health Plan enrollments through Cover Oregon: 198,976

Net private medical 2: 76,275

A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:

As of April 29, 2014, 275,090 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 May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.

The New Jersey Medicaid expansion tally has jumped around a bit due to differing definitions of the enrollments, but this new one seems in line with my expectations and the wording is pretty specific:

Another 140,000 residents joined the state’s newly expanded Medicaid program, which now allows people who are slightly above the poverty line to qualify for coverage.

Well, here at ACASignups.net I'm nothing if not comprehensive...Hawaii has added a whopping 69 exchange QHP enrollees and 3 (yes, 3) SHOP enrollees in the past week or so...

Total since October 1, 2013

  • 31,758 Applications completed in the Individual Marketplace
  • 9,286 Individuals and families enrolled in the Individual Marketplace
  • 595 Employers applied to SHOP Marketplace
  • 631 Employees and dependents enrolled via SHOP Marketplace

Minor update out of the only state whose ACA exchange is still officially open: QHPs up around 1,400, paid up around 200 since last week:

Update as of 5/10: 47,245 Nevadans confirm Qualified Health Plan selections. 35,034 have paid.

— Nevada Health Link (@NVHealthLink) May 14, 2014

Minnesota's official exchange QHP tally has dropped by a whopping...9 people  since the end of April. Meanwhile, their Medicaid tally has shot up another 10,262 people:

As of 5/13:

  • 120,749 Medical Assistance
  • 50,540 QHP
  • 45,121 Minnesota Care
  • Shop: 761 x 1.8 = 1,370

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