Charles Gaba's blog

2018 MIDTERM ELECTION

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According to L.A. Times reporter Chad Terhune, CoveredCA has confirmed enrolling another 70,000 people in private QHPs in the first 9 days of the extension period. They had 1,221,727 as of 3/31, so that brings their total to 1.29 million as of last night:

#CoveredCA added 70,000 (on top of 1.2M) who picked a plan in the 9 days of the "grace period" since March 31 to April 15. @charles_gaba

— Health Access CA (@healthaccess) April 10, 2014

#CoveredCA exchange: 70K more enrolled since 3-31 deadline after extending sign-ups to 4-15, adding to 1.2M already in #ACA

— Chad Terhune (@chadterhune) April 10, 2014

Yeah, I know, I keep bouncing around on this; first I thought 8M was feasible, then I backtracked. However, let's do some simple math.

  • Obviously it wasn't exactly 7.1M on the nose at midnight on 3/31. Let's assume an overage of, say, 20K at a minimum.
  • It's also safe to assume that it was slightly over 7.5M as of midnight last night; let's say 20K there as well.
  • That means that in the first 9 days, QHP enrollments averaged 500K / 9 = 55.5K per day
  • I'd say a final weekend mini-surge is also likely for those who wait until the absolute last possible moment, which should cancel out what I'm assuming is a natural dropoff throughout the week. So...figure something like 30K/day today and tomorrow, then back up to 60K/day for the last 4 days. That's 300K added to the existing 7.52K, or 7.82M.

So, as my final projection for 4/15, I'm going with: Somewhere between 7.7M - 7.9M, with an outside chance of squeaking by the 8M mark after all (wishful thinking?)

Me, last night: Hey, Guess What? I think we just hit 7.5M QHPs.

HHS Secretary Kathleen Sebelius, moments ago: 

Health and Human Services Secretary Kathleen Sebelius says 7.5 million Americans have now signed up for health coverage under President Barack Obama's health care law.

That's a 400,000 increase from the 7.1 million that Obama announced last week at the end of the law's open enrollment period. The figure exceeded expectations, a surprise election-year success for the law after a disastrous roll-out.

Sebelius disclosed the new figure during a hearing Thursday before the Senate Finance Committee.

Assuming that my "back of the envelope" estimates on extension-period exchange QHP enrollment are accurate, the ACA has just crossed several important milestones, including:

  • 7.5 Million exchange-based private QHP enrollments (total)
  • 7.0 Million exchange-based private QHP enrollments (paid or will pay within a month of their policies actually kicking in)
  • 20 Million documented enrollments total (ie, including all types--individual QHPs, on exchange, off-exchange, Medicaid, woodworkers, sub26ers, etc...but not including the 13.9 million undocumented, non-specific additional off-exchange QHPs and ESIs suggested by the RAND Corp. study)

Note that I've modified The Graph a bit more tonight, separating out the ESIs (Employer-Supplied Insurance) into a 4th category (this includes the tiny number of SHOP enrollments, but mostly the controverisal 8.2M ESI estimate noted by the RAND study).

Last night I posted that Washington State, which officially is not offering any sort of extension period, actually is allowing late enrollments on a special, case-by-case basis.

Then, earlier today, I learned that Hawaii (which I never really read an official policy on one way or the other, but which I thought was not extending enrollments) actually is doing so for up to potentially 1,100 people or so (192 to date).

Now it appears that Connecticut, which had been very explicit about their "no extension" policy...apparently is allowing up to 10,000 people to (potentially) sneak in under the wire after all:

Connecticut’s health insurance exchange ended its first open enrollment period with 197,878 people signed up for health care coverage, including 5,917 who enrolled Monday.

Yesterday I posted an update for Michigan's just-started Medicaid expansion. Officially the number was about 32K, but there was a reference to "tens of thousands more" transferred over from an existing state-run healthcare program (similar to the 650K LIHP transfers in CA, the 107K transferred from Commonwealth Care in MA and so on).

Today, it turns out that "tens of thousands" actually meant a whopping 53,700 people:

Since April 1, Michigan has received 54,479 applications and enrolled 32,071 Michiganders into the Healthy Michigan Plan. The difference represents those with applications that are pending confirmation, others who were eligible but enrolled in different Medicaid programs or have applications in progress or have been denied. Prior to April 1, MDCH transitioned the previous Medicaid Adult Benefits Waiver population into the program with coverage beginning on April 1. These enrollment activities combined mean that Michigan has already enrolled 85,761 residents into the new program.

85,761 - 32,071 = 53,690 "bulk transfers".

CO had the official exchange QHP tally as 118,628 as of 3/31, so this means they've added another 2,343 to that total over the past week. The Medicaid number hasn't been updated:

Connect for Health Colorado reports that nearly 280,000 state residents gained coverage during the six-month enrollment period, including 120,971 who signed up for private insurance plans as of Monday and 158,521 who enrolled in the expanded Medicaid program as of April 1. In an interview last fall, Patty Fontneau, CEO of the non-profit organization running the exchange, had estimated that 125,000 to 140,000 Coloradans would sign up for insurance through the exchange during its first year.

