OK, after discussing the Medicaid/CHIP situation with Caroline Pearson of Avalere Health some more (see her more detailed response to our discussion below), I've concluded there's just too damned much uncertainty and too many variables on the Medicaid side of things to try and pin it down to a solid number. This is why Avalere's own estimates ranged greatly from 1.1 million to 1.8 million people. In my case, both the low and high ranges are higher because I'm including more types and more recent data than they are.
I was thinking of 4 different types of Medicaid/CHIP enrollments: "ACA Expansion Only", "Out of the Woodwork", "Bulk Transfers" and "Renewals/Redeterminations". I've prided myself on successfully eliminating the fourth category, which has no business being included under any definition.
I contacted Avalere and asked them to take a look at my own analysis. Caroline Pearson from Avalere got back to me today via Twitter with the following responses (so far):
Regarding my "apples-to-oranges" comparison statement (ie, that my 7.5M number includes both "newly eligible due to the ACA" as well as "woodworkers", while their 1.8M high-end only includes "newly eligible due to the ACA"), she states:
Contrary to your recent post, our analysis does include woodwork AND new eligibles; excludes baseline churn & redetermin.
Ahead of the full January report expected from the HHS Dept. sometime this week, the NY State of Health (New York's exchange) gave out two key numbers. Total enrollments have gone up by over 8% in the past week (from 380,747 to 412,221), which is a nice bump...but the more significant news (politically speaking) is the announcement that 2/3 of those were not previously insured.
ALBANY (Feb. 10, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 696,880 New Yorkers have completed their applications and 412,221 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. Sixty-six percent of New Yorkers who have enrolled to date were uninsured at the time of application....
"We are thrilled to see that more than 412,000 people have enrolled for quality, low-cost health insurance and nearly 697,000 have completed applications since the Oct. 1 launch of the marketplace. Also, 66 percent of enrolled New Yorkers were uninsured when they applied,” Donna Frescatore, executive director of NY State of Health, said.
OK, I don't know for sure that they'll release the January HHS ACA Report tomorrow, but the odds are very high that they will--the October report was released on November 13th; the November report was released on December 10th, and the December report was released on January 13th, so it should come out either tomorrow, Tuesday or Wednesday at the latest.
I've already given my prediction for the total Private Exchange-based QHP total, which I figure should come in at around 3.3 million. Some other key things to bear in mind, however:
I'm about 95% sure that the HHS Dept. is going to release their official January ACA exchange enrollment report on Monday. The prior monthly reports have all come out on or around the 10th of each subsequent month, so Monday is the most logical time.
With that in mind, here's my own January prediction (and for the hell of it, February and March as well). Bear in mind that while I'm fairly confident about January, the February and March predictions are sloppy "back of a napkin" calculations:
OK, looks like I misunderstood the wording of the prior update; while 422 is actually a slight increase, I thought that the prior 395 didn't include dependents; apparently it did. Therefore, the tally actually drops from 711 down to 422. Sorry about the error.
As of Feb. 2, 4,319 employees are in the system, but only 273 have enrolled in health plans. Combined with their dependents, a total of 422 people have selected health plans on the SHOP exchange.
Nothing to get excited about here, folks: Hawaii, with one of the most screwed-up exchanges (although also, in their defense, one of the lowest uninsured rates on the country to begin with) has added a whopping...488 people to their Private QHP roles since January 18. Still, a person covered is a person covered...no Medicaid update, however.
Maryland had another few thousand people enroll in the in both Private QHPs and Medicaid over the past week: Private enrollments are up over 8% to 29,059, while Medicaid/CHIP enrollments have increased by 5%, to 44,592. The number of automatic transfers from the Primary Adult Care program also went up a few hundred to 95,824.
Through February 1, 29,059 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
95,824 Marylanders signed up through the Primary Adult Care (PAC) program were automatically converted to Medicaid coverage effective on January 1, 2014, and now have full Medicaid coverage. As of February 4, an additional 44,592 individuals were newly enrolled in Medicaid effective January 1.
An article in Bloomberg Businessweek about the sluggish early enrollment in SHOP (Small Business) exchanges includes this graphic, which gives updated enrollment data for 5 states. I already have the 2,155 California and 5,000 New York numbers, but didn't have any data for Connecticut or Kentucky until now. Colorado was up to 1,055 previously, so this update bumps it up by 241. Add that to the 500 in Connecticut and 200 in Kentucky, and it's 941 more people with health insurance who didn't have it before. Not much, but every addition counts...
Whew! Lots of updates today, although most of them have been fairly small. Today we see that Oregon continues to make steady progress in spite of their exchange website still being a mess. They've increased their Private QHP tally by another 11% (from 31,664 to 35,247) and their Medicaid/CHIP tally by 16.7% (from 57,858 to 67,517) via the exchange, plus another 475 added via their "fast track" program.
As noted in the previous Oregon update, there's already 120,155 "fast track" enrollees included in the December CMS report, so I'm only adding the difference since then (3,189) to the actual spreadsheet.
Private insurance: 35,247
Oregon Health Plan: 67,517
Oregon Health Authority “Fast Track”
Oregon Health Plan: 123,344
OK, don't let the huge percentages fool you...the actual number of Private QHPs only went up from 3,273 to 5,062, and exchange-based Medicaid enrollments increased from 1,058 to 1,396.
Not sure where the article is getting it's "24%" and "34%" numbers, however. 5,062 is 54.6% higher than 3,273, and the combined total of 6,458 is 49.1% higher than 4,331.
Enrollment in new Obamacare insurance plans increased by about 24 percent in the last month, Delaware Secretary of Health and Social Services Rita Landgraf told the Delaware Health Care Commission this morning....
Since enrollment started Oct. 1, 5,062 people enrolled in plans through the insurance marketplace, Landgraf said. Another 1,396 gained coverage in Medicaid, for those whose income is up to 138 percent of the federal poverty level....In all, 6,458 people have new coverage, up 34 percent from the January report.
As contributor deaconblues put it, "First mention I've heard of 30K new people being enrolled into Medicaid (in addition to the 130K transitioned from the CommonwealthCare plans)."
Before delving into the website issues, Patrick said Massachusetts still has the highest coverage rate in the nation at 97 percent and faced unique challenges to implementing the ACA because of past health reform efforts. He noted that on Jan. 1 130,000 subscribers to coverage through the Connector were successfully transitioned to new plans under the expansion of MassHealth and 30,000 new adults and children were enrolled in the Medicaid program.
So, after yesterday's big CBO report which had some interesting (and, in some cases, extremely misinterpreted) points to make about the impact of the Affordable Care Act, today there was another report released today from Avalere Health which has gotten a lot of attention, regarding the number of new Medicaid/CHIP enrollees which have been added specifically due to the ACA. I don't know much about Avalere Health, but they tout themselves as a healthcare think tank/analysis firm. From their "About Us" page:
"Avalere is a vibrant community of innovative thinkers dedicated to solving the challenges of the healthcare system. We deliver a comprehensive perspective, compelling substance, and creative solutions to help you make better business decisions. We partner with stakeholders from across healthcare to help improve care delivery through better data, insights, and strategies."
OK, fair enough. According to Avalere:
Avalere estimates that from October through December 2013, between 1.1M and 1.8M people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).
These estimates are concentrated in states expanding Medicaid—with expansion states representing roughly three-fourths of total estimated new Medicaid sign ups.
Now, on the surface, even the high end of this range (1.8 million people) would appear to be wildly divergent from my own recent analysis, which currently has "new Medicaid/CHIP enrollments" at around 7.5 million. However...