Charles Gaba's blog

2018 MIDTERM ELECTION

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With the October website disaster at HC.gov and serious problems still plaguing some of the state exchanges, is it still even remotely conceivable that private QHP enrollment could reach the CBO's original 7 Million projection? Well, the CBO doesn't think this is likely; they issued a revised projection last month which dropped that projection down to 6 million.

IMPORTANT: I should stress that this ONLY refers to exchange-based, individual/group policy enrollments. It doesn't include SHOP small business enrollments (about 58,000 to date) or direct/off-exchange enrollments (almost half a million confirmed, likely several million more as well). It also doesn't include Medicaid/CHIP enrollments either, though you probably figured that already.

However, let's look at the possible scenarios, about 6 weeks away from the enrollment deadline.

This is a great article; not only does it update West Virginia's Medicaid Expansion tally (up 16,561 from the current 70,574 number), but it gives other useful info, such as the total number of WV residents eligible for the expansion program (130K). Most importantly, it specifically states that these 87K are in Medicaid due to the ACA expansion provision, an important clarification.

According to West Virginia Department of Health and Human Services, over 87,000 residents have been enrolled for health care coverage through the Medicaid Expansion...

Jeremiah Samples, assistant secretary for the DHHS, said that number is about 70 percent of everyone eligible for the expansion....

The total estimated number of West Virginians eligible for coverage under the expansion is 130,000, according to Samples.

By Feb. 13, a total of 87,135 people have enrolled, which Samples said is about 25,000 more than the projected number for 2014.

Well I'll be damned! Oregon has finally managed to enroll a small number of people through their website! (Until today, all 35,247 private QHP enrollments in OR have been processed manually...literally, paper forms filled out by hand and then manually entered into the system). With only 6 weeks to go, this may seem a bit underwhelming, but it's still something...

A Cover Oregon official says insurance agents and community groups have been able to enroll about 700 people in health coverage entirely online.

Chief Information Officer Aaron Karjala revealed the number to a state legislative committee on Friday.

Cover Oregon launched its website for a limited group of experts earlier this week, more than four months after it was originally scheduled to be operational.

There's still no date for when the system will launch to the general public. Karjala says developers are regularly testing and fixing elements of the system.

Individuals working without an agent or certified expert can continue to apply, but Cover Oregon staff will have to process a portion of their application by hand.

Massachusett's ACA exchange website is still undergoing massive technical problems, but there's been significant progress made in processing a mountain of paper applications. The immediate impact isn't that significant (11,000 total enrollments = only 2,861 more than the Feb. 1st tally), but the article suggests that another 50,000 applications should be getting pushed through the system any day now... 

Officials running the state’s troubled health insurance marketplace reported progress on Friday toward addressing its most immediate problem -- a massive backlog in processing applications...

As a result, people were urged to file paper applications instead, both to replace expiring policies and to enroll for the first time. The nearest-term problem has been simply processing 72,000 applications, many of which come from uninsured residents....

Overall, a spokesman for the marketplace said that there have been about 11,000 people who have newly enrolled successfully for coverage since October, almost all in unsubsidized coverage.

Maryland continues to creep along, adding 2,139 to their QHP tally (about 7%) and another 8,581 to their Medicaid enrollments (a bit under 6%).

Through February 15, 33,251 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,889 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of February 18, 2014, an additional 60,672 individuals were newly enrolled in Medicaid effective January 1. 

Minnesota issued an official update today (as opposed to the estimate that I came up with a few days ago based on a "nearly 95K" line in an unrelated press release); I was only off by 888 people on the private enrollment side, but by more than 5,500 on the Medicaid/CHIP side of the equation:

ST. PAUL, Minn. — Today MNsure announced that more than 100,000 Minnesotans have enrolled in quality, affordable health insurance through the state’s new insurance marketplace. MNsure is working to enroll thousands more Minnesotans in coverage before open enrollment concludes on March 31, 2014. Today’s new milestone highlights the progress MNsure has made to significantly improve its performance, and the services it provides to Minnesota consumers....