So, a lot of people, including myself, have talked quite a bit about the people who had their pre-2014 insurance policies cancelled due to them not being compliant with one or more of the requirements of the Patient Protection & Affordable Care Act (one of the few times I've used the full name, I might add). And yes, those people absolutely do exist; I know, because (as I've noted many times before), I was one of them. My wife and I received one of those "scary" cancellation notices last fall (nothing scary about it...just a simple note saying, "Your current policy isn't compliant with the law, so it'll end as of 12/31/13...we invite you to replace it with a new policy which is compliant with the law."

Whoops...apparently I was wrong about Hawaii not joining in with most other states on the "finish by 4/15 if you started by 3/31" bandwagon. Thanks to deaconblues for the catch:

Total since October 1, 2013

28,374 Applications completed in the Individual Marketplace
 7,788 QHP Enrollments in the Individual Marketplace
557 Employers applied to SHOP Marketplace
269 QHP Enrollments from the SHOP Marketplace

4 different people brought Minnesota's latest update to my attention...their exchange QHPs are up another 651 from 47,046 since 3/31, while their Medicaid tally is up another 5,655 from 128,005:

ST.PAUL, Minn. – Today, MNsure announced 181,357 Minnesotans have enrolled in quality, affordable coverage through MNsure, the state’s health insurance marketplace. The growing numbers come from continued processing of “in line” applications, as well as Medical Assistance and MinnesotaCare enrollments.

...To date, MNsure has enrolled 47,697 Minnesotans in a Qualified Health Plan, 37,050 in MinnesotaCare and 96,610 in Medical Assistance.

Until today, I had The Graph broken into 7 distinct categories:

  1. Exchange-Based Individual QHPs (Paid or To Be Paid Soon)
  2. Exchange-Based Individual QHPs (Unpaid or May Not Pay)
  3. OFF-Exchange Individual QHPs
  4. Exchange-Based SHOP (Sm. Biz) QHPs
  5. Medicaid/CHIP (Strict Expansion)
  6. Medicaid/CHIP (Woodworkers)
  7. Sub26ers (Low Est. / High Est.)

Yesterday, however, the release of the RAND Corp. Survey made me realize that I was handling the 3rd category (OFF-Exchange Individual QHPs) the wrong way.

You see, in the rare cases where I had access to the off-exchange enrollments for a particular company, I mushed their individual and group policies together. The numbers weren't huge--only about 34,000 people--but the potential numbers, as the RAND survey indicated, could potentially be massive.

This is great news for two reasons...not only has the Michigan Medicaid expansion already shot up another 5K in just the past day or two, but at least 20,000 ("tens of thousands") more people have been added to the Medicaid tally due to bulk transfers (similar to the 650K LIHP transfers in CA, 107K Commonwealth Care transfers in MA and so on):

The Healthy Michigan program has received nearly 55,000 applications since April first. 32,000 Michiganders have already had their applications approved. And tens of thousands more have been moved into the expanded Medicaid program from a different state health assistance program.

Thanks to deaconblues for all three of these items:

Avalere Health, with whom I've both clashed and agreed with on ACA-enabled Medicaid enrollments in the past, is projecting as high as a net gain of 4.3M Medicaid enrollees through the end of March:

700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.

However, March and April figures could bring more dramatic increases if outreach and enrollment efforts targeting the end of exchange open enrollment translate into new Medicaid enrollees. Specifically, if Medicaid sign-ups follow a similar pattern as exchanges, new Medicaid enrollees could reach 4.3 million by the end of March. In addition, recent figures released by CMS do not account for individuals assessed eligible for Medicaid through HealthCare.gov who have yet to be determined eligible by states.

For anyone interested, I'm scheduled to appear on the Craig Fahle Show tomorrow (Tuesday) morning at around 10:00am. The show is broadcast from WDET, 101.9 FM in Detroit. No idea what the rebroadcast schedule is but I assume it'll be available as a podcast archive at some point.

Meanwhile, my appearance on Left Jab Radio on Sunday night, complete with my son bursting into the room in the middle of the broadcast, is now available via their website. My segment kicks in around 14:45 in and lasts about 20 minutes, I think.

Finally, I've been hesitant about posting this publicly since there may be copyright issues involved (I'll take it down if necessary), but this strikes me as a reasonable/fair use situation (besides, I tried contacting the producer and no one ever got back to me); my apperance on America Tonight from about 2 weeks ago is now available via YouTube:

Urban, Gallup, and RAND all say the number of uninsured is declining since the ACA went into effect. Now we can debate why and by how much.

— Larry Levitt (@larry_levitt) April 8, 2014

Everything else is secondary. Larry Levitt of the Kaiser Family Foundation wins the day.

Having said that, I'm still not understanding this "3.9 million now covered" number, however, when the number covered thru "mid-March" was actually around 4.9 million:

By our estimate, 3.9 million people are now covered through the state and federal marketplaces. This number is lower than current estimates of marketplace enrollment through the end of March from the Department of Health and Human Services (DHHS), perhaps because some of the HROS data were collected in early March. All HROS data collection reported here ended on March 28, and therefore missed the last three days of the open enrollment period, during which time there was a surge in enrollment.

As noted earlier, the only way 3.9M makes sense to me is if they assumed an 80% Paid rate, which would have been about right at that time.

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