2018 MIDTERM ELECTION

Time: D H M S

Now that we're past the official Open Enrollment period, I've overhauled The Graph with some major changes & updates. These include:

  • By popular request and much pondering (see comments at bottom of link), I am no longer subtracting the 3.7M Cancelled Policies from the grand total. However, these are still clearly and prominently noted in the yellow box.
  • As promised, I have lowered the "Sub-26er" bottom-end estimate again, from a low of 2.2M to 1.6M. I'm done mucking around with this until further notice.
  • With the official announcement of a whopping 1.7M OFF-exchange QHP enrollments from the BCBS Association, I have increased the documented off-exchange total to 2.17M on the graph, causing a noticable spike at the end (obviously these weren't all enrolled in today, but I can't really back-date these so they're all added at once).
  • Note that I've also deleted all of the state-specific BCBS off-exchange QHPs since the 1.7M total noted above supercedes all of them.
  • Since the 9M total off-exchange figure credited to the Rand Survey was a very rough estimate (see update at bottom of link), I've added an "up to" caveat (and the 6.83M balance isn't on the graph itself anyway).
  • I've replaced the 7M arrow with 6M and 7M lines to reduce the clutter.
  • Finally, the most controversial change is probably the removal of the "documented unpaid" exchange QHPs (as well as the "estimated additional" QHPs; instead, I've simplified things greatly by separating the total Exchange QHP number into 2 areas: 93% estimated PAID (or will pay soon) and 7% UNPAID (or may not pay).
    I'll be happy to revise this 93 / 7 ratio one way or the other as more data comes in, but for now, based on all the partial "Paid/Unpaid" data I've seen to date, that seems to be fairly accurate.

About 5 different people have sent me a link to this new study by the Urban Institute, which concludes that the total number of uninsured adults in the U.S. has been reduced by around 5. million people since last fall.

They're pretty clear about the time period: it runs from just before the exchanges launched until...well, actually, until early March (more on this below):

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014.

The results? According to this study, it's a net reduction of 5.4M uninsured:

As deaconblues reminds me, the 29K is in addition to the 720 subsidized enrollees that they've managed to get through their messed-up system.

Massachusetts will not meet its goal of moving more than 200,000 people into insurance plans that comply with the federal law by the end of June. It has managed to enroll about 29,000 residents in unsubsidized coverage, 138,000 in temporary coverage, and another 114,000 in extended coverage since the October launch of its new website, with a significant number applying on paper, said a Connector spokesman Thursday.

Presented without comment (and again, I'm NOT endorsing eHealth, but they're obviously going to come up in conversation a lot since they're essentially a private version of HC.gov without the subsidy factor):

First, don’t believe polemicists who argue that 70% or more of buying policies at HealthCare.gov had insurance already, as Republicans claim, in an interpretation of a McKinsey & Co. study that Politifact ruled “false.” Even at eHealth, which has almost no subsidy-eligible customers so far, 51% of clients this year were previously uninsured, up from 34% in late 2013, Lauer said.

With 83% of the people using HealthCare.gov and the state exchanges eligible for subsidies, it’s highly unlikely that they’re going to skew more heavily toward the being previously-insured than eHealth’s crowd.

Oregon appears to be purging their old unpaid enrollments, for cleaner totals (along with the dental enrollments, which even I haven't really talked about)...I'm assuming this is through yesterday. Note that the Medicaid number doesn't include an additional 128K enrolled via their "Fast Track" program from earlier:

April 3, 2014 Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

  • Medical enrollments through Cover Oregon: 200,165
  • Total private medical insurance enrollments through Cover Oregon 1: 58,833                      
  • Oregon Health Plan enrollments through Cover Oregon: 141,332
  • Total private dental insurance enrollments through CoverOregon 1: 12,066                       

Net enrollments 

  • Net private medical:  55,833
  • Net private dental: 11,208

Background: With three months of open enrollment completed, Cover Oregon is expanding the enrollment report beyond what is required by the federal Center for Consumer Information & Insurance Oversight to include net private insurance enrollments and also dental enrollments. 

Hawaii makes a correction by separating out their SHOP enrollees...

Connector Updates for March 31, 2014

  • Total since October 1, 2013:
  • 24,176 Applications completed in the Individual Marketplace
  • 7,596 QHP Enrollments in the Individual Marketplace
  • 1,280 attestation forms filled out
  • 544 Employers applied to SHOP Marketplace
  • 265 QHP Enrollments from the SHOP Marketplace

OK, this is why CoveredCA was holding off on announcing their numbers: Peter Lee had to testify before Congress today anyway:

Enrollment in Covered California private health insurance plans hit 1,221,727 through March 31. In fact, March was the highest single month of enrollment, with more than 416,000 people signing up for a health insurance plan.

...Medi-Cal enrolled approximately 1.9 million people through the end of March, including 1.1 million through the Covered California portal and county offices, approximately 650,000 former Low Income Health Program (LIHP) members who were transitioned to Medi-Cal by the California Department of Health Care Services (DHCS) and 180,000 individuals who applied through the state’s Express Lane program.

In addition...

