Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

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...

Minnesota issues yet another "mini-update"...no exact numbers or breakout, but QHPs were around 34,942 as of 3/17 while Medicaid was at 90,062 so it's up from around 125K to 128K in only 3 days. Assuming a 25/75 QHP/Medicaid split (down from 28/72?), that would bring Minnesota up to around 35,750 QHPs and 92,250 Medicaid.

This would also suggest that Minnesota's March QHP rate is running about 60% higher than February, up from 50% a few days earlier. (see update below)

As of today, more than 1,000 enrollment opportunities have been organized by certified MNsure navigators during the month of March; and more than 128,000 Minnesotans have enrolled in health insurance coverage through MNsure. 32% of Qualified Health Plan enrollments are from people through age 34. 16% are from the “young invincible” target of 26 – 34 year olds.

This afternoon I'll be a panel guest on the nationally syndicated NPR show "To the Point with Warren Olney".

I'm told that the show will be recorded at 2pm eastern, but it actually airs at different times in different cities. The live feed will be available via Public Radio International's website. The podcast will be available at KCRW 89.9 FM's website after 4pm eastern.

If you want to listen via the actual radio (imagine that!) here's the syndication station list for various cities.


UPDATE: OK, show's over...

The podcast itself should be available for download by around 4:00pm Eastern.

Cover Oregon just posted an unexpected update (wasn't expecting this until tomorrow). They've added a couple of very interesting new features this week: First, they've started including dental policies, which has been pretty much ignored by everyone (including myself). I think Kentucky is the only other state that I've seen call any attention to the dental plans.

Of more interest to me for this site, however, is the fact that they've added net enrollments, explaining that these are the final number after people have "cancelled or terminated" their accounts. They don't specify the reasons for these terminations/cancellations (is it by the customer due to a change in status? is it by the exchange or insurance company for nonpayment?), but it's still a good thing overall as it helps give a truer picture of the situation.

GAH!! OK, earlier today I read two conflicting stories about the Vermont enrollment situation. My conclusion was that the correct numbers were:

  • 18,507 Private QHPs (Paid) / 11,656 Private QHPs (Unpaid)
  • 20,312 Medicaid (Manual enrollment) / 33,549 Medicaid (Auto-Transfers)

However, I've had a chance to look at the actual VT exchange presentation, and it looks like I was partially correct. The actual numbers are as follows (bold-faced are corrected):

Over the months, I've made numerous changes to my methodology and calculations of some of the "fuzzier" numbers which aren't locked down precisely in the HHS, CMS or state-run Exchange reports. For the most part, this refers to the Medicaid/CHIP enrollments, which are difficult to define since there's a lot of variables involved (including the "motive" of the enrollee in the case of "woodworkers").

  • On the Private QHP side, you have Paid QHPs (or Unpaid for Legit Reasons); Unpaid QHPs; SHOP Enrollments; and Off-Exchange QHPs.
  • On the Medicaid side, you have "Strict Expansion" and "Woodworkers" (which both count) as well as "Redeterminations (renewals)" and "Baseline Churn" (neither of which is counted, though the "churn" is very difficult to pinpoint).

However, there's one number which I've pretty much left alone throughout this process: The 3.1 million "Sub26ers"...that is, the 19-25-year olds who are now (and have been, for up to the past 3 years) included on their parents policies specifically due to the provision in the ACA which requires all policies to allow for this.

I very much appreciate the shout-out from the Washington Post earlier today, but I need to clarify something: My projection of 6.2 million exchange-based QHP enrollments as of 3/31 will likely change as new data comes in.

Example: If California experiences a massive 5-day outage like they did in February (which dropped their daily average, which had been 7,200/day the first half of the month, down to only 5,000/month overall), that will drop the needle dramatically. This isn't just idle speculation--yesterday Healthcare.gov apparently was offline for half an hour for some reason or another. Things happen, though obviously I hope everything will run smoothly throughout the next two weeks. Conversely, if CA announces an astonishing 30K/day day like they did back on December 23rd, that will move the projection up higher.

