Well how do you like that? Here I go and spend all morning crunching numbers, reviewing different state reports and so forth...and a few hours later the New York Times goes and makes my point for me:
WASHINGTON — One in five people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts say.
Paying the first month’s premium is the final step in completing an enrollment. Under federal rules, people must pay the initial premium to have coverage take effect. In view of the chaotic debut of the federal marketplace and many state exchanges, the White House urged insurers to give people more time, and many agreed to do so. But, insurers said, some people missed even the extended deadlines.
OK, now that the January numbers are out, let's take a look and see how the individual states are doing. The wonderful Kaiser Family Foundation has a much more sophisticated version of this, but my spreadsheet has two features theirs doesn't: Ugly color-coded cells...and more recent enrollment data for 13 states.
While including post-February 1st data fro some states but not for others does give a bit of an unfair advantage to those states, it's still worth taking a look at to see how the states are faring.
OK, the anti-ACA talking point of "How many enrollees have actually PAID???" has been one of the most commonly-made attacks on the exchanges since the first decent numbers started rolling in at the end of November. It seemed awfully silly back then, since at the time, the actual coveragestart date was still weeks away. Most people I know don't pay their utility or credit card bills until just before they're due, so it seems disingenuous to assume that a health insurance policy (which could be up to $1,000+ per month for some families) would be any different.
Here's what I said about the issue on January 2nd, right after the first wave of policies kicked into effect:
With all the focus on fixing the problems with the individual/group healthcare exchanges, there's been far less attention paid to the more-troubled SHOP (Small Business) exchanges. The administration had already announced that the HC.gov version (covering 34 states*) wouldn't be launched at all until this fall, and 2 of the state-run exchanges (Oregon and Maryland) recently announced that they'd be offline until well after the end of the March enrollment period as well.
Today, Covered California announced that while their SHOP exchange has been operational (with a small number of enrollments to date), they're shutting it down until this fall as well. This leaves 14.5 state-run SHOP exchanges in operation (and yes, that's 14.5, not 15...Washington State's SHOP is only running in 2 counties at the moment).
Still, the press release does give a slight bump in CA's SHOP enrollment before they stop taking new signups: 4,490 individuals covered, plus another 1,200 being processed, for a total of 5,690. That's where it'll stay through the end of the March enrollment period unless they reverse themselves between now and then.
OK, given how messy and confusing the Medicaid/CHIP situation is, I had to think through the best way to incorporate the January HHS Report into the mix. The problem is that not only are the monthly HHS reports only part of the equation (the January CMS report probably won't be released for another 10 days or so, based on prior months), but it's not a simple "add HHS now, then add CMS later". The two actually intermingle, and some of the caveats and overlapping data changes from month to month, which means that some of the data I include today will have to be modified or removed after the CMS report is released, and some of the data which I've removed will have to be added back in...or part of it will, anyway.
Having said all that, I think I have a pretty good grip on how to do this now:
OK, I've scrambled and have updated the Private QHP spreadsheet with the January HHS Report figures.
While the official number as of 02/01 is just shy of 3.3 million, my spreadsheet includes partial updates since February 1st for several states. As a result, the actual current total is at least 3.43 million in all:
3,149,008 from the 46 states which haven't been separated out between Paid and Unpaid enrollees
169,382 known to be paid enrollments from NV, RI, VT, WA & WI
This adds up to 3,318,390, which is the number that I'm counting towards the "Percent of CBO Projection" total...which I'm now calling 46.9% as of today.
Then, there's another 119,164 known to be unpaid enrollments from NV, RI, VT, WA & WI
Add these all up and you get a total of 3,437,554.
Add in the 124,220 known Off-Exchange Private QHP enrollments and the 54,814 known SHOP enrollments, and you have a grand total of 3,616,588.
Add in the 3,101,000 known "sub-26ers" and this goes up to about 6.71 million people on the Private QHP side.
Until now, aside from the official monthly HHS reports, Vermont's enrollment data has been frustrating--not that it hasn't been available, it's just been released in confusing dollops (Massachusetts falls into the same category). Today, however, the Vermont Health Connect exchange released a detailed PDF that does a great job of answering the key questions--along with one bit of data I haven't seen for any other state so far: The breakdown not only of total Private QHP enrollments, but how many of these started in January, February and (upcoming) March.
Page 6 has the key data: A total of 16,906 QHP enrollees as of 2/10, of whom 13,514 are paid up. Overall, this points to an 80% paid rate, which is very good--but the monthly breakout is even more interesting: January-start enrollees have a 92% paid rate (which you'd certainly hope for by now, considering that we're into mid-February) and February-start enrollees are at 79% paid. The March-start enrollees (14%) are the ones providing the main drag on the total...but this is hardly shocking since the start date for that coverage is still over 2 weeks away.
Minnesota's Private QHP enrollments went up a smidge from 28,611 to 29,493 the first week of February, while Medicaid enrollments increased from 61,784 to 63,005 (Medical Assistance + MinnesotaCare combined). Pretty weak tea, I have to admit.
Just received this bit of negative news out of Wisconsin...apparently half of the WI Private QHP enrollees through the end of December still haven't made their first payments yet:
MADISON (WKOW) -- Wisconsin Deputy Insurance Commissioner Dan Schwartzer says only about half of the 40,752 state residents that signed up for health insurance through the Affordable Care Act have paid their premiums and are currently receiving coverage.
Schwartzer tells 27 News that while some of the state insurance companies participating in the federal marketplace have received premium payments for 65 to 70 percent of those policies, others have seen a payment rate of only about 15 percent.
Between the Avalere reconfiguration, the Washington State double-counting news and this discouraging item out of Wisconsin, this isn't a particularly cheery day for ACASignups.net, I admit.
Since January 9th, Private QHP enrollments in DC are up 40% (from 3,646 to 5,090, Medicaid/CHIP enrollments are up over 80% to 8,451 and SHOP (Small Business) enrollments are up about 5% to 12,639 people.
Since the exchange opened for business on October 1, DC Health Link has enrolled 26,180 people. This includes District residents who enrolled in private health plans and in Medicaid, as well as people with coverage through their employers.
5,090 people enrolled in private health plans through the DC Health Link individual and family marketplace and 965 of those have coverage that will be effective March 1, 2014;
8,451 people gained Medicaid coverage through DC Health Link; and
12,639 people enrolled through the DC Health Link small business marketplace.
Similar to the first three months of open enrollment, the largest enrollment – 37% of enrollees in private coverage (individual not SHOP) through DC Health Link – is 26 to 34 year olds; the second largest is 35 to 44 year olds (21%).
For those who still don't understand why I shifted gears and changed the Medicaid/CHIP enrollment tally from a "solid" 7.6 million to a wishy-washy "range" stretching from as low as 2.4 million to as high as 7.6 million, here's a prime example of the problem:
Everything below except for the "updates since 12/28" and some (not all) of the Special/One-Time Transfers come directly from the official HHS and CMS reports. If their data (and especially their footnotes) are accurate and comprehensive, then everything else should be correct. If any key data from their reports is either missing or incorrect, then obviously the rest of my calculations would be off accordingly.
I think you can already see where this is heading.
Washington State just released their weekly update, and as usual it's crisp and clean:
Private QHPs are up to 176,095 (90,723 Paid / 85,372 Unpaid) from 175,595 (88,071 Paid / 87,524 Unpaid); the total only went up a few hundred, but the number of paid enrollments went up about 2,700 people.
Medicaid enrollments are up to 276,263 (184,783 Expansion / 91,480 Woodwork) from 258,087 (172,715 Expansion / 85,372 Woodwork), an increase of about 7% from last week.
Qualified Health Plans: 90,723
Medicaid Newly Eligible Adults: 184,783
Medicaid Previously Eligible but not Enrolled: 91,480
Qualified Health Plan Applicants – Need to Pay: 85,372
Another small update this morning: Rhode Island has released their data through 01/08:
Enrollment data (Oct. 1, 2013 through Feb. 8, 2014):
Total HealthSource RI enrollments (including those who have not yet paid): 16,512
Paid enrollments: 14,086
Medicaid enrollments (per EOHHS): 35,821
Small employer enrollment: 107 (based on their submitted census, these 107 employers represent 420 covered employees and 658 covered lives)
The Paid QHP number is up from 9,902 to 14,086 (a 42% jump in the past month) and the Medicaid number is up from 19,941 to 35,821, a whopping 80% jump...but as the submitter noted, the 4,311 people who were previously listed as being moved into RIte Care are no longer listed, so I think it's safe to assume that they're now included in one of the above increases.