2018 MIDTERM ELECTION

Time: D H M S

As with my recent Alabama post, in which BCBS of Alabama stated that they're seeing an 82% payment rate out of an 87% market share, this is not proof absolute for Maine, but it's the best guideline we have for the state at the moment: In yesterday's Congressional testimony, executives for Wellpoint, the 2nd largest insurer in the country, stated that 90% of their exchange QHP enrollments have been paid so far. I took a look at the states Wellpoint operates in; there's a good dozen or so, and their market share varies in each one, but there's one, Maine, where they had a whopping 74% market share last year.

So, the absurd GOP House Energy & Commerce Committee Report which claimed that only 67% of exchange QHP enrollees are paid up has been thoroughly demolished by not just myself, but pretty much every other legitimate news media outlet there is (which leaves out FOX News, I'm afraid). In addition to only running through 4/15 (when 38% of the total QHP payments weren't even due yet), it only counted 160 of the 300+ insurance providers on the ACA exchanges, among many other ludicrous methodological flaws.

However, something did just occur to me. Take another look at their state-by-state breakout (which, again, only includes states on the Federal exchange...and even then, leaves out Idaho and New Mexico for reasons unknown), and there's several states which I find rather interesting:

OK, this doesn't give a complete picture of Alabama's exchange QHP payment rate for two reasons: First, because the 82% figure is a blend of 85K via the exchange and another 20K off-exchange enrollees; second, because while BCBS does have the lion's share (87%) of exchange QHP enrollees in the state, there's still another 12,870 QHPs (out of the 97,870 total in Alabama) which belong to other insurance companies, which may have a higher or lower payment rate to date.

Having said that, assuming that the ratios are representative on both counts, it looks like about 82% of Alabama's enrollees have paid so far:

Some 82 percent of those enrolling in Blue Cross and Blue Shield of Alabama through the exchanges have paid their first month's premium, mirroring figures released today by other large insurers in preparation for congressional testimony.

"We have enrolled over 105,000 members both on and off the federally facilitated exchange in Alabama," said Koko Mackin, BCBS of Alabama said in an email to Al.com. "Over 85,000 members enrolled through the federal exchange, while another 20,000 signed up directly with Blue Cross -- 82% of our exchange enrollees have paid their first month’s premium."

Presented without comment:

U.S. Department of Health & Human Services
202-690-6343
News Division
media@hhs.gov
www.hhs.gov/news

FOR IMMEDIATE RELEASE

Wednesday, May 07, 2014

New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

Hospital Readmissions Fall by 8 percent among Medicare beneficiaries

Today, the Department of Health and Human Services announced that new preliminary data show an overall nine percent decrease in hospital acquired conditions nationally during 2011 and 2012.  National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

OK, not exactly the most stunning headline in the world (although this does appear to be shocking news to a certain anti-ACA political party), but still kind of cool to have some solid numbers on just how many lives could be saved with universal coverage:

Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.

Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.

Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.

Not exactly surprising, but rather embarrassing for the state which spawned the ACA in the first place.

If the "off-the-shelf" replacement works, great. If not, and they follow Oregon into having HC.gov take over, that would mean a net change of...zero states, with MA and OR moving into the fold while New Mexico and Idaho break out on their own exchanges.

Massachusetts has scrapped its hopes for a totally customized state-based health exchange under the Affordable Care Act, and will instead purchase an “off-the-shelf” solution that can be installed by the fall with the possibility of joining the federal exchange if all else fails.

The state announced Monday that it would contract with Virginia-based hCentive for health insurance exchange software that has been used to power online marketplaces Kentucky, Colorado, New York and other states.

Health and IT officials will simultaneously work to ready the state and its insurers to join the federal health exchange in case the hCentive software solution cannot be implemented in time for the next insurance open enrollment period that begins in November.

If I'm going to boast about the states where high percentages of QHPs are paid for (WA, MA, CT, OR, WV & RI, for starters), I do have to be honest and present the lower figures as well. According to the SC insurance commissioner, only about 71.3% of exchange QHPs in that state had been paid up as of 4/30, which is admittedly not great:

Of the 119,784 individuals in South Carolina who applied and selected a policy on the federal exchange, 85,453 - about 71 percent - paid their first month's premium by April 30, Farmer said. That was the last possible day to make that first payment. Those who didn't pay by that date aren't actually insured, he said.

As a side note, that 119,784 figure is actually higher than the official 4/19 HHS total of 118,324; presumably another 1,460 trickled in from 4/20 - 4/30. Even using the lower number, however, the paid rate would only be 1% higher (72.2%).

I should also note that while 71% isn't very good, it's still 10% higher than the 61% that the GOP House Committee report claimed for SC last week.

As many as 90 percent of WellPoint customers have paid their first premium by its due date, according to testimony the company prepared for a congressional hearing today. For Aetna, the payment is in the “low to mid-80 percent range,” the company said in its own testimony. Health Care Service Corp., which operates Blue Cross Blue Shield plans in five states including Texas, said that number is at least 83 percent.

