Housekeeping & "Purely Expansion-Based" Medicaid Estimate
2018 MIDTERM ELECTION
Time: D H M S
Good Morning! I have some mid-level changes to both spreadsheets this morning which visitors should be aware of:
--On the Private QHP Spreadsheet, I've replaced the very rough percent-based "Total Uninsured" numbers with the raw numbers from the same Kaiser Family Foundation table. Again, this is the same source, I'm just using the raw number view now instead of the percent view. In addition, using percentages were based on the July 2013 census estimates, while the KFF numbers are based on 2011-2012 population totals. Combine this with the percentages being previously rounded off, this resulted in some significant differences in the state numbers.
For example, at the high end, the California number changed from around 7.6 million to only 7.1 million, a half-million difference! Meanwhile, at the low end, Vermont has "dropped" from 57,000 uninsured prior to October 1st to just 47,900…which makes the original CMS projection for Vermont (also 57,000) all the more absurd.
Overall, the total has dropped from 50M to 48.28M, which means I had to modify the "% of 7M Proportional to % Uninsured" formula that I mentioned the other day slightly to accommodate the new total (7.066 million out of 48.28 million = 14.6%).
--At the bottom of the spreadsheet, you'll see several new entries, including "Total Uncertain" (this includes things like enrollments that have been verified as unpaid from several states and the 22,000 people in Massachusetts whose enrollments have been approved but are being covered by a "temporary" state program of some sort until the paperwork clears (or something...I'm a little confused about what's going on here).
--The other new entries are a breakout of the total between the State-run exchanges and the Federal-run exchange (along with the half-million or so which haven't been categorized yet).
--Meanwhile, on the Medicaid/CHIP side, I've replaced the "total uninsured" completely with the KFF's "Total Medicaid/CHIP Eligible" table, which adds up to roughly 14 million people nationally. This makes it look like some states have far exceeded their numbers (Vermont, for instance, is at over 44,000, over 2.6x higher than their "eligible" total), but much of this is because I'm counting the "one-time transfers" (which were only possible due to provisions in the ACA) while KFF isn't. In addition, there's tremendous churn in Medicaid, as Ruth37 has noted, so the numbers are kind of jumping around all the time.
--Finally, on the Medicaid spreadsheet, I've gotten as close as possible to an accurate count of the number of new Medicaid/CHIP enrollees which are PURELY due to ACA Expansion. To achieve this number, I took the total number of new enrollees and first removed the 25 states which haven't expanded Medicaid at all. This leaves 26 states (including DC). Then, I used Washington State as a guideline for the split between "ACA Expansion Only" and "Out of the Woodwork" enrollees (ie, people who were previously eligible pre-ACA but didn't enroll until after October 1st for various reasons). Washington has had a pretty consistent ratio of 2/3 Expansion Only to 1/3 "Woodworkers". I have no idea if that's representative of the other 25 states, but it's the best I can do for now. Note that this still also includes those who are newly eligible...but under the old Medicaid rules (ie, someone who simply fell on hard times after October 1st).
Put together, this results in the following estimates:
- 3.63 Million "Purely Due to ACA Medicaid Expansion"
- 5.33 Million "Medicaid Expansion + Woodworkers + Other Newly Eligible in Expansion States"
- 7.39 Million "Medicaid Expansion + Woodworkers + Other Newly Eligible in All States"
Now again, I personally think that the "Out of the Woodwork" enrollees should be counted as well, since a substantial number of them are only enrolling now because of the massive promotional/outreach programs being enacted thanks to the ACA and the exchanges, but that's a matter of philosophy, which is why I've broken them out here the best I could.