2018 MIDTERM ELECTION

Time: D H M S

It took me a few minutes to figure out why, at this point, Colorado would issue a formal press release with a "final" number when there's still a day and a half to go. However, I realized that it probably simply means that practically everyone who qualified for the 4/15 extension has already done so by now; presumably they're already over 124K and there's only a few hundred partial applications left anyway, so their final tally will come in somewhere between 124K - 125K, thus allowing them to confidently release the news.

On the down side, if this "winding down" effect is true in most other states, it also suggests that instead of one final mini-spike, the 4/15 deadline will actually result in a severe drop-off, making the final total more like 7.7M instead of 7.8M, but that's fine as well.

In any event, CO is up another 3,000 exchange QHPs since last week to over 124K total.

UPDATE 4/14: From a Denver Post article on the same topic:

About 500 small employers participated in the Small Business Marketplace, or SHOP, which saw 220 enroll, covering 1,860 employees and family members.

That's a whopping increase of...90 people. Still, every one counts...

(sigh) OK, until this morning I was under the impression that the exchange QHP enrollment rules were:

  • 46 states +DC (36 on the Federally-run exchange, plus another 11 of the state-run exchanges): April 15 as long as you started the process by 3/31
  • Oregon: April 30, no "started by 3/31" requirement
  • Nevada: May 30 with the "started by 3/31" requirement
  • Connecticut & Washington State: No extensions

I did know that Florida was allowing paper applications received by April 7 to have their enrollments completed by April 30, but I thought that was it.

Well, if this Motley Fool article is correct, the final numbers could be even a little higher yet:

The new federal deadline -- a special enrollment period – already allowed registrations delayed by exchange-related problems to be finished as late as April 30 for those who submitted a paper application by April 7. That extension applied to individuals living in states where insurance enrollment under the Affordable Care Act is conducted through the federal exchange.

A few days ago I gave a final 4/15 exchange QHP estimate range from between 7.7 - 7.9M, with an outside shot of 8M.

Today I'm narrowing my projection within that range; unless there's a really big absolute-last-minute spike today and tomorrow (which is conceivable), it's looking like the final tally will end up somewhere between 7.8 - 7.9M. 7.75 - 7.85M I suspect the 8M mark will remain tantilizingly out of reach.

On the other hand, if I've seriously lowballed here and it does end up around, say, 7.95M, it's just barely possible that a handful of stragglers from Nevada and Oregon (along with paper applications in Florida?) could just barely drag the 4/30 total over the 8M line (Nevada has actually extended their "started by 3/31" policy all the way out until May 30, while Oregon has extended their full enrollment period out to 4/30).

Feeling a bit loopy on a rainy Sunday afternoon, so I present the mystery of one of the most significant songs ever released: Young MC's "Bust a Move":

Your best friend Harry has a brother Larry
In five days from now he's gonna marry
He's hoping you can make it there if you can
'Cause in the ceremony you'll be the best man

Question: If Larry is the one getting married, why are YOU the best man instead of his own brother? You're HARRY's best friend, not LARRY's.

For that matter, who waits until 5 days before the ceremony to ask someone to be in their wedding party, especially the best man? That's awfully short notice, barely enough time to get sized for the tux.

Posit: The brothers had some sort of falling out, perhaps over the bride. If so, that still doesn't explain why he'd ask his brother's best friend to be the best man, unless Larry just wants to rub Harry's nose in it.

As it happens, a friend of mine figured out the answer. If no one guesses it today, I'll post the answer tomorrow.

Earlier today I received the following question via Twitter:

@charles_gaba off-topic? NJ had coverage 4 adult until age of 30-31? Do they go down to 26 under ACA and if so, did you account for that?

— Mary Ann James (@ernestine1006) April 13, 2014

I honestly wasn't sure how to answer this. I had heard that some states already required insurers to allow kids up to 26 to be covered, but wasn't previously aware that NJ (or any other state) went beyond 26...

@ernestine1006 I have no idea. Didn't know any state required policies to offer higher than 26. Would imagine it works like min. wage...

— Charles Gaba (@charles_gaba) April 13, 2014

...and thanks to the power of Twitter, this was quickly confirmed to be the case:

I talked about this a couple of weeks ago, but given that the March HHS report should be released sometime this week (unless it's delayed due to the craziness of the late-March surge), I thought it was important to post again:

The March HHS Enrollment Report may leave off March 30th and 31st, and therefore leave 600,000 exchange QHP enrollments to be tacked onto the April report instead.

Every one of the prior 5 HHS reports on ACA enrollments has been tied to the calendar week instead of the calendar month, cutting the tally off on whatever Saturday happens to fall closest to the end of that month:

Earlier today a friend of mine (Eclectablog...who, by the way, is also the head of the best blogging team in America, and who could use your help with his quarterly fundraiser at the moment) noted that there was an anti-ACA banner ad from the Koch Bros running at the bottom of this site earlier today.

