Charles Gaba's blog

Another update from Nevada: Private QHPs up from 16,030 paid / 7,656 unpaid to 17,047 paid / 8,595 unpaid from 2/08 - 2/15.

This also gives some additional data to work with regarding the February Drop-off issue...and there's some good news here, whether you look at total QHPs or paid only:

Update as of 2/15: 25,642 Nevadans confirmed QHP Selections. 17,047 have paid.

— Nevada Health Link (@NVHealthLink) February 18, 2014

Over the weekend, I threw some cold water on the ACA enrollment momentum theme with a one-two punch: First, I pointed out that the February report will only include 4 weeks of data (2/02 - 3/01) vs. January's 5 weeks (12/29 - 2/01); then I looked into the actual data to see if this story from Yahoo Finance was correct in suggesting that enrollments have dropped off even on a daily-average basis since January.

Ah, just in time to help clear up my confusion about the New York situation from over the weekend: The latest tally has NY with a total of 266,177 private QHP enrollments, up 14,871 from 251,306 a week earlier. Medicaid enrollment via the exchange is up to 189,865 from 160,915, an increase of 28,950.

This is noteworthy for a couple of reasons. First of all, this gives some additional, solid data to plug into my weekend "NY Enrollment Number Mystery Project" that I've written a couple of posts about the past few days. Connected to this, however, is something which may be cause for a bit of concern--up until now, New York has been bucking the tide and averaging around a 60/40 split in favor of private QHP enrollments. Today's additions, however, reverse that with the numbers switching to 34/66 in favor of Medicaid enrollments:

Another 44,000 people enrolled in a health insurance plan through the state's exchange over the past week, pushing the total to 456,042, according to the state Department of Health.

Earlier today, I pointed out some potentially bad news for total ACA enrollmentthat February's enrollment tally is likely to be a good 20% lower than January's for the simple reason that the February HHS report is only going to include 4 weeks' worth of data, while January's included 5 weeks. Nothing neferious or evil going on here, just measuring 28 days instead of 35 (for the record, the final report for March will include 30 days' worth of data (March 2nd - 31st)).

While writing up the main part of the entry, however (which addressed a Yahoo Finance article which claims that February enrollments will be way down for a variety of unrelated reasons), I noticed something very curious about New York's enrollment numbers. I went into this in the earlier entry but decided that it's important enough to merit it's own full repost.

Here's the official enrollment numbers from the October, November, December and January HHS Reports...and the most-recent official press release from the NY State of Health Exchange:

NewA couple of weeks ago I predicted the total January Private QHP enrollment number with accuracy that surprised even myself (I called it at precisely 3.3 million; it came in at 3,299,492).

I also gave airy, back-of-the-napkin predictions for February and March, figuring that February would come in at around 1.14 million in Febuary and between 1.5 - 2.0 million in March, for a final total of roughly 6.0 - 6.5 million enrollments. Note that this does not take into account the "paid vs. unpaid" factor, since some people won't be paid in full until mid- to late-April or beyond.

This just in...Kentucky's latest update has KY Private QHP enrollment up to 49,662 from 48,611 on February 1st (a modest 2% increase) and Medicaid enrollment up to 181,705 from 155,172 (a 17% increase).

231,367 Kentuckians are enrolled in new health coverage through @kynectky. If #ACA is repealed, 231,367 Kentuckians are SOL. #kysen

— Joe Sonka (@joesonka) February 14, 2014

181,705 Kentuckians have enrolled in Medicaid, 49,662 in private insurance through @kynectky.

— Joe Sonka (@joesonka) February 14, 2014

Maryland's Private QHP enrollment is up to 31,112 (up from 29,059 on 2/01), and their Medicaid/CHIP enrollment has increased to 52,091 people plus another 95,889 transfees from the Primary Adult Care program; this is up from 44,592 Medicaid + 95,824 PAC transfers a week earlier.

Through February 8, 31,112 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 11, 2014, an additional 52,091 individuals were newly enrolled in Medicaid effective January 1.  

OK, not exactly an eruption of new enrollees, but add 265 more people to the list...

Total since October 1, 2013

3,879 Enrollments in the Individual Marketplace

Happy Valentine's Day!

