Time: D H M S

Kaiser Family Foundation

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

The Kaiser Family Foundation has just released their 3rd Annual survey of people enrolled in the "Non-Group Health Insurance Market", otherwise known as the Individual market. It's important to note that this survey includes Americans enrolled in all individual market plans, both on and off-exchange. There are technically 5 separate categories, although they can effectively be merged into three categories for most purposes:

  • 1. EXCHANGE-based QHPs (Qualified Health Plans)
  • 2a. OFF-Exchange QHPs
  • 2b. OFF-Exchange ACA-compliant non-QHPs
  • 3a. OFF-Exchange NON-ACA compliant "Grandfathered" plans (ie, enrolled in prior to 2010)
  • 3b. OFF-Exchange NON-ACA compliant "Transitional" or "Grandmothered" plans (ie, enrolled in between 2010 and 2013)

I tend to merge #2 & 3 together (off-exchange, ACA-compliant) in virtually all cases, and merge #4 & 5 together (grandfathered/grandmothered) except in cases where I need to make a distinction.

First, KFF's methodology:

This really shouldn't be considered profound or prescient, but the entire concept of of "free market competition" only works as intended if the customers actually shop around and compare their options. If people just ignore changes in the offerings available and stick with what they have regardless of the new options available, the "competition = better value" mantra collapses.

That's why I've been stressing the importance of shopping around on the ACA exchanges (or even off-exchange) so much this year. As I noted back in October: