Charles Gaba's blog

2018 MIDTERM ELECTION

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A regular site visitor has sent me some in-depth information about the public healthcare program situation in Minnesota, which is evidently quite a bit more complicated than most other states. I've put together this information into what I hope is a cohesive whole, with my response below. Anyone who's more familiar with the Minnesota situation can feel free to correct or clarify any of this if you'd like.

Regarding your blog post entitled Minnesota Update: Nominal private increase; Medicaid up 10% In it, you quote the Minnesota StarTribune, which states, in part, that:

"Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans."

Several thousand more than 26,000 should be counted as exchange sign-ups rather than Medicaid signups. Minnesota has a sort of in-between basic health plan called MinnesotaCare. It covers people between 133% and 200% (I think?) of poverty. It is not Medicaid (which is called Medical Assistance in Minnesota) and therefore not part of the ACA Medicaid expansion, but it is a public plan. So, when the StarTribune refers to "public plans," they are lumping Medicaid and MinnesotaCare together. The state has cleared this up before in reporting on Minnesota's enrollment numbers in the New York Times. MinnPost reported on this correction back in November.

As a follow-up to Friday's news that Idaho has hit around 20,000 private enrollments comes this story about the status of those enrollments from the actual insurance companies' perspective. While the major thrust of the article is the unusually long payment deadline extensions that have become necessary due to the technical and paperwork confusion caused by the Federal HC.gov exchange, as contributor Witgren notes, there's two important points which are quite telling.

First, in Idaho, at least, it appears that at least 75% of those 20K people have made their first payment. While you can certainly spin this as being "25% are deadbeats" if you want to, this certainly goes a long way towards disproving that the "OMG!! NOBODY IS ACTUALLY PAYING!!!" meme that the ACA opposition has been shouting about.

Secondly, it appears that, according to the insurance companies themselves, having a large percentage of new policy purchasers not make their payment until the last possible moment is standard for the industry as a whole, and has been for a very long time.

Right after last night's South Dakota update we have their sister state to the North. ND was at just 265 private enrollments as of 11/30, so this represents a four-fold increase as of January 7. I've subtracted 800 from the "unspecified" pool at the bottom of the spreadsheet to compensate.

Meanwhile, their Medicaid expansion has gone from 1,001 up to around 1,700.

As of the first week of January, when coverage started through plans under the Affordable Care Act, 977 members had signed up with Blue Cross Blue Shield of North Dakota, the state’s dominant insurer.

The Sanford Health Plan enrolled 92 in North Dakota through the new marketplace exchange.

By contrast, enrollment in North Dakota under expanded Medicaid eligibility stands at about 1,700 in the first week of January....

In North Dakota, estimates of new Medicaid enrollees under the expanded eligibility have ranged from an increase of 20,000 to 32,000.

A 42% increase from South Dakota since 12/23 is pretty good by itself. However, this number only covers 2 of the 3 insurance companies participating in the exchange. I have no idea what sort of market share the 3rd company has in SD, so I can't speculate as to how many more enrollments they have to add to the total.

I've also subtracted a the corresponding 1,000 difference from the "unspecified" Federal pool at the bottom of the spreadsheet to compensate.

As of Jan. 1, about 3,550 people in South Dakota had signed up through the federal marketplace website from Avera and Sanford, with about 2,700 from Avera and about 850 from Sanford. DakotaCare figures weren’t available.

Just some minor adjustments here; I had CT down as 40,895 private enrollments; I have to drop this by 895. However, the Medicaid number needs to be bumped up by about 1,552.

So far, about 40,000 Connecticut residents have enrolled in private insurance plans under the Affordable Care Act. Access Health CT CEO Kevin Counihan said that number rapidly growing...

Overall, about 76,000 residents have signed up for health insurance in Connecticut, either through private health plans, or the state's low-income Medicaid program.

