Charles Gaba's blog

2018 MIDTERM ELECTION

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In my prior estimated breakdown, I had NY private QHP's as 237, 411 and Medicaid/CHIP at 106,785. Turns out I was only missing 3,800 on the private side, but they've added an additional 30,000+ more on the Medicaid/CHIP side.

Of the 380,747 who have signed up, 241,242 people have enrolled in private health plans and 139,505 have enrolled in Medicaid.

I should note that just as the Private QHP number doesn't include direct off-exchange enrollments, neither does the Medicaid/CHIP tally; when you add those, the new Medicaid enrollment total comes to over 330,000 for New York.

The first number is only slightly higher than last week, but at the time I didn't know if that referred to employees only or their families as well. This article is more specific, so using Covered California's very conservative 1.8x factor for dependents, the actual number of people covered by the SHOP exchange comes to about 711.

As of Jan. 28, 1,612 New Mexico employers had signed up to buy insurance on the SHOP for their employees. A total of 395 employees and their dependents have selected plans on the SHOP.

In addition, as the submitter noted, the numbers aren't huge but the 1,612 employers signing up is extremely promising.

Maryland continues to move along...

Through January 25, 26,832 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,318 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 January 28, an additional 42,302 individuals were newly enrolled in Medicaid effective January 1.

Leigh McGivern, PR & Social Media Manager for CoOportunity Health of Iowa and Nebraska, has done me a huge favor by agreeing to release the Co-Op's on-exchange and off-exchange (direct) enrollment figures through January 24!

Unfortunately, the on-exchange numbers are both less than the 12/28 totals for either states (there are 2 insurance companies operating on Iowa's exchange and 3 on Nebraska's), so I don't know how much those have gone up since December, but the off-exchange numbers are quite impressive and very telling! I'm not breaking out the age data, but here's the key numbers:

Iowa Off-Exchange QHP Enrollments: 5,325 Individual; 4,694 Small Group; 147 Large Group = 10,166

Nebraska Off-Exchange QHP Enrollments: 7,867 Individual; 8,079 Small Group; 1,833 Large Group = 17,779

Between the two, that's nearly 28,000 more people added to the Private QHP tally.

OK, this is a new one...two updates for the same state only 14 hours apart:

Hot off the press at #RWJFRR - Kentucky official says 195,502 have used Kynect to get coverage (up by 12,000 this week). 44,160 are in QHPs.

That's 760 more QHPs / 12,742 more Medicaid/CHIP enrollees than I had last night. This also brings Kentucky up to over 20% of their absurdly-high "projection" of 220,000 QHPs (or, conversely, 46.4% of the more reasonable "Proportional % of 7 Million" figure).

UPDATE: I should have noted that the actual total number of new Medicaid enrollments for Kentucky is now over 206,000 if you include direct (off-exchange) enrollments.

OK, no exact numbers here, but the totals on 1/24 were 42K Private and 136K Medicaid/CHIP, so similar ratios would be about 1,400 extra QHPs and 4,600 Medicaid/CHIP additions.

Kentucky Gov. Steve Beshear said Monday that 182,000 Kentuckians have signed up through Kynect since October 1.

Some minor updates out of Oregon today: Private QHP enrollments are up to 31,664 from 30,157 a week ago; exchange-based Medicaid enrollments have gone up to 57,858 from 53,018, and Medicaid "Fast Track" direct enrollments are up to 122,869 from 121,190. As noted last week, only the difference in Fast Track enrollments since 12/28 are being listed on the spreadsheet, since the other 120K or so are already included in the CMS report numbers.

Cover Oregon: Private insurance: 31,664 / Oregon Health Plan: 57,858 
Oregon Health Authority “Fast Track”: Oregon Health Plan: 122,869

No exact numbers, but roughly 5,600 more private QHPs than the 1/15 official update of 63,407. No new Medicaid/CHIP here, however:

Almost 69,000 people have gotten private health insurance through the exchange that meets new federal mandates, Fontneau said. That's a big uptick from the end of 2013, when just over 50,000 had gotten coverage.

Since this period is evenly split pre- and post- Sec. Sebelius' "3 Million Total" announcement, I'm subtracting a little more than half from the "Not Broken Out Yet" amount and considering the other half to be newly added since then.

The next quote from a Colorado exchange representative is also quite telling:

"As much as we may have overestimated what would happen in October and November, we underestimated what would happen in January," she said.

Arkansas' unusual "Private Medicaid Option" already had 74,000 enrollees at the end of December; it looks like they've added another 5,000 people since then. The other 74K are already included in the "CMS Direct" report columns on the spreadsheet, so I'm only increasing the tally by the new 5K.

More than 79,000 people have enrolled in Arkansas' private option program, and state officials say they expect it to hit 100,000 when the Legislature convenes next month for a session focused primarily on the state's budget. 