Contributor Ruth 37 sent a link to this open letter from Peter Lee from 2 days ago, regarding California's 1M QHP milestone and what CoveredCA's plans are going forward.

The number of people who have picked a Covered California health insurance plan now tops 1 million. This is an amazing accomplishment, and it means that with two weeks to go we have exceeded the highest “enhanced forecast” for the entire open-enrollment period. The health insurance companies report that more than 85 percent of those who have enrolled are paying their premium and getting coverage. That means 850,000 Californians are on their way to coverage through Covered California, which surpasses the top projection of 830,000....

This is a much bigger deal than it might appear to be.  The title is a bit misleading; NM's Medicaid tally hasn't suddenly shot up 10x overnight, it's just that until now, I've only had New Mexico's ACA-enabled expansion number pegged at around 14,400 (10,300 Strict Expansion, 4,100 Woodworkers) because NM mixes together new enrollees with renewals (redeterminations) when they report the data to CMS. This means I couldn't use any of the CMS data (witness the red bar on the NM section of the Medicaid spreadsheet).

Today, I can replace both numbers with this one; the article is pretty damned clear that all 103K are specifically due to the expansion provision alone, but I'm willing to concede that perhaps 10% of it might be "woodworkers". Thereferore, "woodworkers" goes up to 10,300 while "strict expansion" increases to 92,700:

Two different people sent me two different articles which help piece together more of the off-exchange puzzle.

From January, this article about Independence Blue Cross of Pennsylvania:

Independence, the region's largest health insurer, with 13 plans on the marketplace, reported enrolling 52,278 people from Oct. 1, when healthcare.gov opened, through Dec. 24, the last day to buy for the new year....

Just over half of Independence's new members - 27,528 - went through the federal marketplace; 24,750 of them used the company's website, telesales, or the mobile Independence Express and brokers.

OK, that's 24,750 (47.3%) off-exchange enrollments through 12/24.

Then, yesterday (3/18):

Vermont's method of enrolling people has always confused me.

There are 36,846 Vermonters who have enrolled in health coverage, 33,549 who were automatically transitioned to Medicaid and 30,000 to 40,000 in the small-group market who were enrolled directly by the insurance carriers participating in the exchange.

A second article, from the Burlington Free Press, confuses things because it says the 36.8K are households, representing 50.4K people:

a state official reported to lawmakers Tuesday that 36,846 households had signed up for 2014 plans....

Larson’s presentation Tuesday showed that 50,475 individuals applied for coverage using Vermont Health Connect between Oct. 1 and March 17. A significant number of these applicants, 20,312, found they qualified for Medicaid, which has expanded eligibility this year.

At long last, the 'Bagger Brigade seems to have discovered this website (I'm surprised it took them this long). I have a special welcome message just for them.

(I should note that "bagger" refers to any Nutbag, not just the Tea-bearing kind.)

A couple of weeks ago I pointed out that at least two states, Massachusetts and Oregon, may end up extending their enrollment period beyond the official March 31st "deadline" due to their exchange websites still being partially or completely hosed.

In Massachusetts' case, there's about 219,000 people currently stuck in coverage limbo; the HHS Dept. has granted an extension of some sort to as far out as June 30th to get these people squared away, although I'm pretty sure the extension only applies to those folks, not anyone who's just trying to enroll now...but that's still a hell of a lot of people.

Now that we're hitting crunch time and I'm getting some national TV buzz (well, The Graph is, anyway), people have started asking me what the best comparison to use for The Surge should be. There are three examples which come to mind for obvious reasons...and while all three are indeed very similar to the current situation in many ways, they're also very different.


Massachusetts/Romneycare, 2006: The irony of having the very guy who ran against President Obama on his signature healthcare law happening to be the same guy who implemented essentially the same law in his own state as Governor in the first place aside, there were a lot of similarities between the 2006 Massachusetts healthcare law and the Affordable Care Act. This article from last fall does a good job of going over the main ways that the two are similar...and how they're different. In short:

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.

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