Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

A couple of hours ago I stated:

So, for my final, FINAL projection (again, assuming no massive, multi-hour outages by HC.gov or CoveredCA), I'm gonna go with a range: Between 6.9 Million and 7.0 Million.

Well, guess what?

Obamacare sign-up closes at midnight and enrollment is surging, but a technical flare-up on HealthCare.gov Monday morning marred the administration’s momentum.

The online portal, which had been handling millions of visitors over the past few days as enrollment pushed past 6 million, was “down for maintenance” starting at around 3:20 a.m. Officials said it returned to functionality at 9 a.m.

Hmmm...well, on the one hand, this was indeed a "multi-hour outage by HC.gov". On the other hand, it doesn't appear to have been anything critical (ie, they're back online now and all appears to be well...it's not like the earth opened up and swallowed the server farm or anything), and it happened in the wee hours of the morning, so hopefully the impact was minimal.

Yeesh. Like I'm not scrambling enough this morning...

At least 5 different people have sent me the link to the following story from yesterday's LA Times. Here's the key passage:

Precise figures on national health coverage will not be available for months. But available data indicate:

• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law's implementation.

They all starred in something called "Seven".

I feel a little silly this morning after my overdramatic post last night which bumped my projection up from 6.72 to 6.78M, but I'm now thinking that exchange QHPs may, against all odds, manage to push over the 7 million mark by tonight after all.

Why? What accounts for my casually increasing it by 220K this morning after stressing so much over a 60K bump last night? Several things:

First (and I'm incredibly embarrassed to to admit this), but I made a basic, 2nd-grade arithmatic error last night. I was incredibly tired and had been pushing numbers around in my head and on the spreadsheet all day, along with my wife having the flu (she's feeling better this morning, thanks)...and I made a basic "forgot to carry the 2" type of mistake. Result? My projection table was way off. With the correction, I now have it at 6.86 million.

(Also, it was just brought to my attention that I accidentally uploaded a blank version of "The Graph" to Twitter last night...it included the graphics but no text. I was very, very tired, folks...)

In addition, there are two other things:

OK, I have a confession to make:

I was quite confident of my projections through the 5 million and 6 million milestones...however, since Wednesday, I admit that I've been somewhat "winging it".

My estimates for the past 4 days have been about 2/3 based on solid data...but the other 1/3 has been a mish-mash of anecdotal evidence and instinct. I could be dead wrong here, but I'm going ahead and bumping up my projection for 11:59pm on Monday, March 31st one more time, to just shy of 6.78 million exchange-based QHPs.

On the hard data side, it's the latest numbers out of New York and Washington State, both of which appear to have doubled their already-spiked March enrollment rates in the past few days.

On the instinct side, maybe it was those "Apple store opening"-like line photos that I posted this morning (although most of those folks will probably end up actually enrolling during the extension period, if you think about it).

Maybe I'm just getting swept up in the heat of the moment. Maybe I'll look like a complete schmuck on Tuesday, and my flavor-of-the-month will turn sour.

I don't like basing my estimates on "gut feelings" or "hunches". This is the antithesis of everything that statistical analysis and the scientific method should be based on (at least, I think...I'm neither a statistical analyst nor a scientist). However, when you don't have solid evidence, sometimes you have to go with instinct. In this case, it's a mixture of both.

So, very soon we'll know how good my instincts are on this.

The thing is, I have no problem being off here (and I will be to some degree)...as long I've underestimated the actual total.

NOTE: Hopefully everyone noticed the (?) next to "final". One more update tomorrow.

The headline is negative (shocker!), but the data is positive (imagine that!):

The Washington Health Benefit Exchange reported Thursday it had 131,000 private insurance sign-ups through its online portal, wahealthplanfinder.org.

The milestone comes on the eve of a major Obamacare deadline. Individuals not exempted by law due to low incomes must have health insurance by Monday or risk paying tax penalties next year.

The private insurance sign-ups are in addition to the more than 250,000 newly eligible adults who have enrolled in Medicaid since the exchange opened Oct. 1. Thousands more are enrolled in other Medicaid programs for the first time, according to the state Health Care Authority.

If they "reported" the numbers Thursday the 27th, I presume they were through midnight on the 26th at the latest. The previous tally (125,207 QHPs) was through the 23rd, so that's about 5,800 more in 3 days, or 1,933 per day.

This compares with WA's February rate of 654/day (nearly 3x) and their existing March rate of 816/day (over 2.3x).

Several people have noted that my estimated Exchange QHP number as of today (around 6.58M) has actually surpassed the "combined" Medicaid/CHIP number (6.49M). This is obviously a long way from just a couple of months ago, when Medicaid enrollments were outpacing QHPs by a factor of 3 or 4 to one.

However, this brings up two important points about estimated enrollments vs. documented ones.

I have to be careful about using this as an actual spreadsheet entry because it doesn't specify the start date, the end date or the QHP/Medicaid breakout, but things are moving so quickly now that I'm not sure how much difference it makes:

According to @NYStateofHealth Nearly 100,000 New Yorkers have enrolled over the last week.

