California

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

This article is both very helpful but also has 2 frustrating data points missing. The key numbers: While CA was averaging around 7,200 QHP enrollments per day in the first half of February, that rate is apparently up to 8,000/day now. This is excellent, but I don't know whether that 8K/day rate is only for the past week or if it includes the full 2nd half of February (I would guess that it's risen steadily since then.

On the other hand, CoveredCA also suffered from a 3-day outage, which could skew the daily average...they had 3 days of no enrollments, followed, presumably, by the 22K people who tried on those days possibly joining another 22K over the subsequent week or so. Either way, it's looking pretty good, though California will have to end up averaging around 20,000/day in March to do their part in hitting 7M total by 3/31, or 13,000/day to hit 6M.

The other big news here (the main point of the article) is that payment rate for enrollees through 1/31 has gone up from 80% as of 2/19 to 85% as of a couple of days ago:

Contributor Steve Ciccarelli just pointed out a fun fact about California's ACA exchange using my February QHP Projection Table:

California was averaging 7,182 QHP enrollments per day in the first half of February; they hit 828,638 QHPs as of 2/15.

Assuming this average has held at around that rate since Feb. 15th, they should have added another 151,000 through today, bringing them to around 979,000.

That leaves them just 21,000 away from 1 Million even, which they should reach sometime on Tuesday.

Yesterday the Obama administration announced several new modifications to ACA implementation. The one that's getting the most attention is a 2-year extension on non-compliant, pre-ACA healthcare plans. After getting criticized for "lying" about his "if you like your plan you can keep it" statement last fall, Pres. Obama gave individual states the option of extending existing plans by 1 year if they wanted; this just extends that period further, out to pretty much the end of Obama's term of office:

Americans with health coverage that predates Obamacare can stay on their plans for two more years, insurers will have an extra month to enroll customers next winter and states will get more time to decide whether to manage the law themselves, officials said. Also, a program aimed at covering financial losses for insurers will be adjusted to help ensure it doesn’t cost taxpayers, the Obama administration said.

There's so much info in today's California press release I've had to move the Medicaid info to a third entry. There's a ton going on in the following passages:

Additionally, 877,000 applicants were determined to be likely eligible for Medi-Cal coverage. DHCS also transitioned 652,000 individuals into the Medi-Cal program from the state’s Low Income Health Program. Automated enrollment allowed county human services agencies to enroll 106,000 individuals into Medi-Cal coverage, and another 65,000 were enrolled through the Express Lane program.

approximately 1.5 million additional Californians have enrolled or been found likely eligible for Medi-Cal since October. 

** Does not include applicants for current Medi-Cal coverage through county human services agencies. 

OK, let's break this out: The 877K figure is up fro 850K in the January HHS report, which itself was already up from 584K as of January 15, which means a ton of new people enrolled in the 2nd half of January alone.

Some additional positive news out of California today; so much going on I decided to break it out into a second post:

Lee also noted that of those enrolled through Jan. 31, 626,210 are eligible for subsidies, and insurance companies are reporting that 80 percent of all enrollees have paid their first month’s premium. 

The wording of this makes it hard to tell whether "all enrollees" means all of them or only those through Jan. 31, but this CoveredCA Tweet clarifies:

#CoveredCA health insurance companies are reporting that 80% of all enrollees have paid their first month's premium.

— Covered California (@CoveredCA) February 19, 2014

OK, so this really does mean all enrollees. Fair enough. The downside is that I have to move 165,272 people over to the "Unpaid" category. The upside is that the "How many have PAID???" question just became about 12% cleaner.

Well THAT just figures! In the words of Emily Litella..."Never mind..."

Hot off the presses: California has released their first-half of February enrollment data: 100,228 people have enrolled in Private QHPs in "the first 2 weeks" of February (actually February 2 - 15, I assume, since the 728K number includes Feb. 1st). This breaks down to 7,159/day:

Nearly half of those covered [through 2/01] — 728,410 Californians — selected a Covered California health insurance plan. This strong enrollment trend is extending into February, where in the first two weeks more than 100,000 individuals enrolled in Covered California, increasing the cumulative total enrollment in Covered California to 828,638.

California's January enrollment rate was (728,410 - 498,794) = 229,616 / 35 days = 6,560/day, which means that their February enrollment rate is actually increased from that of January, by over 9%!

So, how does this impact the "February Drop-Off" factor? MASSIVELY! Take a look:

With all the focus on fixing the problems with the individual/group healthcare exchanges, there's been far less attention paid to the more-troubled SHOP (Small Business) exchanges. The administration had already announced that the HC.gov version (covering 34 states*) wouldn't be launched at all until this fall, and 2 of the state-run exchanges (Oregon and Maryland) recently announced that they'd be offline until well after the end of the March enrollment period as well.

Today, Covered California announced that while their SHOP exchange has been operational (with a small number of enrollments to date), they're shutting it down until this fall as well. This leaves 14.5 state-run SHOP exchanges in operation (and yes, that's 14.5, not 15...Washington State's SHOP is only running in 2 counties at the moment).

Still, the press release does give a slight bump in CA's SHOP enrollment before they stop taking new signups: 4,490 individuals covered, plus another 1,200 being processed, for a total of 5,690. That's where it'll stay through the end of the March enrollment period unless they reverse themselves between now and then.

