Connecticut

A ton of great ACA news coming out of Connecticut this morning, courtesy of Arielle Levin Becker (posted in reverse-chronological order, newest at the top):

Arielle Levin Becker provides some updated numbers out of Connecticut, which is great...but I'll have to do some calculations to parse the data out for my purposes:

Current Access Health membership: 76,094 in private insurance, 207,020 in Medicaid (total Medicaid enrollment is much higher)

— Arielle Levin Becker (@ariellelb) September 18, 2014

OK, so those are the current enrollment numbers. 76,094 QHPs is 4% net attrition from the 4/19 total of 79,192, or less than 0.8% per month, which is fantastic.

However, since that 76K figure combines both additions and subtractions (ie, it's the net total, not gross), I can't really tell what the cumulative total is, which is what I use for my off-season projection chart.

The news broke just a few hours ago that Kevin Counihan, the head of AccessHealthCT (Connecticut's extremely successful ACA exchange, which works so well that they were able to actually sell the software platform to Maryland to replace MD's original broken system) is leaving the CT exchange for an unspecified position at the HHS Dept:

Access Health CT CEO Kevin Counihan, who spearheaded Connecticut's largely successful first round of Obamacare enrollment through the state's public insurance exchange, is departing, a source close to the matter confirmed.

Access Health has scheduled a noon press conference Tuesday to make the announcement. No replacement will be named today, according to the source, who said Counihan is leaving to take a federal position within the U.S. Department of Health and Human Services.

Well, Sarah Kliff over at Vox.com has now broken the news about just what that new HHS position actually is...and it's very good news indeed:

Breaking: White House announces Kevin Counihan will be new Healthcare.gov CEO. Currently runs the Connecticut exchange.

Over at the CT Mirror, Arielle Levin Becker does the same type of wonky number-crunching that I specialize in here at ACASignups.net to figure out whether the state's recent claims of the ACA slashing their uninsured rate in half (from 8% to 4%) hold water.

It gets a bit involved, but her conclusion is that yeah, it probably has been cut significantly, but a specific percent number is hart to pinpoint since there's still a lot of noise on the ESI side as well as continuous churn across the board as people move on & off of different plans.

However, it does include a few nuggets which help me update my own data. For one thing, CT's SHOP enrollment has gone up from 500 as of February to a whopping...602 people last month:

Access Health also operates an exchange for small businesses, although uptake has been low. As of mid-July, it covered 602 people.

A couple of weeks ago, I posted about how insurance providers in Connecticut requested rate changes ranging up to 12.8%...but the approved rate increase, overall, appeared to only be around 4.5% when weighted by market share. However, that was based on the assumption that the largest provider, Anthem BCBS, would end up with an approved average of around a 6% increase.

Today, it was revealed that Anthem's actual rate changes for 2015 will be an average of 0.1% lower:

Anthem, the state’s largest insurer, initially requested approval to raise rates by an average of 12.5 percent. But the insurance department rejected the proposal and asked the company to resubmit its plan using different calculations.

The result: An average premium decrease of 0.1 percent for Anthem customers.

A few days ago, AccessHealthCT (Connecticut's state-run ACA exchange) gave me their exact total enrollments as of 8/02: 250,633. Unfortunately, they were unable to provide a breakout between QHPs and Medicaid/CHIP enrollments. Yesterday the Hartford Courant reported a higher combined total:

Access Health CT, the state-run onlinehealth insurance marketplace created under the federal Affordable Care Act, has enrolled more than 256,000 state residents in private health plans or Medicaid since the website launched last fall.

The open enrollment period total of 218,100 (including everything through 4/19) broke out roughly 36:64. Assuming "more than 256K" is roughly 256,100, that means about 38,000 more people since then. If that ratio has stayed consistent, it should be around 13,700 QHPs and 24,300 Medicaid. However, as I noted the other day, with off season enrollment being limited for QHPs but open-ended for Medicaid/CHIP, the ratio has almost certainly shifted substantially in Medicaid's favor.

Sometimes you just have to go straight to the source. I flat-out asked Access Health CT (Connecticut's ACA exchange) if they could provide an off-season enrollment update, and here's their response:

@charles_gaba our total as of July 22nd is 250,633 overall enrolled. That's all I can share now, but more coming near OE

— Access Health CT (@AccessHealthCT) August 2, 2014

They weren't able to provide a breakdown between private QHPs and Medicaid/CHIP enrollment, but I can make a pretty good guess.

