2018 MIDTERM ELECTION

Time: D H M S

A bit of an update out of Massachusetts; the article is another rundown of the MA Mess, but there's actually small enrollment update included as well: Exchange QHPs have gone up from 12,965 on 3/01 to 15,140 as of "this week" (I'll call it Wednesday the 19th).

As of this week, only 740 Massachusetts residents have been able to enroll in newly subsidized plans under the act, Health Connector Authority spokesman Jason Lefferts said.

He said 14,400 people were able to enroll in unsubsidized plans on the private market by using the connector's website. Their success rate is tied to not needing to go through the income eligibility process, Lefferts said.

However, here's the actual good news: It turns out that Massachusetts only includes paid enrollees in their reports. From a CNBC article a week ago:

I just posted a lonnnnnng explanation the details of the "But how many have PAID???" situation. It gets kind of deep into the weeds, so I'll stop now, but I do just want to simplify things with a shorter, separate post:

Let's be clear about this: SOME of the people who haven't paid ARE going to prove to be deadbeats. That's inevitable in any industry that serves millions of people, just as shoplifting is a real problem that retailers have to deal with (and as I noted earlier, what was the insurance industry norm for cancelled/unpaid premiums prior to the ACA? Probably fairly low, but how low? 1%? 2%?).

The problem is that the "But how many have PAID???" attack seems to be based on the premise that ALL of the non-payments are deadbeats (or, alternately, that they're ALL due to exchange technical problems).

Here's the thing, though: There's 5 reasons I can think of why the first premium might not be paid yet:

Not exactly a huge spike, but a person covered is a person covered...

As of March 18, 524 people had enrolled in health plans through the New Mexico small business, or SHOP exchange, according to figures from NMHIX. That includes 345 employees and 179 dependents.

In response to my Paid/Unpaid Brouhaha update last night, a commentor brought this story out of BizTimes.com to my attention, which in turn links to this memo (PDF) from the Wisconsin Insurance Commissioners Office.

In the middle of it we find this (partial) paid/unpaid data, which indeed only applies to January and February start-dates:

4. How many consumers have enrolled in coverage through the federal exchange? How many consumers have paid their premium?

(Reposted with updated numbers and additional info given that NewsBusters has decided to launch a hit piece on me using the "But how many have PAID???" attack point)

I've written about the "But How Many Have PAID???" issue many times before, but going into the final stretch, I wanted to explain my reasoning as clearly as possible.

The following chart only includes states which have broken out Paid vs. Unpaid Enrollments. If you only use these 10 states as a guideline, it looks like the paid rate is around 85%:

NOTE: This represents the Paid vs. Unpaid enrollments out of all enrollments reported to the HHS as of the Thru Date listed.

Massachusetts doesn't report unpaid enrollments at all, and Washington lists unpaid enrollments separately in their press releases but does not included them in HHS report data. As a result, both states are actually at 100% paid (in terms of the numbers in the HHS reports, which is what we're talking about here).

OK, this is a tiny number but every data point helps...in an article about the final crunch-time outreach efforts is this bit about the Nevada Health CO-OP's success:

The CO-OP sells plans both on and off of the exchange, but the “vast majority” of consumers who ask about plans are subsidy-eligible and buying on the exchange, Egan said. The CO-OP has actually sold more plans through the exchange than any other insurer: It’s responsible for 37 percent of plans sold, beating out industry titans UnitedHealthcare and Anthem, the state’s two biggest insurers. The CO-OP had sold about 9,500 plans on the exchange and just under 1,000 off of it as of Tuesday.

I'm gonna call "just under 1,000" 990 (shrug).

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:

Pages