And there we have it: Glenn Kessler of the Washington Post reports that BCBSA (the family of Blue Cross companies, as well as Anthem, Regeant, etc) confirms 1.7 million ACA-compliant QHPs sold OFF-exchangenationally from October 1st through March 1st (that's right, the rest of March isn't included; for comparison, March made up 40%of the exchange QHP total for the open enrollment period):

Newsy: BlueCrossBlueShield companies sold 1.7 million ACA-compliant policies OFF-exchange between 10/1-3/1. #obamacare

— Glenn Kessler (@GlennKesslerWP) April 3, 2014

@charles_gaba @Cripipper no link. I had been asking for the data and I got it the old fashioned way--a phone call.

— Glenn Kessler (@GlennKesslerWP) April 3, 2014

Since I'm shifting the "Paid/Unpaid" tally to a simplified "93% Paid or Will Pay Within a Reasonable Time" model, I'm no longer distinguishing the paid/unpaid factor for states which do so (although I am still listing them when released by the states):

Enrollment data (Oct. 1, 2013 through March 31, 2014)

Total HealthSource RI enrollments (including those who have not yet paid): 27,961

Paid enrollments: 21,097

Medicaid enrollments (per EOHHS): 64,590

Small employer applications initiated: 1,319

Small employer enrollment: 175 (based on their submitted census, these employers represent 700 covered employees and 1,110 covered lives)

Small employers who enrolled in Full Employee Choice: 103

  • Thru 4/02: QHPs: 63,002
  • Thru 4/02: Medicaid: 232,075 (295,077 - 63,002, includes one-time PAC transfers)

O’Malley points out that despite the problems, Maryland exceeded its overall enrollment goal of 260,000. As of Tuesday night, that number had hit 295,077. It includes people who have enrolled in private plans (which has dramatically lagged expectations) and Medicaid (which has exceeded expectations).

...Sharfstein said in late February that a more accurate projection is 75,000 to 100,000 private enrollees.

As of Tuesday evening, there were 63,002, with hundreds or thousands more expected to finish their applications in coming weeks.

As a follow-up to my follow-up last night, HuffPo healthcare reporter Jeffrey Young tweets:

About 3/4 of the 28K @HealthSourceRI enrollees had paid a premium as of 3/31. People who signed up after 3/23 have until 4/23 to pay.

— Jeffrey Young (@JeffYoung) April 3, 2014

@asymmetricinfo And the paid rate through 3/8 was 83%, including people whose bills were due later.

— Jeffrey Young (@JeffYoung) April 3, 2014

Interim CEO of @MNsure, Scott Leitz, to tell U.S. House subcommittee that 95% of its 47,000 enrollees have paid, and the rate will rise.

— Jeffrey Young (@JeffYoung) April 3, 2014

OK, looks like I completely misunderstood the Vermont figures from a few days ago; half of them were supposed to go on the Medicaid side after all. From a source at the Vermont Health Connector:

In the meantime, I can provide the enrollment figures: 48,150 are fully enrolled in a plan through Vermont Health Connect; 25,930 of those enrolled in Medicaid or Dr. Dynasaur, our CHIP program.

Doesn't impact the overall national total, but it does change the dynamic for Vermont to something...rational (prior to this it looked like they had hit a whopping 585% of their year 1 target!

This means 22,220 QHPs and 25,930 Medicaid.

The Hawaii Health Connector has enrolled 7,861 individuals as of the March 31 deadline, with another 24,176 who completed applications for coverage through the state-run online health insurance exchange. 

...It is important to note there are only about 50,000 uninsured people in Hawaii who are not deemed Medicaid eligible, which makes Hawaii’s market small compared to other states.

...Kayla Rosenfeld, spokeswoman for the state Department of Human Services, told PBN on Wednesday that since Oct. 1 — when the department launched its new online eligibility system KOLEA— net Medicaid enrollment in Hawaii has increased by 46,605, which is close to the expected increase of 48,000.

Van Pelt highlights the more than 300,000 "enrolled in health care coverage since October thanks to Cover Oregon ... and the Oregon Health Authority."

That figure includes:

  • 55,000 people enrolled in private plans using the backup manual processing system set up to cope with the exchange's technology issues.
  • more than 120,000 people enrolled into Oregon Health Plan after the exchange forwarded their information to the state for processing, a workaround for the exchange's broken Medicaid interface.
  • 125,000 people enrolled directly into the Oregon Health Plan using a streamlined system set up to bypass Cover Oregon.

OK, this just adds to the confusion over the "extension periods"...not only is Kentucky joining the "you have until 4/15 if you started by 3/31" brigade, but it appears that they're also allowing people to start the application/enrollment process between 4/4 - 4/11 as well:

Gov. Steve Beshear announced Tuesday that the state will extend its deadline. People will be able to file for health insurance from April 4 to April 11.

The official deadline had been midnight March 31. Gwenda Bond, spokeswoman for the Cabinet for Health and Family Services, said 21,000 people signed up over the weekend, including 12,000 people who signed up Monday. The deadline affected only those signing up for private health insurance, because those eligible for Medicaid can apply at any time.

Because of the high demand, Bond said, state officials decided to add additional days for enrollment or a "special enrollment period." The days between the March 31 deadline and the special enrollment period will allow for some tweaks to the technical system to allow for the extension, she said.

Huh. Good for them, but if that's the case, why not just bump this out to 4/15 and be done with it? Weird.

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