Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

Yesterday, in response to a partially-reasonable, partially-not critique, I added something to The Graph: A prominent note that no, neither the spreadsheet nor the graph take into account the estimated 4.8 million non-compliant policies which were cancelled last fall (my own included). I concluded my response with the following:

However, you've [the commentor] chosen to completely ignore the single largest missing piece of the puzzle here, which I've discussed many, many times: OFF-EXCHANGE QHP ENROLLMENTS.

Minnesota just broke through their own goal of 135K total enrollments. The 36,176 exchange QHPs are only up 566 from 35,610 from 4 days earlier, but the combined Medicaid number (100,598) is up 4,731 from 95,867.

ST. PAUL, Minn.—Today, MNsure announced 136,774 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s health insurance marketplace, exceeding its open enrollment goal.

“We are thrilled that more than 136,000 Minnesotans have enrolled in quality, affordable coverage through MNsure,” said interim CEO Scott Leitz. “We’re not done yet. There are six days left in open enrollment and we want to make sure every Minnesotan has the ability to obtain health insurance coverage.”

MNsure’s original goal of enrolling 135,000 Minnesotans during the 2014 open enrollment period was established at the MNsure Board of Directors meeting on October 16, 2013.

To date, MNsure has enrolled 36,176 in a Qualified Health Plan, 27,512 in MinnesotaCare and 73,086 in Medical Assistance.

A very nice find from a contributor: This press release which just came out today, detailing private off-exchange online insurance broker eHealth Insurance's demographic breakdown of ACA-compliant QHP enrollments since January.

You may recall that eHealth Insurance makes up about 25% of the total known off-exchange QHPs I have listed on the spreadsheet so far; the 148K entered from them so far only runs through the end of December.

While this new press release doesn't include their updated enrollment numbers, it does prove, once again, that off-exchange enrollments are vitally important:

In an editorial piece from the The Courant newspaper, a non-exact QHP update is revealed: 65K, up from 62K as of 3/13:

Even without that money, Connecticut created a model portal in http://www.accesshealthct.com. This state should take pride in being among the most successful in enrolling at least 65,000 consumers in private health insurance plans. Maryland is reportedly considering abandoning its own dysfunctional portal and using Connecticut's in the next open enrollment period in November.

(SIGH) OK, in the words of Emily Litella..."never mind..."

It looks like I was right to be suspicious of the seemingly fantastic QHP enrollment numbers reported out of both North Carolina and Louisiana.

Thanks to Jed Graham (via Twitter) for pointing me towards Page 21/22 of the February HHS Report. Normally I only focus on the 3rd and 4th columns ("Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace" and "Number of 
Individuals Who Have Selected a Marketplace Plan", since these are the actual exchange enrollment numbers through the end of that month.

I've updated The Graph as I'm doing every evening, and while there's nothing terribly dramatic to see, there are two notable changes:

  • First, I've changed my mind from a few nights ago and have decided to remove the 217,000 "Massachusetts Limbo Status" enrollees after all. These have been troubling me for some time, but on further reflection they really fall into the same category as other people who got halfway through their enrollment process before getting stuck. The difference in these folks case is that some of them (all of them?) have actually paid for their policies already, and are facing a ticking clock. However, I'm just not comfortable including them until their situation is settled.
  • Second, my "polite critic" this morning did have one valid point: I should acknowledge the 4.8 million cancelled non-compliant policies on The Graph. So, I've added a large, prominent note about them...but, as I explained, I'm not going to subtract them from the total until I also document the millions of Off-Exchange enrollments which are absolutely still remaining out there among 47 states. I'm guessing that there's a good 4 million or so, but without knowing for sure I can't list those either...so instead I'm just listing the two missing numbers next to each other, one positive, one negative, in the interest of total transparency.

OK, I either have some very good news...or one heck of a misunderstanding here.

Earlier today I updated both New York and Colorado's QHP numbers...and while both were very fine, they were actually down somewhat from last week (large drop for NY, small one for CO). This may actually make sense, as both of these state exchanges have been running very smoothly for months now; it's possible that they've simply started to reach the end of the line in terms of residents actually signing up (or perhaps they'll both experience a final mini-surge right at the tail end this weekend).

However, the apparent news out of both North Carolina and Louisiana has me thrown for a heck of a loop (visit the links for details).

Another find from Stevef101 (and this one, while impressive, is not setting off any warning bells with me either): Colorado breaks 106K QHPs as of this morning, up 6,000 from 100,112 as of a week ago:

As of Monday morning, Connect for Health chief executive Patty Fontneau said, 106,000 Coloradans had signed up for private insurance. About 24 percent of enrollees were in the prized young (and presumably healthier) adult category of ages 18-34.

...More than 151,000 Coloradans had been added to Medicaid rolls by March 17.

This keeps Colorado's QHP rate at around 91% higher than February...which is actually down slightly from the 93% increase it had been earlier in the month.

OK, not only are the numbers here as hard to believe as North Carolina, but the source is the same: Dr. Renard Murray of CMS:

In Louisiana the numbers put the state near the back of the pack.  Dr. Renard Murray with the Centers for Medicaid and Medicare services say there needs to be a late surge in enrollment.

''We've got well over 100,000 who have signed up but well over 800.000 are eligible,'' said Murray.

As of March 1st, HHS only had Louisiana down as having 45,561 exchange QHPs, plus another 9,105 new Medicaid enrollees (again, LA is not an expansion state). Just like with NC, even if the 100K includes both (and he says it's "well over" 100K), assuming an 83/17 split between the two, that would still be an increase of 37,627 QHPs for a total of 83,188...an 83% increase in just the past 3 weeks...at a daily rate 3.8x that of February.