His Tweet was intended as snark, of course, but at least a couple of people didn't appear to get the joke, and actually think this means I'm either hypocritical or some sort of 11th Dimensional Chess-playing Double Agent Mole working for the Koch Bros. Not sure how that would work, exactly, but whatever.

OK, I actually do have one update today (it's 8:30 at night and my kid is getting ready for bed).

When I first learned that Washington State's off-exchange total was a whopping 2.2x that of their exchange-based enrollments back on February 20th, I casually noted that if that held true nationally, it would make the off-exchange QHP tally easily 7.7M or higher ...and this was back when the exchange QHPs were only around 3.5M.

However, I also tried to be cautious in my "official" estimate, keeping it to around 4M or so since I didn't know how many there really were beyond the 300K (later 560K) or so I had documented at the time. After all, other states would likely have a much lower ratio of Off- to On-exchange QHPs; In Wisconsin, for instance, Off-Exchange QHPs were only about 23% as high as exchange-based.

Because sometimes you just want to take your kid to the zoo for the day.

A few days ago, the much-discussed Rand Corporation healthcare coverage survey was released.

There's a lot to absorb and discuss in it, but the one number which I found the most puzzling was their estimate of around 3.9 million private QHP enrollments via the ACA exchanges.

As I noted at the time, this puzzled me because around "mid-March" (the point at which the vast bulk of survey responses had come in), the actual number of exchange QHPs was roughly 1 million higher, around 4.9M.

The survey itself lists a +/- 1.1 million margin of error for that figure, but it still didn't make much sense to me, since the official HHS report through 3/01 (2 weeks earlier) was already 4.24 million.

At first, I figured that perhaps they were lopping off about 20% to account for the unpaid enrollments. This would make the 3.9M figure correct, but there was no mention of payments in the survey.

Maryland's press releases are getting shorter and more abrupt. With the enrollment period wrapping up and their exchange site still an utter mess (and about to be completely scrapped and replaced), this isn't terribly surprising.

Still, this is up another 2,184 QHPs and 16,420 Medicaid enrollees in the past week, which isn't too bad, all things considered.

Through April 9, 2014, 65,186 Marylanders have chosen to enroll in qualified health plans through Maryland Health Connection. As of April 8, 248,495 have gained Medicaid coverage in 2014 and remain active in Medicaid.

Enrollments in qualified health plans since March 31 include 2,229 enrollments completed with assistance from a dedicated team responding to Marylanders who contacted our 1-800 hotline and other channels to request additional help.

This just in from healthcare reporter Dan Goldberg (and others in various formats)...

.@charles_gaba @charlesornstein NY now enrolled 933,232 Of those, 508,016 have signed up for Medicaid and 425,216 have enrolled in a QHP

— Dan Goldberg (@DanGoldbergCNY) April 11, 2014

In addition, there's this from a story at WAMC public radio:

I think this is the first Nevada update I've posted which didn't come from the Nevada Health Link's Twitter feed. Technically only 28,208 have actually paid their first premium so far, but another 4,332 have scheduled their payment which is certainly a huge step ahead of having "enrolled but not even arranged for a payment" (and my model has 7% of this total being lopped out for potential non-payment anyway). So, 32,540 it is until further notice.

And the number of people who enrolled in and paid for a qualified health plan through the exchange hit 28,208 on April 5, up from 25,899 people on March 31. Another 4,332 consumers have scheduled payments.

Yesterday, at around the same time that (outgoing) HHS Secretary Kathleen Sebelius confirmed my estimate that ACA exchange QHP enrollments had hit 7.5 million people, Edward Morrissey wrote an article over at Yahoo News claiming that (wait for it) the HHS Dept. was "cooking the books":

Last week, that [the ACA being here to stay] sounded like wishful thinking. Two new studies released this week prove it. 

The studies that he uses are the Rand Corp. survey and a study released by Express Scripts regarding prescription drug coverage. I'm not even going to get into the Express Scripts study, because Mr. Morrissey makes so many errors in the Rand section I don't even think it's necessary to continue beyond that:

While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates. 

This is great news, but I have to reduce Ohio's Medicaid total by about 54,000 due to a bit of sloppy double-counting on my part. However, there's another (potential) 120K in the batter's box:

More than 106,000 Ohioans have signed up for Medicaid under an expansion of the taxpayer funded health program, while thousands of others are waiting to hear whether they are deemed eligible.

...Ohio's monthly report on Medicaid caseloads shows that 106,238 residents had enrolled under the extension as of March 31. That's about 29 percent of the roughly 366,000 newly eligible people estimated to sign up by the end of June 2015.

More than 345,000 people have sought Medicaid coverage through the state's benefit site since Oct. 1. About 65 percent of the applications have been resolved, while roughly 120,000 are still pending. Many of those cases await eligibility determinations by the state's largest counties.

Pages