Now that the dust is settling on the January HHS Report and I've had a chance to fully tackle the "But how many have PAID???" issue, I decided this would be a good point to do some cleaning up of The Graph.

First of all, as I announced last night, I've added a "90% Either Paid or Unpaid for Legitimate Reasons" marker to address the "Paid/Unpaid" issue.

Secondly, now that I've switched both the Medicaid and Private QHP numbers over to a "range" format, I've decided to drop the Grand Total numbers from 2 decimal points to one (that is, the range is now 8.8 - 14.4 million instead of 8.78 - 14.46). All of the numbers involved are large enough now that it doesn't make sense to be so anal about it anymore (don't worry, the actual spreadsheets will remain as precise as I can make them).

Well how do you like that? Here I go and spend all morning crunching numbers, reviewing different state reports and so forth...and a few hours later the New York Times goes and makes my point for me:

WASHINGTON — One in five people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts say.

Paying the first month’s premium is the final step in completing an enrollment. Under federal rules, people must pay the initial premium to have coverage take effect. In view of the chaotic debut of the federal marketplace and many state exchanges, the White House urged insurers to give people more time, and many agreed to do so. But, insurers said, some people missed even the extended deadlines.

OK, now that the January numbers are out, let's take a look and see how the individual states are doing. The wonderful Kaiser Family Foundation has a much more sophisticated version of this, but my spreadsheet has two features theirs doesn't: Ugly color-coded cells...and more recent enrollment data for 13 states.

While including post-February 1st data fro some states but not for others does give a bit of an unfair advantage to those states, it's still worth taking a look at to see how the states are faring.

First, let's use the official CMS Projection percentages. These absurdness of these numbers has already been discussed repeatedly, so I won't rehash that here, but we should at least check it out before looking at a more rational measurement.

SEE UPDATE BELOW!!

OK, the anti-ACA talking point of "How many enrollees have actually PAID???" has been one of the most commonly-made attacks on the exchanges since the first decent numbers started rolling in at the end of November. It seemed awfully silly back then, since at the time, the actual coverage start date was still weeks away. Most people I know don't pay their utility or credit card bills until just before they're due, so it seems disingenuous to assume that a health insurance policy (which could be up to $1,000+ per month for some families) would be any different.

Here's what I said about the issue on January 2nd, right after the first wave of policies kicked into effect:

Less than 8 hours after the HHS Dept. released their big January enrollment report, Nevada has already issued another update to their numbers: 

Update as of 2/8: 23,686 consumers have confirmed Qualified Health Plan selections, 16,030 have paid.

The 16,030 number is a 7% bump over a week earlier (14,999), and the unpaid number (7,656) is slightly higher than the prior week (7,598).

With all the focus on fixing the problems with the individual/group healthcare exchanges, there's been far less attention paid to the more-troubled SHOP (Small Business) exchanges. The administration had already announced that the HC.gov version (covering 34 states*) wouldn't be launched at all until this fall, and 2 of the state-run exchanges (Oregon and Maryland) recently announced that they'd be offline until well after the end of the March enrollment period as well.

Today, Covered California announced that while their SHOP exchange has been operational (with a small number of enrollments to date), they're shutting it down until this fall as well. This leaves 14.5 state-run SHOP exchanges in operation (and yes, that's 14.5, not 15...Washington State's SHOP is only running in 2 counties at the moment).

Still, the press release does give a slight bump in CA's SHOP enrollment before they stop taking new signups: 4,490 individuals covered, plus another 1,200 being processed, for a total of 5,690. That's where it'll stay through the end of the March enrollment period unless they reverse themselves between now and then.

OK, given how messy and confusing the Medicaid/CHIP situation is, I had to think through the best way to incorporate the January HHS Report into the mix. The problem is that not only are the monthly HHS reports only part of the equation (the January CMS report probably won't be released for another 10 days or so, based on prior months), but it's not a simple "add HHS now, then add CMS later". The two actually intermingle, and some of the caveats and overlapping data changes from month to month, which means that some of the data I include today will have to be modified or removed after the CMS report is released, and some of the data which I've removed will have to be added back in...or part of it will, anyway.

Having said all that, I think I have a pretty good grip on how to do this now:

Pages