And, just like with North Carolina, if that number doesn't include Medicaid, that would mean a more than doubling of the total through 3/01...at a rate 5.5x that of February.

Good gravy. 391,000 people in North Carolina?? They were only at 200,546 as of 3/01. Even if you assume this number includes Medicaid enrollments, that's still only another 55,691 as of 3/01...and NC is not an expansion state. Assuming that 391K includes both...and assuming the same 78/22 split between the two...that still suggests that QHPs have gone up to around 305,000, a 105,115 increase over the end of February, and over 3.8x the February daily rate.

If it doesn't include Medicaid (which seems likely from the wording of the article), then it's a whopping 190,454 increase--a doubling of their 3/01 total, and a near 7x increase over February.

I find either of these rather difficult to believe, so for the moment I'm only entering it into this blog entry. If I can confirm the QHPs as either of these I'll change it tonight or tomorrow.

Charles Ornstein reports that the New York State of Health issued a press release this today that states:

New York State of Health reports 717,000 enrollees in exchange plans and Medicaid, up from 660k last week.

— Charles Ornstein (@charlesornstein) March 24, 2014

@charles_gaba Emailed press release. As of 9 a.m. today, 1,055,931 New Yorkers have completed their applications and 717,207 have enrolled

— Charles Ornstein (@charlesornstein) March 24, 2014

@charles_gaba More than 70 percent of those who have enrolled to date were uninsured at the time of application--but they've said that b4.

— Charles Ornstein (@charlesornstein) March 24, 2014

While waiting to see whether I was right about the national exchange-based QHP total hitting the 5.5M mark yesterday (and bear in mind that there's no guarantee that HHS will make an announcement about it even if I was correct; they didn't do so for 3.5M or 4.5M...I just figure that they will since it's a logical milestone and would be a nice momentum-building PR move going into the final stretch), I just wanted to call attention to this article from yesterday out of KTVU/Fox in California:

SAN FRANCISCO — One week from Monday is the open enrollment deadline for Covered California. The insurance exchange hit the one million mark for sign-ups last week, and is expecting about 20,000 people a day to sign up in the final push.

I've already contacted the reporter who wrote the story to make absolutely certain this doesn't include Medicaid enrollees, but the context makes me pretty sure they're talking about exchange QHPs only. Also, "expecting" 20K/day doesn't necessarily mean they've already ramped up to that; it could just mean that they're preparing for that volume just in case.

A lengthy comment in response to my "5M as of Sunday" post from yesterday criticizes the work done at ACASignups.net for a variety of reasons. For the most part these are the same issues which I've already addressed repeatedly, but he's more polite about it than the prior critic and some of his points are new (or at least I haven't really talked about them before), so I've decided to respond:

Let me start by saying that the work you have done is truly impressive but it is beyond comprehension that we can not get this type of granular info from the people who are actually responsible for designing, implementing and running this program. They are either completely incompetent or intentionally withholding the detailed data and simply releasing the more favorable headline numbers.

Just throwing that out there again. Since it's a Sunday, I wouldn't expect an HHS announcement until tomorrow. I could be wrong, of course; as I keep stressing, I'm NOT Nate Silver...and judging by the reaction to Mr. Silver's relaunched FiveThirtyEight site the other day, even he doesn't seem to be acting like Nate Silver at the moment, at least when it comes to climate science. Hopefully this is all a big misunderstanding, but as a long-time fan of his, I admit to being extremely disturbed by this development.

Anyway, back on topic: Regarding my 5.5M projection for today (Sunday, 3/23), it's pretty simple: If QHPs haven't hit 5.5M by today, the odds of hitting 6.2M by 3/31 are worse; if they have, then I'm virtually certain that 6.2M will be reached by 3/31...and in fact could be somewhat higher. The 6.2M number has held pretty firm until today, but now we're entering the real crunchtime as we head into the final week--that number could start jumping around quite a bit.

If I am correct about 5.5M today, however, reaching 7M by 3/31 would be pretty much a pipe dream, as QHPs would have to shoot up to over 187,500 per day for the entire final week. I noted last week that 100K - 150K is conceivable for a few days based on California hitting 30K in a single day on 12/23...but it's been another week with the average appearing to hold steady at around 60,000/day, and sustaining 187K for 8 days straight just seems pretty implausible. 6.5 million, on the other hand, would "only" require 125K/day for 8 days straight...which, while also pretty implausible, isn't too crazy.

On a related note, I do figure that I've earned the right to archive my accuracy record a bit at this point, so I've added a permanent link to my Greatest Hits to the site, right under the March Projection link. Each projection is in turn linked to the earliest source I could find containing my projection (this was more difficult than you'd think, since I wasn't really making a big deal out of the estimates until the past month or so).

Here's how I've done so far:

This article contains a breakdown between "strict expansion" (30,000) and "bulk transfers" (51,000), modified from the 13,000 and 55,000 prior estimates (not sure what happened to the other 4,000 who were listed as being transferred from IowaCare previously). Still a net gain of 13,000 people.

In addition, state officials say about 81,000 Iowans have enrolled in the new Iowa Health and Wellness Plan or Marketplace Choice Plan, which are Iowa’s versions of an expanded Medicaid program.

About 51,000 of those people used to have limited coverage from IowaCare, a program that ended Dec. 31.

 Interestingly, there's even a reference to a specific "woodworker" figure

 In February, 403,609 people were enrolled in the program. That represented an increase of 0.5 percent from the 401,582 who were in the program in February 2013.

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