31,088 Minnesotans selected private health plans;
21,574 Minnesotans enrolled in MinnesotaCare; and
48,682 Minnesotans enrolled in Medical Assistance (MA).

101,344 total enrollments

This update/correction also makes a slight improvement in the overall Feb/Jan enrollment model (from 75.6% of January's total to 75.8%).

Well this was unexpected...apparently at a fundraiser, President Obama gave a very rough update on the current ACA exchange tally:

President Obama said Thursday that "close to 4 million Americans" had signed up for insurance on the ObamaCare exchanges, a hint that enrollments may be accelerating as the deadline to purchase coverage nears....

"Right now, we've already got close to 4 million Americans who signed up for exchanges," Obama told a gathering of Democratic donors and governors at a luxury hotel just blocks from the White House.

Let's see how that jibes with my current February-vs-January rate projection.

At the moment, based on the still-limited data available, I'm showing an expected February total enrollment of around 866,000 people through March 1st:

President Obama's statement was yesterday (the 20th), which presumably means that the "close to 4M" number was based on data through the end of the day before (Feb. 19th).

Quite a day for Direct/Off-Exchange Enrollment news. First the Washington revelation, now this profile in USA Today of eHealth Insurance, a private web-based health insurance exchange that's seen tremendous success selling ACA-compliant plans to people who don't qualify for tax credits through the government-run exchanges.

Not exact numbers, but these are reasonable given the previous breakdown (49,662 Private / 181,705 Medicaid): KY Governor Steve Beshear announced that the combined total of enrollments in Kentucky has hit 244,000, broken out roughly 25% to 75%, which would be 61K private, 183K Medicaid. However, to be safe I'm erring on the side of caution and making it 59K Private / 185K Medicaid until a formal press release comes out.

[as of Thursday], 244,000 Kentuckians have signed up for coverage through Kentucky's exchange, Beshear said.

About three-fourths of them enrolled in the state's expanded Medicaid program and the rest in private insurance plans. The state's performance has earned praise from PresidentBarack Obama.

"Those aren't just numbers," Beshear said. "They represent ... real improvement in people's health."

This is significant for another reason. Previously, Kentucky's limited February data made it look like private QHP enrollments had plummeted, down to 20% of their January rate.

No fuzzy terminology here. Unlike some other Medicaid enrollment data which leaves you guessing as to whether it's "expansion", "base churn", "redeterminations" or "woodworkers", this AP article is pretty clear and to the point:

COLUMBUS (AP) — More than 23,000 low-income Ohioans enrolled in Medicaid last month under an expansion of the taxpayer-funded program supported by Republican Gov. John Kasich.

That's about 6 percent of the roughly 366,000 residents who the state projected would be newly eligible for coverage by the end of June 2015.

The state's monthly report on Medicaid caseloads does not include those who have applied to the health program for the poor and disabled. But the numbers released Monday provide the first glimpse as to how many people have successfully enrolled under the expansion. The report shows 23,156 residents have obtained coverage so far.

Sometimes it really is that simple.

For months I've been trying to hunt down the ever-mysterious "Off-Exchange" private QHP enrollment data...people who have purchased new, ACA-compliant healthcare policies since October 1st, but have done so directly via the various insurance companies. These are, for the most part (at least in the states which haven't granted a 1-year extension of non-compliant policies) the same (or very similar) policies as those sold via the exchanges; the enrollment process simply bypasses the exchange websites, that's all. There are several reasons why people do this; the most obvious is if their taxable income is too high to qualify for an ACA subsidy. Why go through the hassle (on some exchange sites, not others) of jumping through the extra hoops of the Exchange process if you're certain that you aren't going to qualify for a tax credit anyway? In other cases, the insurance company itself may have made some sort of special offer for enrolling directly (or, in some unfortunate cases, they may have pretended that it was a better deal or not even mentioned the exchange as an option).