Who would have thought that it would be Idaho, of all states, that would mark the first significant milestone since hitting the 2.1 million mark a around Christmas? In any event, the spokeswoman for Your Health Idaho announced that ID has shot up from just 1,730 private enrollments at the end of November to a whopping 20,000 people "in time for January 1st". Since the final January deadline for Federal exchange states was Christmas Eve, I assume this means that an additional 18,270 people enrolled from 12/01 - 12/24, increasing Idaho's total 11-fold.

Of course, most of those 18K new people will probably have to be taken out of the HHS's non-specific "1 million" enrollments which haven't been officially broken out by state, but even after doing so, the total number of private enrollments now still sits at just over the 2.2 million mark.

At the same time, since Idaho's CBO projection for 3/31/14 was only 40,000 people to begin with, this means that just like that, they've jumped up to 50% of their target.

Maryland added another 2,093 people to the private exhange rolls from 12/28 - 01/04, a 11% increase. The Medicaid situation is a bit more confusing: Actual enrollments increased from 19,578 to 26,500 (a 35% increase), but the prior week's tally had it at 43,065. It turns out that about 20,000 or so of the Medicaid applications need to be double-checked for duplicates, so they can't be counted yet, making it look like a huge drop by comparison. Sorry about that, folks.

As of Jan. 4, just over 20,350 people had enrolled in private insurance plans on the Maryland health exchange, up 2,100 from the week before, according to a weekly report by exchange officials. The pace of enrollment slowed from recent weeks.

...About 26,500 people had enrolled through the exchange in Medicaid, the federal-state health program for the poor, according to the latest numbers, up some 7,000 from the previous week. Tens of thousands more have been found eligible, but officials say many might be duplicate applications.

Well, that just figures. Right after I post a screed whining about the lack of big numbers since New Year's--in which I specifically call out the DC Health Link for not releasing any data since mid-November--what happens? Whammo: Private enrollments have skyrocketed from 1,115 on Nov. 15 to 15,613, a whopping 14x increase. They also released the first Medicaid expansion figure at all, since neither the HHS nor anyone else has had a number for that since the exchanges lauched on October 1st: 4,677 people.

Amusingly, it looks like the majority of enrollments (up to 10,000 of the 12,000 small business enrollments) were from Congressional staffers who were, ironically, required to do so due to a clause insisted upon by Congressional Republicans.

The top line talking point: More than 20,000 people have secured medical coverage.

But nearly 60 percent, or 11,967, enrolled through the small business side of the exchange, which is designed for companies with fewer than 50 workers but also — via the Republican amendment and Obama administration rules — Congress.

After the massive spike in enrollments seen in mid- to late December, regular site visitors might be a bit disappointed at the relative dearth of increases since New Year's. There have actually been quite a few updates, including several impressive percentage increases, but the actual numbers involved have been relatively small compared to the massive jumps seen just a few weeks ago. In short, you're probably wondering why the total number of private enrollments which shot up to 2.1 million in late December only seems to have gone up about 80,000 more since then.

There are three reasons for this:

First, obviously there was a tremendous sense of urgency for people to enroll in time for January 1st coverage. A drop-off after Christmas has long been expected, although this has been a bit fuzzy as the actual enrollment deadline bounced around, from 12/15 to 12/23, then 12/24 (for most states), then 12/27 or 12/31 for a handful, and finally as late as 01/06/14 for Oregon.

Ironically, even though the article itself is primarily about Medicaid expansion in Nevada (from a newspaper in Georgia), I can't actually use the Medicaid numbers provided since they're fuzzy. It does, however, give slightly higher numbers for private enrollments in NV.

It also mentions 23,000 dental plans, which I'm not even covering. In other news, the spreadsheet includes minor corrections to both Colorado (private enrollment typo had it off by 10) and Minnesota (I had MN down as 26,001 based on "just over 26,000", this article specifies it as being exactly 26,011...or an increase of 10, although that also means decreasing  the MN Medicaid number by 10 as well).

Another report presented later Thursday to the board overseeing Nevada's insurance exchange shows 17,946 people who shopped for private insurance through the online portal have confirmed plan selections. Of those, 10,776 have paid the premiums. About 23,000 have chosen stand-alone dental coverage.

