2018 MIDTERM ELECTION

Time: D H M S

We’re seeing many types of outreach efforts to reach the uninsured. Navigators are doing their utmost (at least in states where their work is not being obstructed), and many church groups are addressing their congregations. Nevada has mounted a concerted door-to-door effort. Here are the results, as reported by Allison Bell.

Exchange managers want the canvassers to reach 450,800 people who seem likely to need individual or family health insurance. Mi Familia Vota says it made 53,052 total attempts from Nov. 1 through Dec. 31. The organization’s workers talked to people in 7,935 homes, or 18 percent of the homes in the target area, and generated 661 enrollment appointment leads. The canvassers found 8,377 households were inaccessible, and no one was home in 33,875. In 5,596, the residents already had health coverage. In 806 of the homes, residents refused to talk to the canvassers.

We’ve already dealt with Oregon’s recently updated enrollment numbers, but this bit of news from Nick Budnick’s article in The Oregonian the other day really caught my attention:

About half of those who applied for coverage effective Jan 1 were turned away because their applications were not fully filled out, state officials have said. Instead, they'll be processed for insurance effective Feb. 1.

If Oracle had delivered a working website to Cover Oregon, then online applicants would immediately have received feedback that they needed to fill in more information. Clearly this is an added source of frustration for Oregonians who had every reason to think that their paper application was complete and in order.

On the other hand, this speaks to a huge potential. If Cover Oregon can assist those 20,000 applicants quickly, that alone should double the state’s enrollment numbers! Who knows – with dedication and luck, Cover Oregon might well achieve that before the end of January.

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.

The problems with the Obama Administration’s rollout of HealthCare.gov are reminiscent of the troubled rollout of the Medicare Part D expansion under President George W. Bush. In a candid interview with Kaiser Health News, former Health and Human Services Secretary Michael O. Leavitt offers telling details of their technical problems – and the Bush Administration’s solution.

…people were walking up to the pharmacy counter to get their drugs and their name wasn’t in the computer. Ultimately, we had to say, ‘give them their drugs, and we’ll work it out later.’ Then we spent 15 or 18 months working it out later. It was an expensive proposition and less than ideal.  But it allowed the limited number of people who were having problems with the system to have their human needs met.”

By contrast, the Obama Administration has spent just over three months working out glitches of HealthCare.gov, which was launched on October 1st, 2013. Perhaps after 15–18 months have passed, we can do a more complete comparison with President George W. Bush’s rollout of Medicare Part D?

We have our 3rd Oregon update this week today; they're now up to 20,000 private enrollments as of Monday, plus another 35,000 Medicaid expansion additions. Add this to the 114,500 automatic enrollments via the Oregon Health Authority, and that brings their total Medicaid tally to 149,500.

In total, about 170,000 people have new health insurance beginning this month under new funding and rules of the Affordable Care Act. A majority of them are Oregon Health Plan enrollees, a program for low-income residents...

Monday was the last day for Oregonians to finalize their commercial plan selections on Cover Oregon. Of the 55,000, about 20,000 new enrollees purchased private plans. About 35,000 enrolled in Oregon Health Plan through Cover Oregon, and the majority of the new OHP enrollees signed up directly through Oregon Health Authority.

The Nevada ACA exchange, which apparently only uses Twitter for press releases, just announced that private enrollments have gone up from 12,745 as of 12/23 to 17,673 as of January 4th, a 38% increase.

They're also one of only 3 states to specify paid vs. unpaid status so far; they've gone from 49% paid as of 12/23 to 60% paid (10,647) as of 1/4.

Update as of 1/4: 915,977 unique individuals visited Nevada Health Link. 17,673 consumers confirmed QHP selections, 10,547 have paid.

The final December tally for Rhode Island is in, and also gives a clearer picture of the "But how many have PAID???" talking point. As of New Year's Eve, 11,305 people had enrolled in a plan, of which 2,300 still hadn't paid as of 2 days ago. That means that at least 80% of RI private exchange enrollees are paid in full. No new Medicaid numbers in the article.

Depending on your POV, this also means that Rhode Island has also now hit either 94% (if you're counting unpaid enrollments) or 75% (if you're not) of their 12,000 CBO projection for 3/31/14. See this story for additional discussion.

Monday night, HealthSource RI, the Obamacare marketplace in Rhode Island, sent emails to 2,300 people who had not paid as of Jan. 5 to tell them they had until 4 p.m. on Jan. 8 to pay the first month's premium, and their plans will still be effective retroactive to Jan. 1.

HealthSource RI reported Monday that 11,305 people selected plans as of the Dec. 31 deadline, but not all had paid.

Yesterday, Theda Skocpol of Harvard University cited the data at this site in a brief about state progress in implenting the Affordable Care Act posted at the Scholars Strategy Network website. This brief--particularly the accompanying visual graph--was in turn cited in articles posted at both Talking Points Memo and Mother Jones. The gist of both the brief as well as these articles is that the states which have been cooperating with the ACA have been far more successful in enrolling people in both private insurance plans as well as publicly-funded plans such as Medicaid, SCHIP and related state-run programs.

It is well known, and highly embarrassing, that Oregon has yet to enroll a single person in a new insurance plan online. Since the 1st of October, Cover Oregon has had to do it all by hand, based on paper applications.

But did you know that in 2008 Oregon had an impressive success, enrolling 61,000 teachers and educators in a single month?

That, of course stands in stark contrast to today’s situation. In the course of three months, Cover Oregon has managed to enroll just 18,000 people in private insurance plans – and towering piles of applications are still awaiting the attention of their stressed case workers.

Connecticut, the first state to exceed their March 31 enrollment deadline back on December 23rd, continues to keep their momentum up, adding at least another 12,000 people to their rolls since the 12/23 deadline for January coverage. The article doesn't distinguish between private plans and Medicaid expansion, so I've broken it out roughtly 55/45 for now to match their previous numbers.

This brings CT up to nearly 41,000 private enrollments and over 33,000 added to Medicaid/CHIP.

Many state residents are aware that enrollment is still open, as Counihan said enrollment through Access Health CT has remained strong over the past week or so.

"We're still doing a thousand a day," Counihan said. "I would have thought that, after Dec. 23, things would have really dipped."

For California, we presently have data through the December 23rd. However, at the last minute, California extended its deadline to 12/27. This means that we are still waiting for four days of enrollment data! Keep in mind that just prior to the deadline, California was seeing 20,000 private plan enrollments daily.

It that rate continued unabated, we could be looking at as much as 80,000 signups beyond the 428,000 already registered. During the three days December 20–22nd more than 77,000 Californians enrolled in private plans. Granted, this is speculation – we won’t know until Covered California releases its figures.

An important develepmont is that Covered California extended its deadline for paying health insurance premiums to January 15th. Payment was originally due Monday the 6th. The extension also relieves pressure on insurers who were inundated with hundreds of thousands of new customers in December.

As part of its effort to reach minority uninsured, California has made paper applications available in Spanish, Chinese, Vietnamese and Korean.

The Vermont numbers have been alternately impressive and confusing at the same time.  The wording of a prior article from 12/12 made it sound like the 45,000 (at the time) people were split between private enrollments and Medicaid expansion, but also made reference to 29,200 people being enrolled "directly via their employer". At the time, I wasn't sure what to do with that number, so I ignored it. However, the more recent article again references the same 29,200 people; after comparing the 2 articles, it seems pretty clear to me that these would fall under the category of "direct" or "off-exchange" enrollees (although they also might fit under "small business exchange enrollments", which is a category I haven't even added yet). Add this to the 22,800 private exchange enrollments and you have 52K total.

Pages