According to the final HHS report, Connecticut's official exchange QHP total as of 4/19 was 79,192, and Medicaid determinations were 138,908, for a combined total of 218,100. Since then, this total has gone up 32,533. The QHP/Medicaid ratio during open enrollment was roughly 36/64, which, if consistent during the off season would mean around 11,700 more QHPs to around 20,800 Medicaid enrollees.

There's been a recent batch of insurance rate change requests reported across various states which has gotten a lot of press. However, as I noted a couple of weeks ago, there can be a big difference between what the insurance companies ask for and what the state insurance commissioner approves. This is one of the most important (and least-written about) aspects of the ACA: Insurance companies can no longer just jack up their prices however much they feel like; those rates have to be approved by the insurance commissioner for the state they're operating in if they want to sell their wares on the exchange.

Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:

Illinois:

After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.

The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.

...United's participation also could help lower rates for consumers, a key concern among the law's supporters.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

This story out of Connecticut breaks down their Medicaid enrollees using a handy chart and some very specific numbers, giving fairly hard "Strict Expansion" and "Woodworker" updates:

Unsurprisingly, the biggest percentage growth occurred among adults who don’t have minor children. The income limit for people in that category [HUSKY D] to qualify for coverage rose Jan. 1 as part of the federal health law commonly known as Obamacare, from 56 percent of the poverty level to 138 percent.

...But another portion of the Medicaid program also saw a significant enrollment increase, even though eligibility requirements remained largely unchanged. That portion, known as HUSKY A, covers low-income children and their parents.

...Between the end of September and the end of April, total number of people in HUSKY D rose from 94,058 to 137,260 -- a growth of 43,202 people.

During that time, the number covered by HUSKY A grew by 29,792 people, to 460,103 members.

After my back-to-back Cranky Screeds, this is a breath of fresh air.

Given the "How many have PAID???" fuss & bother, I've been debating how to handle an interesting number-crunching dilemma ever since the (final???) HHS report for March/part of April was released a few weeks back.

The question is this: When people ask "how many have paid?" their first month's premium, are they really interested in the percentage or in the actual number of people who are paid up?

This may seem like a curious distinction, but consider the following: Officially, the maximum total number which could potentially be "fully enrolled" (ie, premium paid) is 8,019,763. That's the number that the HHS Dept. listed in their last report, which runs through April 19th.

So, 90% of that number would be around 7.22 million, give or take.

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.

No exact numbers here, but the wording of the article gives the rough breakdown:

About 3,500 Connecticut residents have enrolled in health insurance through the state’s health care exchange, Access Health CT, since the official open enrollment deadline passed on March 31. That’s in addition to the nearly 200,000 who enrolled by the health care deadline.

Access Health CT CEO Kevin Counihan said there were roughly 10,000 people in the state who wanted to enroll but couldn’t complete the process by deadline for some reason. Those people were told to leave their contact information, and that the state would follow up with them to make sure their enrollment was completed.

...Customers to the state marketplace could either buy insurance through one of three private carriers on the exchange, or get covered through Medicaid. The majority of those covered through the exchange — more than 120,000 — were covered under Medicaid.

Last night I posted that Washington State, which officially is not offering any sort of extension period, actually is allowing late enrollments on a special, case-by-case basis.

Then, earlier today, I learned that Hawaii (which I never really read an official policy on one way or the other, but which I thought was not extending enrollments) actually is doing so for up to potentially 1,100 people or so (192 to date).

Now it appears that Connecticut, which had been very explicit about their "no extension" policy...apparently is allowing up to 10,000 people to (potentially) sneak in under the wire after all:

Connecticut’s health insurance exchange ended its first open enrollment period with 197,878 people signed up for health care coverage, including 5,917 who enrolled Monday.

Connecticut reports their 3/31 totals...just shy of their 200K upgraded goal, but still very impressive:

A total of 197,878 residents secured a policy through the system, including 76,597 with a private carrier and 121,281 in Medicaid. Since open enrollment began last October, Access Health CT logged 801,509 unique website visitors. 

Pages