In any event, this data is difficult to hunt down because unlike the Exchange enrollments, the insurance companies are under no legal obligation to make it public (at least I don't think they are...possibly in their quarterly SEC filings or something?) Until today, I only had hard numbers from 2 companies: WellPoint, whose CEO revealed last month that about 19% of their enrollees since October 1st have been signed up directly. I don't have a more recent update on this, and he didn't break those numbers out by the half-dozen or so states that WellPoint operates in, but that's still 95,000 people. In addition, one other company, a Co-Op that operates in Iowa and Nebraska, cheerfully provided a full breakdown of their enrollments. Add these together and you have about 124,000 people...until today.

Hot off the presses (well...ok, hot off a CT Mirror reporter's Twitter feed, anyway): Connecticut is reporting an additional 3,000 private QHP enrollees over the past week (up to 53,673 on 2/18 from 50,665 as of 2/10), and an increase in Medicaid enrollment of around 1,600 people. They also apparently have a "paid" rate of at least 91% ("low 90%"):

As of midnight Tuesday, Access Health CT had 126,653 enrollees, including 53,673 signed up for private insurance.

— Arielle Levin Becker (@ariellelb) February 20, 2014

CT exchange CEO Kevin Counihan says state's paid premium rate is in low 90 percent. Natl avg is 80-81 percent.

— Arielle Levin Becker (@ariellelb) February 20, 2014

So, how does this impact the "February Drop-off" factor? Well, previously CT's February enrollment was running about 39% below January; this has improved to only 19% lower per day, which has the effect of increasing the overall daily average a bit, even after adjusting to only include the 91% paid enrollments:

Eureka! That rarest of things, a mid-month enrollment update from a federally-run exchange state! Idaho reports hitting 38,000 private enrollments, up from 32,899 as of February 1st (I'm sure this is private enrollments only, because they were already at over 16K Medicaid enrollments as of 2/01. It's a short article and the whole thing is a gem, so here it is verbatim:

Idaho’s state-based health insurance exchange has now enrolled 38,000 people in health insurance, state Department of Health & Welfare Director Dick Armstrong told lawmakers today. And another 56,000 are “in the queue,” in the process of enrolling. “Our original target was 42,000,” he said, for signups by the end of the open enrollment period at the end of March. “Very rapidly, Idaho’s enrollment … has come up.”

When the exchange opened and faced problems due to computer system hang-ups in Washington, D.C., initial enrollment numbers were very low. “Everybody was just wringing their hands,” Armstrong said. “This is a breath of fresh air, to see that the enrollments are picking up this rapidly.”

One more very small update today. This isn't an official data release, but this press release from yesterday mentions the total enrollment in Minnesota as being "nearly 95,000". This presumably includes enrollments through 2/17.

Assuming the same 32% / 68% ratio between existing private QHPs and Medicaid enrollments in Minnesota, this should break out to roughly 30,200 Private / 64,700 Medicaid, an increase of around 700 and 1,700 respectively.

Today, MNsure announced new TV and radio ads that tell the stories of Minnesotans who have used MNsure to find better, more affordable health care coverage. The ads highlight the affordability of MNsure plans and underscore the fact that MNsure offers the lowest premium rates in the country – with additional financial help available through tax credits. The ads are aimed at encouraging more Minnesotans to enroll in affordable, quality health coverage before the March 31 deadline. Nearly 95,000 Minnesotans have already selected health insurance through MNsure.

Yes, it's true...sort of. With the addition of the latest numbers from Colorado, Hawaii and especially California, if you include all ACA Exchange-based enrollments reported to date--both paid and unpaid--the total currently sits at a tad over 3.56 million people. The original CBO projection for exchange-based private QHP enrollment was 7 million, so we've finally hit the halfway mark. Of course, the enrollment period itself is actually over 77% of the way through, so this is more of a purely symbolic milestone than anything else, but it's still worth noting.

There's a few additional caveats as well, of course; if you remove all enrollments known to be unpaid (about 265K) from the 5 states which have broken that out, and then subtract another 10% from the remaining 46 states, you'll only have about 3.05 million enrollments which are paid (or unpaid due to billing problems on the insurance company's end, which can hardly be blamed on the customer or the exchange system). However, this works out nicely as well, since 3.05 million is still over 50% of the revised CBO projection of 6 million total!

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