Charles Gaba's blog

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

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.”

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