2018 MIDTERM ELECTION

Time: D H M S

Nevada keeps things short & to the point, as usual:

Update as of 2/1: 22,597 confirmed Qualified Plan Selections, 14,999 have paid. 27.1% of paid enrollees are under age 35.

— Nevada Health Link (@NVHealthLink) February 6, 2014

These numbers compare with 13,159 paid and 7,240 unpaid as of January 18th (20,399 total), a 10.7% increase in the past 2 weeks.

So, after yesterday's big CBO report which had some interesting (and, in some cases, extremely misinterpreted) points to make about the impact of the Affordable Care Act, today there was another report released today from Avalere Health which has gotten a lot of attention, regarding the number of new Medicaid/CHIP enrollees which have been added specifically due to the ACA. I don't know much about Avalere Health, but they tout themselves as a healthcare think tank/analysis firm. From their "About Us" page:

"Avalere is a vibrant community of innovative thinkers dedicated to solving the challenges of the healthcare system. We deliver a comprehensive perspective, compelling substance, and creative solutions to help you make better business decisions. We partner with stakeholders from across healthcare to help improve care delivery through better data, insights, and strategies."

OK, fair enough. According to Avalere:

Avalere estimates that from October through December 2013, between 1.1M and 1.8M people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).

These estimates are concentrated in states expanding Medicaid—with expansion states representing roughly three-fourths of total estimated new Medicaid sign ups.

Now, on the surface, even the high end of this range (1.8 million people) would appear to be wildly divergent from my own recent analysis, which currently has "new Medicaid/CHIP enrollments" at around 7.5 million. However...

Minnesota's Private QHP enrollments went up about 3% between January 18 and February 1st, from 27,775 to 28,611, while Medicaid/CHIP enrollments went up a more dramatic 18%, from 52,225 to 61,784 (when combining Medicaid & CHIP along with MinnesotaCare, which still counts).

Insurance sign-ups through Minnesota's health care marketplace continued to grow into February to more than 90,000 people, but enrollment continues to be weighted more toward public plans over private insurance.

MNsure released its latest enrollment measures on Wednesday, which covered mid-January through Feb. 1. By that date, more than 28,000 people had enrolled in commercial plans — an increase of about 3 percent from two weeks earlier.

In addition, Minnesota's SHOP (Small Business) exchange tally has gone up a bit as well, to 541 employees covered; multiplying this by a conservative average of 1.8 per employee household brings it up to around 974 people covered by MN SHOP plans.

As always, Washington State is the Gold Standard in breaking down their enrollments; Private QHPs are up to over 175,000 (88,071 paid, 87,524 unpaid as of January 30), up from about 168,000 a week earlier. Medicaid enrollments are up to over 257,000 (172,715 newly eligible and 85,372 "woodworkers"), up from about 238,000 the prior week.

Colorado does this odd thing where they simply upload an image file with the latest metrics, which can be irritating but also handy. To that end, here's their latest tally which runs through January 31st:

From this we have the latest Private QHP enrollments up slightly to 69,627 (from a prior estimate of 68,999 a few days ago) and Medicaid enrollments up to 117,607 from 101,730 two weeks earlier. It's important to note that Colorado's Medicaid tally supposedly includes only brand-new enrollees, not renewals. This represents a 15.6% increase from 1/15.

An interesting, but hardly surprising development today: The CBO, which had previously projected that appx. 7 million people would enroll in Private QHPs via the Health Exchanges created by the Affordable Care Act (as well as 9 million additional people enrolling in Medicaid or CHIP thanks to the expansion provisions within the ACA) by the end of 2014 have now reduced both of these projections by 1 million apiece, to 6 million and 8 million in the first year. Thanks to Dan Diamond for bringing this report to my attention.

You have to scroll all the way down to page 108 of the report to find it, but here's the relevant screen shot, and the relevant paragraph from pages 112 - 114 of the report:

4,975 more people enrolled since January 30. No Private/Public breakdown, but based on the existing ratio, I'm guessing around 23% Private QHP / 77% Medicaid/CHIP, or 1,145 / 3,830. This brings KY up to 45,305 and 155,172 respectively.

Add another 55K direct new Medicaid enrollments and you're at 210K on the Public side.

200,477 Kentuckians have signed up for affordable healthcare using @kynectky! #kynect #ACA #GetCovered http://t.co/6B8TGA8NMH

— Steve Beshear (@GovSteveBeshear) February 3, 2014

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.

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