Washington State

2018 MIDTERM ELECTION

Time: D H M S

I can't really use any of these numbers directly in the spreadsheet, but some excellent data to show the impact in Washington (state). Also note the point regarding many people enrolling directly with the insurance companies:

Statewide, about 375,000 people have insurance due to this law. That’s the net gain, counting those who had their policies “canceled” last winter (most simply signed up for a new one with their same company).

The Medicaid program in the state has grown 25 percent since October, from 1.2 million to 1.5 million.

...The private individual insurance market has also grown, by 19 percent, from 272,000 plans last October to 325,000 today. These figures include plans sold on the state exchange and directly by companies.

Whether that’s big enough to be stable and affordable remains to be seen. But before Obamacare it was shrinking.

Plus the state says there are 32,000 young adults on their parents’ policies due to the new law.

A huge turnaround from last week, when it looked like WA was starting to slow down. Exchange QHPs are up from 112,225 as of 3/13 to 125,207 as of 3/23...an increase of 12,982 in 10 days (not quite the "past week" described in the press release, unless it took the first 3 days for 901 of them to go through).

The impact on the projection chart is equally dramatic: Washington State has now gone from running 37% below February's daily average to 25% higher than February did.

On the Medicaid side, new enrollments now stand at 250K "strict expansion" and 130K "woodworkers", up from 235K & 122K respectively, for a total increase of 23,000 new enrollees.

OK, the cutesy title is kind of a misnomer; my two previous entries didn't use that title originally...but they should have, and do now.

March 31st is supposed to be the final day to enroll in QHPs via the exchanges...but it's looking more and more as though that won't quite be the case in not two, not three...but possibly up to seven states now, including a couple whose websites have been working smooth as silk??

On March 7th I pointed out that due to Massachusetts having some 154,000 people stuck in health insurance limbo, they've been granted some sort of temporary extension, twice...out to as far as June 30th in some cases...

An interesting, if somewhat disappointing update from Washington State this evening. Paid QHPs are up 3,204 from 3/06 - 3/13 to 112,225, but this still leaves WA at 63% of their February rate for March so far (granted this is better than the 54% they were at through last week).

More interestingly, the number of unpaid enrollments has dropped from 82,060 down to 71,787...a reduction of 10,273 people.

What this means is that even if all 3,200 of the paid enrollees are "conversions" (enrollees actually paying for their policies), that still leaves over 7,000 people who are apparently being, as deaconblues put it, "purged" from the list. I'm guessing that these are mostly people from last fall or early this winter who let their final payment deadline expire without paying.

After a couple of weeks where the paid QHPs seemed to only be drawing from the existing unpaid enrollments (a sign of new additions drying up), WA seems to be back in gear with 2,740 more paid QHPs, 4,019 more unpaid QHPs and 16,247 new Medicaid/CHIP additions, all since February 27th.

Enrollments Completed:

  • Qualified Health Plans: 109,021
  • Medicaid Newly Eligible Adults: 222,607
  • Medicaid Previously Eligible but not Enrolled: 115,159

In-Process Applications

Qualified Health Plan Applicants – Need to Pay: 82,060

*Note: These numbers reflect enrollments and applications through March 6.

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

Hmmm...I'm hoping that either this weeks or last weeks press release from the Washington exchange contains a clerical error, because if both are accurate, it means that private QHP enrollments in Washington State all but dried up in the last week of February. They're showing an increase of paid enrollments from 101,857 (as of 2/20) to 106,281 (as of 2/27), which isn't bad (about 4,400 more)...but a decrease of unpaid enrollments from 82,249 to 78,041. This means that the total number of enrollees only went up by 216 during that week; the rest were all conversions of unpaid to paid. The good news is that this improves WA's paid percentage from 55% to 58%.

Meanwhile, WA's Medicaid expansion increased at a more reasonable rate, from 202,168 expansion-only + 102,238 woodworkers (304,406 total) to 212,633 expansion + 108,886 woodworkers (321,519 total), or by about 17,000 people.

