2018 MIDTERM ELECTION

Time: D H M S

Today was filled with fantastic news across the board. The only bummer is that the actual HHS report for March (and the first half of April?), with the state-by-state breakdown, was not released today.

So, you know what? I'm so geeked about the 4/15 total actually breaking the big 8M mark after all that I'm going to attempt to estimate the state-by-state totals for every state which hasn't published their official 4/15 total yet myself.

This may sound insane, but it's not as difficult as you may think (well, it's not difficult to do; that doesn't mean that I'll be accurate).

First of all, I can obviously eliminate any state which has already released their data through 4/15. That gets rid of California, Colorado, Connecticut, DC, Minnesota, Nevada, New York and Oregon.

I can also eliminated Washington State, since they never participated in the expansion period (they may have a few hundred stragglers via "special case-by-case basis" but that should be about it.

The wording of the story makes it look like MA's exchange QHP total dropped by over 6K, but in fact they had only reported 12,965 to HHS as of March 1st, so this still represents a slight increase over the last number entered on 4/02 (29,720):

Unsubsidized enrollment in exchange plans fell to 29,775 April 8, from 36,060 Dec. 1, 2013, when the state had its own, homegrown exchange plan program in place. The exchange is planning to conduct a survey to learn why enrollment fell.

deaconblues, ever detail-oriented, also made sure to find the subsidized number of QHP enrollees as well: 769

Add 'em together and you get 30,544.

This number out of NC is a bit squirrelly; I'm not updating the actual spreadsheet with it, but it's still worth at least mentioning:

Overall, Terrell said, the state has received 95,000 Medicaid applications via the federal ACA sign-up, representing 132,000 people, since October 2013. And that number is likely to grow. 

The number of people added to Medicaid/CHIP in NC thru 3/01 via the HC.gov site was 55,691, so this could potentially be a more than 2.3x increase, but they're noted as applications, so presumably some of them will be denied. Still impressive.

Connecticut officially didn't have an extension period, but they did allow late enrollments on a "special case" basis, which apparently amounted to about 5,000 more people:

A total of 208,301 Connecticut residents enrolled in health care coverage through the Access Health CT online marketplace as of Sunday, the quasi-public agency announced Thursday.

The numbers reflect those who signed up before the March 31 deadline for open enrollment, plus 5,000 people who attempted to enroll by that date but encountered some difficulty, but were able to enroll over the last two weeks.

“Over the past two weeks, our team has made follow up calls to each of those individuals to assist them through the enrollment process, and we have now completed all open enrollment applications,” Kevin Counihan, head of the agency created as the state’s response to the federal Affordable Care Act, said in a news release.

Of the 208,301 enrollees, 78,713 enrolled with a private insurance carrier and 129,588 enrolled in Medicaid. Of the 78,713 residents who enrolled with a private insurance carrier, 78 percent received a tax subsidy and 22 percent did not.

Colorado issued a rough update the other day ("over 124K"), but they gave the official 4/15 tally today:

  • Exchange-based Commercial Health Insurance (QHPs): 127,233
  • New Medicaid Enrollees: 178,508

Oh, by the way: The "over 124K" press release issued on the 14th was a big part of the reason why I downshifted my total projection from the 7.9-8.0M range down to around 7.78M a few days back. I assumed that the only reason they would issue a number press release the day before the deadline would be if the enrollments were tapering off so much that there would only be a handful left to count on the final day.

Obviously I was wrong; CO managed to add another 3K QHPs on the last day.

Oregon continues to plug along, adding an impressive 3.8K more NET QHPs and 7.3K more Medicaid enrollees the past week...not sure if this runs through 4/15 exactly or if it includes yesterday as well (Oregon is one of the states going beyond 4/15), but I'm lining them up at 4/15 for the moment:

April 17, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 228,795
Total private medical insurance enrollments through Cover Oregon 1: 67,474                   

Oregon Health Plan enrollments through Cover Oregon: 161,321

Net enrollments 
Net private medical:  63,709

Update as of 4/15: 44,468 consumers confirmed Qualified Health Plan selections through Nevada Health Link, 30,176 have paid.

— Nevada Health Link (@NVHealthLink) April 17, 2014

I felt kind of bad for turning FOX News down for their kind offer to have Bill O'Reilly or Sean Hannity scream at me for 10 minutes (Then again, I don't recall which show they wanted me to appear on...perhaps it was FOX & Friends?)

Fortunately, my friend LOLGOP has provided a gift for me to pass along to them to make up for any hard feelings:

And there you have it:

President Barack Obama announced Thursday that 8 million Americans had enrolled in private health coverage under Obamacare.

"The bottom line is the share of Americans with health insurance is up," he said from the White House briefing room. "This thing is working."