And voila, with the quarterly earnings conference call for WellPoint Insurance, we have our first clue as to just how many ACA-compliant policies have been sold directly via the insurance companies instead of being run through Healthcare.gov and/or the state-based exchanges: Around 95,000 nationally:

Of the half million new members Wellpoint said that have applied for coverage so far, more than 80 percent came through public exchanges and two-thirds of those were “subsidy eligible.”

Unfortunately, these are pretty rough numbers--"half million" could be as few as around 490,000 or as high as perhaps 520,000, and "more than 80%" could mean anywhere from 81 - 83%, but for the moment I'll assume 81% out of 500,000, which means 19% off-exchange.

Oh, and no, these should not include any of the "1-year extensions of non-compliant/junk accounts" which the Obama administration has been allowing; the article specifies these as new members of WellPoint, not renewals/extensions of existing policies.

Good Morning! I have some mid-level changes to both spreadsheets this morning which visitors should be aware of:

--On the Private QHP Spreadsheet, I've replaced the very rough percent-based "Total Uninsured" numbers with the raw numbers from the same Kaiser Family Foundation table. Again, this is the same source, I'm just using the raw number view now instead of the percent view. In addition, using percentages were based on the July 2013 census estimates, while the KFF numbers are based on 2011-2012 population totals. Combine this with the percentages being previously rounded off, this resulted in some significant differences in the state numbers.

For example, at the high end, the California number changed from around 7.6 million to only 7.1 million, a half-million difference! Meanwhile, at the low end, Vermont has "dropped" from 57,000 uninsured prior to October 1st to just 47,900…which makes the original CMS projection for Vermont (also 57,000) all the more absurd.

OK, no press release or private/public breakdown yet, but the home page of New York's health exchange website is displaying a total of 351,605, up from 328,796 as of January 20.

Assuming the same 67/33 split that their previous exchange enrollments have followed, that means roughly 15,400 private enrollments and another 7,409 added to Medicaid/CHIP. I'll adjust these numbers as appropriate once a formal press release comes out.

In addition, this is the first update that takes us beyond January 23 (the date of the "3 Million" announcement), so only about half of that 15,400 will be subtracted from the "Not Broken Out Yet" amount. And with that, we've moved onto Week 17.

Washington State just released their latest official update, and as usual, they do a fantastic job of breaking down the numbers in an easy-to-follow manner, especially on the Medicaid/CHIP side.

Private QHP enrollments are up from a total of 149K (73,098 paid, 76,058 unpaid) as of 01/09 to about 168K (86,031 paid, 81,872 unpaid) as of 01/23, a 12.7% increase in 2 weeks.

Medicaid enrollments are up from a total of 198K (134,700 via Medicaid Expansion + 63,070 "Out of the Woodwork" folks who were previously qualified but weren't already enrolled) as of 01/09 to a total of almost 238K (160,587 expansion + 77,144 "woodwork") as of 01/23. This represents a 20% increase.

Between these and the other recent updates, the grand totals now stand at 3.16M Private QHPs and 7.38M Medicaid/CHIP enrollees. It's also important to stress that the Medicaid number does not include renewals of existing Medicaid/CHIP recipients.

I've written about this in passing before, but after repeated requests about the subject, I've decided to devote a full blog entry about the serious problems inherent in the CMS's state-level Private QHP projection numbers.

As far as I can tell, while the national "7 million" private enrollment projection figure issued by the CBO was based on solid analysis of the demographic situation at the time, the state-level CMS projection breakdown is, in many cases, based on little more than educated guesswork.

As the CMS put it in their own report: 

 In general, the enrollment targets provided by state- based Marketplaces are more ambitious than the initial Department enrollment targets for those specific states. As a result, using the publicly available SBM targets without adjusting other states would have raised the projected number of 2014 Marketplace enrollees by 1.4 million; therefore, the Marketplace ramp-up rates for other states were revised downward accordingly to maintain the 7 million total. 

Contributor deaconblues provides an interesting Rhode Island update. While the standard Private QHP and Medicaid/CHIP numbers haven't changed from what I already had listed (although the paid QHP number has increased slightly), there's also the addition of 4,311 RIte Care parents automatically enrolled in RI's non-profit Neighborhood Health Plan.

As deaconblue notes, "Rite Care looks like it fully covers the premium for up to 150% FPL and offers premium assistance to those between 150% and 250%...the context implies that all of the 4,311 should be somewhere under QHP - if some of these plans were fully paid by the state, would they have appeared as an asterisked note under the Medicaid Enrollments section?"

I see his point, but at the same time, seeing how it fully covers the cost up to 150% FPL while even the ACA's Medicaid expansion only goes up to 133%, it really sounds like the vast majority of these folks should be categorized on the Medicaid/CHIP side. I'll look into it and may move some or all of these over to the Private QHP side later, but for the moment I'm listing them as "Medicaid/CHIP".

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