Another way of looking at it: According to the Kaiser Family Foundation, prior to the ACA, WA had a total of around 959,000 uninsured residents, of which around 449,000 are supposedly eligible for Medicaid.

The official press release hasn't been posted to the state exchange website yet, but here's the latest out of the Evergreen State:

Feb 25, 2014 - More than 100,000 Washingtonians have now enrolled in private health plans offered on the Washington state health insurance exchange www.wahealthplanfinder.org, exchange officials said Tuesday.

Overall, a total of 717,933 have enrolled in health insurance on the website. 

Here’s the breakdown: 

101,857 have enrolled in private plans
202,168 newly eligible residents have enrolled in Medicaid.

102,238 who had previously been eligible fro Medicaid but had not enrolled.
311,670 who had been previously eligible for Medicaid who have reenrolled.

And additional 82,249 have enrolled in private plans but have not yet paid their premiums.

These numbers bring WA's Private QHPs up from 90,723 Paid / 85,372 Unpaid as of 2/06 for a total increase of 8,011. More notable is that the state's Paid percentage is slowly increasing, from about 50% a month or so ago up to 55% this week.

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.

Washington State just released their weekly update, and as usual it's crisp and clean:

  • Private QHPs are up to 176,095 (90,723 Paid / 85,372 Unpaid) from 175,595 (88,071 Paid / 87,524 Unpaid); the total only went up a few hundred, but the number of paid enrollments went up about 2,700 people.
  • Medicaid enrollments are up to 276,263 (184,783 Expansion / 91,480 Woodwork) from 258,087 (172,715 Expansion / 85,372 Woodwork), an increase of about 7% from last week.

Enrollments Completed

Qualified Health Plans: 90,723

Medicaid Newly Eligible Adults: 184,783

Medicaid Previously Eligible but not Enrolled: 91,480

Qualified Health Plan Applicants – Need to Pay: 85,372

 

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.

Washington State just released their latest official update, and as usual, they do a fantastic job of breaking down the numbers in an easy-to-follow manner, especially on the Medicaid/CHIP side.

Private QHP enrollments are up from a total of 149K (73,098 paid, 76,058 unpaid) as of 01/09 to about 168K (86,031 paid, 81,872 unpaid) as of 01/23, a 12.7% increase in 2 weeks.

Medicaid enrollments are up from a total of 198K (134,700 via Medicaid Expansion + 63,070 "Out of the Woodwork" folks who were previously qualified but weren't already enrolled) as of 01/09 to a total of almost 238K (160,587 expansion + 77,144 "woodwork") as of 01/23. This represents a 20% increase.

Between these and the other recent updates, the grand totals now stand at 3.16M Private QHPs and 7.38M Medicaid/CHIP enrollees. It's also important to stress that the Medicaid number does not include renewals of existing Medicaid/CHIP recipients.

Hmmm...the same article uses 2 slightly different numbers (368 and 370)...I'll split the difference for the moment :)

New Mexico is also noteworthy in that while their individual ACA market is being handled by the federal exchange (HC.gov) for the first 2 years, they're already running their own small business (SHOP) market themselves.

Meanwhile, I've been informed that Washington State only has their SHOP program running in 2 counties, while Maryland's won't be operational until April (SHOP enrollments are open year-round, while individual/family enrollments are only available through 3/31).

As of Jan. 15, 368 people had purchased insurance through New Mexico’s SHOP (Small Business Health Options Program) exchange for small businesses. 

...So far, 370 people have enrolled in insurance plans on the SHOP exchange, according to the NMHIX. A total of 1,542 employers have set up accounts on the exchange and they represent 3,962 employees.

I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).

As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.

Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.

As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.

Qualified Health Plans: 73,098

Medicaid Newly Eligible Adults: 134,700

Medicaid Previously Eligible but not Enrolled: 63,070

Qualified Health Plan Applicants – Need to Pay   76,058

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