— Tara McGuinness (@HealthCareTara) March 30, 2014

NY State of Health had already reported 717K total enrollments as of 3/23, which had increased to 782K as of 3/28, which accounts for 65,000 of this number (call it 99K since they say "nearly" 100K). Call it 34,000 in the past 2 days.

If the QHP/Medicaid breakout is the same 38% / 62% that the other 65K from last week was (it should be very close to this), that's another 12,920 QHPs in 2 days, or 6,460 exchange QHPs per day.

I can't really use any of these numbers directly in the spreadsheet, but some excellent data to show the impact in Washington (state). Also note the point regarding many people enrolling directly with the insurance companies:

Statewide, about 375,000 people have insurance due to this law. That’s the net gain, counting those who had their policies “canceled” last winter (most simply signed up for a new one with their same company).

The Medicaid program in the state has grown 25 percent since October, from 1.2 million to 1.5 million.

...The private individual insurance market has also grown, by 19 percent, from 272,000 plans last October to 325,000 today. These figures include plans sold on the state exchange and directly by companies.

Whether that’s big enough to be stable and affordable remains to be seen. But before Obamacare it was shrinking.

Plus the state says there are 32,000 young adults on their parents’ policies due to the new law.

So, a couple of weeks ago I started a new #hashtag on Twitter, #ACASurge (at least I think I started it...perhaps not). Anyway, today the White House Blog posted this entry:

The line started forming at 5 a.m. in front of an enrollment center in Miami -- where trained workers have signed up 25,000 of their fellow Floridians since November. It was standing-room-only at a center in Houston yesterday.

The final deadline to get covered in 2014 is in just two days, and Americans are literally lining up at grassroots events across the country to make sure they're covered.

This is what momentum looks like.

Some nice, solid numbers in an otherwise negative article about Maryland bailing on their existing software in favor of Connecticut's:

O'Malley said that as of Wednesday, 273,582 people have signed up for coverage. That includes 220,043 people (80% of the total enrollment) who had enrolled in Medicaid, and 53,539 people (20% of the total enrollment) who had enrolled in private insurance.

This brings MD's QHPs up from 49,293 on 3/22, an increase of 4,246 in 4 days; the Medicaid number hasn't changed.

A 1,000 increase in the number of paid exchange QHPs since 3/22:

Since Nevada Health Link opened, the state's exchange for insurance, there have been many problems in finishing the enrollment process.

More than 24,000 Nevadans have enrolled and paid, far lower than the projected estimates.

Meanwhile, Xerox (which botched the Nevada exchange just as Oracle botched Oregon's) thinks they'll be able to "convert" 57,000 of the partially-completed enrollments into full enrollees during the extension period (which actually runs all the way out until May 30th in Nevada's case...):

Xerox officials told the board that they’ve identified about 77,000 people they’ll target during special enrollment, which runs through May 30. Consumers eligible to sign up then include people who have selected an exchange plan but not paid for it, as well as people who qualified through the exchange for a federal premium subsidy but who have not bought a plan.

Company officials said they believe they could convert about 57,000 of the 77,000 targeted consumers into actual enrollees.

OK, not exactly a shocker or particularly relevant until after Monday (unless they're gonna be foolish enough to try and switch over to the new system during the deadline weekend frenzy), but worth noting:

Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.

OK, this isn't exactly a major update but it's nice to get the occasional nugget from a Federal Exchange state (especially a deep red one):

@AntonJGunn can you confirm # of #ACA enrollments for South Carolina at 76K? Saw post on Facebook yesterday. Any idea exchange vs. Medicaid

— Burt Insurance Group (@BurtInsGrp) March 29, 2014

"@AntonJGunn: @BurtInsGrp all marketplace enrollments." @charles_gaba

— Burt Insurance Group (@BurtInsGrp) March 29, 2014

This doesn't really make much difference to the projection table, but I'm adding it anyway.

I included the 80K in 4 days info yesterday, but didn't realize the implications of the second sentence until a commentor pointed it out:

The Covered California exchange said sign-ups have been building throughout the week with about 80,000 people picking a health plan Monday through Thursday. An additional 150,000 households created an online account and started the shopping process in the last three days, officials said.

That's 50,000 households--not individuals--PER DAY who JUST ceated an account for 3 days straight.

Pretty sure most of those are actually enrolling even as I type this.

I think this final weekend surge is going to be MUCH larger than even I've been projecting.

Gotta run for the moment, but I'm going ahead and calling it 6.7 million exchange-based QHPs as of now.

OK, I meant to post this yesterday but had to double-check a couple of things with the reporter first. He confirmed that a) the 750K figure was slightly outdated (NY announced a higher total enrollment figure shortly after he posted the story), b) these 10,000 people are indeed enrolled in New York's SHOP exhange for small businesses and are therefore not part of the individual private exchange QHP figure, and c) the 10K figure does include dependents as well as employees.

Therefore, NY's SHOP total just doubled, from around 5,000 as of January to 10,000 today.

Close to 4,000 small businesses across New York state have enrolled their employees in the state's online marketplace for buying health insurance.

The six-month-old market, called an exchange, has become a noteworthy part of the federal Affordable Care Act. The law aims to spark the largest expansion of health insurance nationwide sinceMedicare and Medicaid were created nearly 50 years ago.

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