It looks like the exchanges are starting to become more sensitive to the distinction between paid and unpaid enrollments; Delaware is the 5th state exchange to start separating these numbers out (or perhaps the media is just starting to do so based on the numbers released). In any event, depending on how you look at it, Delaware's private enrollments have gone up either 44% or 400% since the 793 enrolled as of December 12, and Medicaid enrollees have gone up 3.7x the 1,822 that it stood at as of 11/30.

Delaware officials reported Thursday that 1,145 people have enrolled in the state’s new health insurance exchange and paid their first premiums under the federal health care reform law.

The 1,145 paid enrollees are among 3,183 people who, as of Jan. 3, had chosen one of the health care plans offered on the exchange, suggesting that most of those who have chosen plans have not yet paid for coverage.

No new private enrollment numbers, but Rhode Island's Medicaid expansion jumped from 6,627 at the end of November to 19,941 as of yesterday. For some reason the article claims a "quadrupling" from 5,280, but the official HHS number for 11/30 is 6,627, so I'm not sure what that's about (they also claim the quadrupling was "in December" even though the same number shows up as being "through Wednesday" which was January 8th).

In any event, a nice Medicaid bump (or a horrific one, depending on your POV) for Rhode Island.

The number of Medicaid enrollments through HealthSource RI totaled 19,941 as of Wednesday, with an additional 1,500 sign-ups pending, David Burnett, chief of government and public affairs at the R.I. Executive Office of Health & Human Services, revealed Wednesday in response to a request from WPRI.com.

The number of Medicaid sign-ups on HealthSource RI roughly quadrupled in December, jumping from 5,280 to 19,941, amid a drumbeat of publicity about deadlines to get coverage under President Obama's new health law.

The prior MA update was extremely confusing; this one is more straightforward but is still pretty fuzzy. As far as I can tell, Massachusetts increased their private enrollments by 24% from Dec. 30 to Jan. 7...but that only brings them up from 3,759 to 4,676. There's another 22,000 or so enrollments in semi-limbo which appear to be approved but not fully processed due to the technical problems they continue to have.

The Republican/MassLive.com previously reported that as of Dec. 30, only 497 people were enrolled in permanent subsidized health insurance plans. The state was providing temporary insurance for another 22,000 new enrollees while it worked to process their applications. The state had extended coverage for existing customers of its Commonwealth Care plans through March 31.

Lefferts said that as of Jan. 7, 4,676 people enrolled in both subsidized and unsubsidized plans through the Health Connector, up from 3,759 as of Dec. 30. He did not have a breakdown of how many of those were subsidized. Individuals whose plans are not subsidized have until Friday to pay their premiums, so that number is likely to tick up.

Pretty slim pickings here on the private enrollment front (up just 141 assuming "slightly more than 26K" = 26,001), but the Medicaid number is up 9.6% to 45,981.

Despite MNsure's problems, so far 71,982 people have signed up for insurance coverage through the exchange. According to newly released demographic details, 53 percent are women and the median age is 48. The largest number signed up for mid-level "silver" plans — about 35 percent of total enrollees. Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans.

Some interesting numbers out of Washington State. While private enrollments are only up 6% over 12/23 (143,383 vs. 135,078; the % paid as of 01/02 has increased from 48% to 52%), the Medicaid numbers are quite different, due to changes in how they're being reported.

Previously, "Newly Eligible" and "Previously Eligible" were lumped in together with "Redeterminations" (ie, people who were already on Medicaid prior to ACA expansion and are simply renewing their accounts). However, WA is the only state (so far) to list "redeterminations" separately, so I've left those out this week. With all the concern and confusion about how many ACA enrollees are "new" to having healthcare coverage, this seems like a wise move. Of course, this also means that the Medicaid total is actually somewhat lower than I had it previously, even with the additional new enrollees since 12/23. 

As a result, the total Medicaid number for WA is now 177,065 vs. the previous 194,398, a "drop" of 17,333. The new number is lower, but more accurate reflection of the actual impact of the ACA on Medicaid...in 1 state. Hopefully other states (and the HHS) will start separating out "redeterminations" going forward as well, if possible.

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