In a fact sheet released simultaneously, the White House said 28 percent of those enrollees were ages 18 to 34, the key "young and healthy" population, up from 25 percent at the end of February.

Details to follow as they're released (where's that HHS report, darn it???)

One thing to note: The NY Times is reporting that it's 35% "under 35". Presumably the 7% difference between the two numbers are made up of children under 18:

So, now that I have the data through at least 3/31 (and in most cases, through mid-April) for all 15 state-run exchanges, I can start to play with the statistics a bit.

At the end of February (technically March 1st), the 15 state-run exchanges totalled 1,621,239 QHPs. As of 4/15, these add up to at least 2,564,005, or 58.1% higher. There's anywhere from 2-14 days missing from some of these, however (perhaps 30,000 total, for a total of around 2.59 million), so let's call it about a 60% increase since then.

However, we also know that the total exchnage QHP enrollment figure is a minimum of 7.5 million, and almost certainly closer to 7.9 - 8.1 million. Let's assume the low end: 7.9M total.

I was so caught up in the national tally implications, I forgot to actually devote a proper entry to California itself. There's some additional key numbers to look at here:

From April 1-15, 205,685 consumers – including a one-day record of more than 50,000 on the final day – completed their applications and selected health plans through the Covered California exchange, bringing the total to 1,395,929 at the end of the historic, first open enrollment period. The total exceeds the base projection for Covered California for the entire six-month enrollment period by more than 815,929.

As noted earlier, let's assume that "over 50,000" means, say, 50,100. To put this in context, they're saying there were (205,685 - 50,100) = 155,585 QHP enrollments in the first 14 days (about 11,100/day)...followed by 50,100 on the last day. That's 4.5x the rate it had been.

Holy Crap on a Stick!

From April 1-15, 205,685 consumers – including a one-day record of more than 50,000 on the final day – completed their applications and selected health plans through the Covered California exchange, bringing the total to 1,395,929 at the end of the historic, first open enrollment period. The total exceeds the base projection for Covered California for the entire six-month enrollment period by more than 815,929.

Let's assume that "over 50,000" means, say, 50,100.

To put this in context, they're saying there were (205,685 - 50,100) = 155,585 QHP enrollments in the first 14 days (about 11,100/day)...followed by 50,100 on the last day. That's 4.5x the rate it had been.

Until this, I was estimating that the national 4/01 - 4/15 average would be around 45K - 55K/day nationally during the extension period, or around 675K - 825K total, for a grand total of around 7.77- 7.93 million exchange QHPs total. I settled on 7.78M as my "official" projection to be on the cautious side.

Just a reminder: Assuming that Inside Health Policy has it right, the official HHS report should be released sometime today and should include about 99% of the exchange QHP enrollment data through 4/15.

In the past, they've usually released the monthly reports around the 11th or 12th of the following month. In this case they've obviously been delayed because of a) the insanity at the end of March and b) thankfully, they apparently want to squeeze in the first half of April as well (as you know, I was deeply concerned that they might lop off the last 2 days of the month and roll them over to an April report next month, which would cause no end of confusion among sloppy media outlets which can't take a glance at the calendar and do basic math).

They generally release these reports around 4pm. I know this because there've been at least 2 cases where the conference call with Kathleen Sebelius started up right as I was waiting for my kid to get home from school, so we'll see if that holds true today as well.

This is a guest post by Paul Mullen, Consultant Economist, Austin, TX; former Economic Advisor to the UK Minister for Local Government, Minister for Housing & Secretary for the Environment:

I would love to believe RAND's estimated 8.2 million increase in ESI between September and March but my experience in commissioning similar polls suggests to me that it is not real but due to an unanticipated side effect of the poll methodology.

We know that there is a pretty large "churn" in insurance status. Some people will gain jobs with insurance, while others lose them. Some people retire, get sick, or die. But one would expect the number gaining and losing employer coverage would be about equal. RAND's 8.2 million increase is the difference between 14.5 million estimated to have gained employer sponsored insurance and 6.3 million estimated to have lost it (with an estimated 102.4 million having employer coverage in both polls).

Yesterday I posted a poll asking whether people found the term "woodworker" (used to describe new Medicaid enrollees who were already eligible to be enrolled even without the expansion provisions of the ACA) to be offensive. The thinking is that "woodworker" makes it sound like you're an insect creeping around under the floorboards and so forth; not the prettiest image.

Anyway, the poll is now closed, and the results are in...out of 505 votes total:

  • 83% felt that I should keep using the term "woodworker" enrollees
  • 10% felt that I should switch to the friendlier-sounding "welcome mat" enrollees
  • 7% felt that I should use some other term

This led to a robust discussion about what seems to be a pretty minor issue, but apparently means a lot to people. Other suggestions included:

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