...in which we find the third ACA-created SHOP (Small Business Health Options Program) addition of the day. 2,155 employees is a pretty miniscule number (especially for the largest state in the country), but it's something. Note that it says "2,155 employees", which most likely means about double that when you include dependents, but as always, I'm leaving it here unless I find specific sources stating otherwise.

A total of 289 small employers have signed up for coverage through Covered California’s Small Business Health Options Program, better known as SHOP. These employers will provide coverage to a total of 2,155 employees.

The December report released Jan. 21 by Covered California shows that from Oct. 1-Dec. 31 the exchange received 1,107,229 electronic applications for health care coverage through both private plans and Medi-Cal. Multiplying that number by 1.8, "based on an average of 1.8 individuals per application," it was estimated that the number of applications represented 1,993,012 individuals.

The 1.8 factor was not used for "completed applications." From Oct. 1-Dec. 31, there were 771,008 completed applications for health care coverage through Covered California (including Medi-Cal) for 1,456,909 individuals. If the 771,008 completed applications had been multiplied by 1.8, there would have been only 1,387,814 individuals. This indicates that individuals, not households, were counted in the completed applications.

From Oct. 1-Dec. 31, there were 500,108 enrollments in a Covered California health plan (this did not include Medi-Cal). Of the 730,449 individuals who were "determined to be eligible for enrollment in Covered California", more than 2/3 enrolled. Clearly these were enrollments by individuals, not households.

When I posted my big Medicaid/CHIP spreadsheet overhaul, I was understandably concerned that I missed something major--that there had to be some factor lost in the messy, semi-overlapping reports from HHS and CMS that would account for big swaths of the 1.7 million "extra" Medicaid enrollments that I've "found" (in reality, those 1.7 million have been gradually accruing ever since the beginning of October, I just wasn't able to pin them down into a tangible format on the spreadsheet & graph until now). As a case in point, after the overhaul, I have California sitting at 1.214 million new additions to Medicaid/CHIP programs.

Today a friend provided a link to a story out of the Fresno Bee from 4 days ago, in which the Cailifornia Dept. of Health Care Services reveals that enrollments in Medi-Cal (CA's implementation of Medicaid) have gone up from 8 million people last year up to about 9.2 million as of now...a difference of about 1.2 million.

I'm not saying that there aren't flaws in my methodology; no doubt there are, but this certainly helps set my mind more at ease.

Ka-Pow! This is the most eagerly-awaited enrollment update we've had in weeks. California has finally let the dust settle on their Christmas-week craziness and have released new, comprehensive enrollment data for both Private QHPs as well as Medicaid/CHIP, and the numbers are impressive indeed: After closing out 2013 with just over a half a million private enrollments (about 1,300 more trickled in in the final 3 days of the year), the first half of January has proven that, while the completely expected post-December drop-off did happen, enrollments are still proceeding at a very healthy pace, as over 125,000 more people enrolled in the first 15 days of the month, more than a 25% increase since New Year's Eve. Broken out, that comes to over 8,300 per day for California alone.

It's also worth noting that with this update, the total Private QHP enrollment figure has now broken the 2.5 million mark.

Meanwhile, Medicaid enrollments have also continued to show a similar 25% gain, up from around 460,000 (or 472,000...see today's Medicaid Spreadsheet update) up to 584,000.

For California, we presently have data through the December 23rd. However, at the last minute, California extended its deadline to 12/27. This means that we are still waiting for four days of enrollment data! Keep in mind that just prior to the deadline, California was seeing 20,000 private plan enrollments daily.

It that rate continued unabated, we could be looking at as much as 80,000 signups beyond the 428,000 already registered. During the three days December 20–22nd more than 77,000 Californians enrolled in private plans. Granted, this is speculation – we won’t know until Covered California releases its figures.

An important develepmont is that Covered California extended its deadline for paying health insurance premiums to January 15th. Payment was originally due Monday the 6th. The extension also relieves pressure on insurers who were inundated with hundreds of thousands of new customers in December.

As part of its effort to reach minority uninsured, California has made paper applications available in Spanish, Chinese, Vietnamese and Korean.

Mississippi: Private up to 2,000 from 802 (h/t Steve Mullinax, aka rsmpdx)

Transcript from Jeffrey Hess of Mississippi Public Radio, NPR Audio:

Only two insurance companies are offering plans in Mississippi, and they only overlap in four of the state’s 82 counties. However, those two companies appear to be betting that the web site problems and skepticism about the exchange in general are passing. One of the two companies, Humana, launched a late-December ad campaign to drive more people to the site, says spokesman Mitch Lubitz. “There’s been a ramp-up as the HealthCare.gov web site has gotten easier to use and there have been other options for people to go on and get information and enroll.” Mississipi’s Insurance Commissioner Mike Chaney says the improvements to the enrollment process are good, but he’s still skeptical they’ll be able to get enough people signed up this year. “From zero to ten, I’d give it a confidence level of about a three.” Hess: “That’s still not very good.” Chaney: “That’s not, but it’s better than where I was, a one, a week before last. “Chaney says the unofficial count is around two thousand people enrolled, but he says if the confidence trend continues upward, his confidence will rise to a five.”

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