Oh, yeah...and regarding that absurd "67%" Republican House committee report from last week, I'm not the only one who knew it was a big pile of crap:

“That was just foolishness on the part of the committee to even publish that number because it was completely out of context,” Bob Laszewski, an insurance industry consultant in Alexandria, Virginia, said in a phone interview.

Reminder: My estimate has always been around 93% as of late May.

Overdid it last week; partial relapse of sorts.

The main symptoms are gone but the pain is still bad and now it seems to have gotten into my eye itself.

Went to the ophthalmologist this morning, on eye medication etc.

no updates for a few days again, sorry.

OK, I now have confirmation that the 200K Medicaid expansion figure from last week was not an error...in fact, Michigan's expansion program is now up to nearly 207K:

Healthy Michigan Plan Enrollment Statistics

Total Healthy Michigan Plan Beneficiaries: 206,842

*Statistics as of May 5, 2014 
*Updated every Monday at 3 p.m.

Not much for me to add to this, really, other than to say that THIS is the correct answer to the "But...but how many were ALREADY INSURED???" complaints:

Uninsured rate down nearly four percentage points since late 2013

WASHINGTON, D.C. -- The uninsured rate for U.S. adults in April was 13.4%, down from 15.0% in March. This is the lowest monthly uninsured rate recorded since Gallup and Healthways began tracking it in January 2008, besting the previous low of 13.9% in September of that year.

The uninsured rate peaked at 18.0% in the third quarter of 2013, but has consistently declined since then. This downward trend in the uninsured rate coincided with the health insurance marketplace exchanges opening in October 2013, and accelerated as the March 31 deadline to purchase health insurance coverage approached -- and passed -- for most uninsured Americans. The Obama administration decided in late March to extend the deadline to April 15 for those who had already begun the enrollment process.

A couple of days ago, Avalere Health (with whom I've alternately butted heads and agreed with on various Medicaid enrollment data issues) released a study which, at first glance, seems to paint a fairly positive picture of how well the ACA exchange QHP enrollment ended up doing: Enrollment expectations were exceeded in 22 states, even if you assume only an 85% final premium payment rate!

However, there's a couple of data points which Avalere chose to use which made me furrow my brow. The first is that they based their findings on the CBO's lowered projection number of 6 million exchange-based QHPs instead of the original 7 million figure. I suppose there's nothing wrong with doing this, but considering that the actual grand total ended up being well over 8 million, it seemed a bit odd to me that they'd choose to compare the state-level figures against the lower, 6 million figure when there really isn't a need to do so.

More curious to me, though, was this line from their press release:

In addition to the March/April HHS report being released on Thursday, the CMS Dept. decided to take care of everything in one shot and also released the March (only...no April data included) CMS report as well.

As a result, I just finished plugging in the data from both reports onto the Medicaid/CHIP spreadsheet (followed, of course, by having to go through and delete out big chunks of the data from one or the other to avoid double-counting or any Medicaid renewals).

Normally each of these reports (which are usually released a couple of weeks apart) bumps the new Medicaid/CHIP numbers up by a half-million or so apiece after separating out the renewals & baseline churn. This time around, the impact looks much more dramatic because 1) both reports were added on the same day, 2) the HHS report includes 2/3 of April as well as March and 3) there appears to have been a bit of a spike in Medicaid enrollments as the 3/31 open enrollment deadline approached just as there was for QHPs (this may sound strange since there's no deadline for Medicaid, but a lot of people might not have realized that, and the frenzied outreach effort probably swept up a lot of potential Medicaid enrollees in the final weeks of March as well).

Online private insurance broker eHealth Insurance has provided a detailed Price Index Report covering the full open enrollment period from October 1, 2013 - March 31, 2014. For the most part it focuses on the pricing demographics, but also gives an updated number of policies as well (all of which are fully ACA-compliant QHPs purchased off-exchange):

Data collected and presented is based on over 213,000 individual and family health insurance applications submitted through eHealthInsurance.com between October 1, 2013 and March 31, 2014.

The prior number I had from back in January was around 148,000, so this is a significant increase...but it also specifies "individual and family" applications, so I'm assuming the standard 1.8x-per-household factor, which brings the total number of lives covered up to around 383,000 people.

However, until/unless I'm able to separate out any Blue Cross (or other BCBSA) enrollments from the total, I can't really plug this number into the spreadsheet, so I'll leave it as a blog entry for now.

One of the more interesting parts of the March/April HHS report is that they finally released the data for the "Are you currently insured?" question on the HC.gov enrollment process.

Given all the fuss about "But how many were ALREADY INSURED???" from various outlets, this would seem to be a bit of a Holy Grail answer: At last, we know the answer, and it's pretty impressive: Only 13% responded that they had health insurance coverage at the time of their application, meaning a whopping 87% were newly insured! Wowzers!!

HOWEVER...there's a LOT of caveats here, just as there were with the infamous McKinsey study which claimed only 27% were previously uninsured back in February.

As the HHS report itself puts it:

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