First Oregon told Oracle to go pound sand after paying the company hundreds of millions of dollars for a useless website; now Nevada has officially done the same thing to Xerox:

The Silver State Health Insurance Exchange board voted unanimously Tuesday to end its relationship with Xerox, the vendor contracted in 2012 to build the exchange’s Nevada Health Link website.

In place of Xerox, the exchange will adopt the federal Healthcare.gov exchange’s eligibility and enrollment functions for the sign-up period that begins Nov. 15, though it will keep its status and funding as a state-controlled system. The exchange will also issue a request for proposals to evaluate replacement systems in coming years. A new platform could come from a state with a functional marketplace, or from a vendor with a similar, proven program.

Unlike Massachusetts, which is taking a dual-path approach (they're scrambling to replace their own crappy site with a new one while simultaneously preparing to move over to HC.gov just in case the first plan doesn't pan out in time), Nevada is sort of doing the opposite: They're moving over to HC.gov this year, but reserving the right to try a do-over on their own exchange for 2016 and beyond.

Interestingly, even though we're well past even the extended QHP enrollment period, Hawaii continues to have new enrollments trickle in. I'm not sure if these are clerical corrections from before 4/30 or if these are "Qualifying Life Events", but either way they just added another 111 people to the tally (plus a whopping 5 more people in their SHOP enrollments).

Total since October 1, 2013

32,086 Applications completed in the Individual Marketplace
9,397 Individuals and families enrolled in the Individual Marketplace
604 Employers applied to SHOP Marketplace
636 Employees and dependents enrolled via SHOP Marketplace

In addition, Hawaii's exchange just became a slightly better value, dropping from $23,899 per person enrolled down to $23,617 per person. So, there's that, I guess...

Wyoming's QHP enrollments didn't add up to much (understandable given that the entire state only has 576,000 people), but the state insurance commissioner states that around 92% of those who did enroll have paid up so far:

Nearly 12,000 people in Wyoming have enrolled in a plan on the federal marketplace created by the Affordable Care Act, according to the latest data announced Monday at a legislative committee meeting.

About 11,000 of them have begun paying their premiums, Wyoming Insurance Commissioner Tom Hirsig told members of the Joint Labor, Health and Social Services Committee at Casper College.

“I’m surprised, frankly, that there’s this many,” Hirsig said. “I was thinking 7,000 or 8,000.”

The actual number of exchange QHPs in Wyoming is 11,970, so yep, 11K would be about 92% of that.

(To clarify the last statement: Contributor Esther F. also gives a link to another story which clarifies that the "7-8K" quote refers to how many people he thought would enroll, not how many he figured would pay):

Michigan continues to quietly enroll thousands and thousands of people in ACA-expanded Medicaid, having already reached 81% of the 320K first-year goal in just 7 weeks (or, alternately, 52% of the total eligible for expanded Medicaid state-wide):

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 259,007

*Statistics as of May 19, 2014 

OK, due to my unexpectedly-far-longer-lasting bout of shingles, I've gotten a bit backed up with my ACA news the past few weeks, but I did want to address the "cost per enrollee" story which popped up a week or so ago:

Sometimes there really are economies of scale. And the nation’s health insurance exchanges may be a case in point.

As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report.  It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.

The article (and others like it) goes on to break out the individual state exchange costs. Some do better than others, of course, and Hawaii comes in dead last (in part simply because their uninsured population is so small to begin with). While it's certainly interesting to see which ones were the most efficient and which were the least, there's a big part of me which keeps asking "why is anyone surprised by this?"

In spite of all the hand-wringing that people have had about the insurance company premium rates for the 2nd year of the exchanges (this is the main reason for all the freaking out about how many "young invincibles" there would be, etc etc), the truth is...the new premium levels appear to be all over the place:

May 15--A first-glance snapshot of the lowest premium rates being proposed for individual health-insurance plans to be sold in the Washington Healthplanfinder exchange marketplace reveals spirited competition and more choices for consumers.

These rates are not yet approved, and it's likely the number of plans requested will decline, according to the Office of the Insurance Commissioner.

That office is now reviewing rate changes the companies requested.

Changes proposed by companies asking to sell plans on Healthplanfinder ranged from a nearly 7 percent decrease in one case to an increase of more than 11 percent in others.

If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:

Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.

...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.

They may have flushed a couple hundred million dollars down the drain on their website, but that just makes Oregon's manual QHP processing achievement all the more impressive. Over 6 weeks after the official enrollment period ended, and over 2 weeks after their extension period wrapped up, Oregon continues to push their QHP and Medicaid enrollment totals up:

Medical enrollments through Cover Oregon: 280,334
Total private medical insurance enrollments through Cover Oregon 1: 81,358                

Oregon Health Plan enrollments through Cover Oregon: 198,976

Net private medical 2: 76,275

A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:

As of April 29, 2014, 275,090 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

As of May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.

The New Jersey Medicaid expansion tally has jumped around a bit due to differing definitions of the enrollments, but this new one seems in line with my expectations and the wording is pretty specific:

Another 140,000 residents joined the state’s newly expanded Medicaid program, which now allows people who are slightly above the poverty line to qualify for coverage.

Well, here at ACASignups.net I'm nothing if not comprehensive...Hawaii has added a whopping 69 exchange QHP enrollees and 3 (yes, 3) SHOP enrollees in the past week or so...

Total since October 1, 2013

  • 31,758 Applications completed in the Individual Marketplace
  • 9,286 Individuals and families enrolled in the Individual Marketplace
  • 595 Employers applied to SHOP Marketplace
  • 631 Employees and dependents enrolled via SHOP Marketplace

Minor update out of the only state whose ACA exchange is still officially open: QHPs up around 1,400, paid up around 200 since last week:

Update as of 5/10: 47,245 Nevadans confirm Qualified Health Plan selections. 35,034 have paid.

— Nevada Health Link (@NVHealthLink) May 14, 2014

Minnesota's official exchange QHP tally has dropped by a whopping...9 people  since the end of April. Meanwhile, their Medicaid tally has shot up another 10,262 people:

As of 5/13:

  • 120,749 Medical Assistance
  • 50,540 QHP
  • 45,121 Minnesota Care
  • Shop: 761 x 1.8 = 1,370

Not exactly the most shocking headline of the day, but this is still a great story by Jason Millman of the Washington Post (full disclosure: Millman wrote a nice feature piece about me a few months ago):

The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.

I may have had some issues with Avalere Health's methodology in the past, but they're pretty well respected in the industry, and they've certainly brought up legitimate issues with my own methodology as well (they're the ones who pointed out that the early version of my Medicaid/CHIP estimates was mixing "baseline churn" into the mix, which has since been corrected).

Anyway, they're out with an interesting new study which estimates that there of those newly-added to the Medicaid/CHIP roles, roughly 550,000 of them--specifically in the 24 NON-expansion states--rightly belong in the "woodworker" category: People who already qualified for Medicaid under the pre-ACA rules, but who didn't enroll until after October 1, 2013 for any number of reasons (not knowing they qualified, not knowing how to apply, being embarrassed about doing so, etc). Since the ACA exchanges also included a massive education/outreach effort (some of which even spilled over into the states which didn't expand the Medicaid program), and since the application process was streamlined in many states as part of the law, these folks who "came out of the woodwork" to enroll in Medicaid are rightly considered part of the success of the ACA specifically.

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