Confirmed Exchange QHPs: 12,101,891 as of 7/29/15
Estimated: 13.00M (9.88M via HCgov) as of 7/29/15

Estimated ACA-Enabled Policy Enrollment: 32.1M
(10.4M Paid/Effectuated Exchange QHPs, 7.0M OFF-Exchange QHPs, 200K SHOP, 14.5M Medicaid/CHIP)

Assuming my ballpark estimate of appx. 7,500 Off-Season QHP Selections Per Day is accurate, the grand total nationally should be breaking the 13 million milestone right (or at least sometime this week).

I should note that thanks to this morning's New York update, the confirmed total has now officially broken the 12.1 million mark. The other 900,000 or so haven't been reported yet, and are mostly via Healthcare.Gov, of course.

NOTE: Updated with Minnesota's data 7/29/15
NOTE: Updated with New York's data 7/29/15

Recently, Richard Simpkins (aka icowrich) took my latest state roundup of the known state-wide 2016 rate increase requests (updated with 15 states +DC) and took it one step further. He plugged the weighted average rate increases for each state into a spreadsheet and then ran a "weighted" average based on each state's proportion of the total U.S. population, like so: an overall rate increase of about 9.6%, which isn't fantastic but is still a bit lower than the 10-12% which was typical nationally prior to the ACA.

Obviously this is a very partial picture, for several important reasons:

A judge has blasted a California software giant's claim that a cabal of campaign advisers are to blame for the decision to tank the state's $300 million Cover Oregon website project.

Oracle in February sued five campaign advisers and consultants to former Gov. John Kitzhaber, who resigned in February. Oracle argued the exchange was ready to roll out in February 2014, but said advisers led by Patricia McCaig pulled the plug on the project for political reasons.

On Monday, Multnomah Circuit Court Judge Henry Kantor issued a written opinion ripping Oracle's legal arguments using language that went far beyond his earlier e-mailed notice of the decision. He called Oracle's arguments "totally unsupported by the evidence provided."

Earlier today I posted about a mountain of data being released by the New York State of Health ACA exchange, including, among many other data points, the rough market share breakdown of the 19 insurance carriers operating on the exchange this year, like so:

  • Fidelis Care: 20%
  • Health Republic: 19%
  • Healthfirst: 10%
  • Empire BCBS: 10%
  • MetroPlus: 7%
  • MVP: 6%
  • Emblem: 6%
  • Oscar: 5%
  • Affinity: 5%
  • Excellus BCBS: 4%
  • UnitedHealthcare: 2%
  • North Shore: 2%
  • BCBS West. NY: 1%
  • CDPHP: 1%
  • Independent: 1%
  • Univera: <1%
  • Wellcare of NY: <1%
  • Empire BC (Upstate): <1%
  • BlueShield of NE NY: <1%

Right on top of the Humana SEC filing I just wrote about comes this Q2 earnings conference call with Joe Swedish of Anthem (formerly WellPoint), which is an even larger insurance company nationally:

Our growth continues to be balanced so far in 2015 as we added 571,000 Medicaid members, 331,000 national members, 51,000 individual members and 16,000 local group members. As a reminder, we closed on the Simply Healthcare acquisition in February of this year, which contributed 209,000 members. These results have been supported by strong operating cash flow of $2.8 billion year-to-date, which represents 1.6 times net income.

Humana Group is one of the largest health insurance companies in the country. As such, their enrollment data being made available is extremely helpful in seeing where things stand and how they've changed nationally.

Today, Bob Herman of Modern Healthcare provided me with a link to Humana's latest SEC filing. In addition to a whole mess of financial info which is of little interest to me, there's also all sorts of year-over-year data about their enrollment numbers...including a very handy section about their individual market, broken out by ACA exchange-based, Off Exchange and even their non-ACA compliant enrollments (ie, "grandfathered" and/or "transitional" enrollees).

Here's the key section:

The New York State of Health (NY's ACA exchange) just released detailed numbers from the 2015 Open Enrollment Period.

Unfortunately, the data gets cut off as of 2/28/15, so this doesn't give any insight into the attrition rate since then (or a precise count of how many additional people enrolled during the #ACATaxTime special enrollment period which followed). However, it does give a lot of detailed analysis of the open enrollment period numbers, and does tack on an extra week's worth of private enrollments & 2 week's worth of CH+/Medicaid numbers (the official HHS report only ran through 2/21 for New York and the last press release with CH+/Medicaid numbers was as of 2/15).

As a result, the official numbers are slightly higher than what I had until now across the board:

(sigh) Just 2 days ago there was excellent news on the 2016 rate increase front from the largest state (California, 4% weighted average) and one of the smaller ones (Maine, just 0.7%). Today brings the other side of the coin: Assuming the requested rate hikes are approved, Minnesota is looking at some pretty unpleasant increases next year:

A team of actuaries at the Minnesota Department of Commerce are currently scrutinizing the proposed rates that have been filed for 2016, and final rates will be announced on October 1. But for now, four MNsure’s individual market carriers have proposed the following rate changes for coverage effective January 1, 2016 (market share is as of the end of the 2015 open enrollment period):

Remember that University of Michigan study I posted about last week which claimed that in spite of all the predictions by ACA opponents that expanding Medicaid would make it impossible for enrollees to actually make a doctor's appointment, the opposite ended up being the case?

A new University of Michigan study shows that the availability of primary care appointments actually improved for people with Medicaid in the first months after the state launched the Healthy Michigan Plan, the state’s Medicaid expansion under the ACA. What’s more, it remained mostly unchanged for those with private insurance.

Well, apparently the Michigan results are not an outlier:

I very rarely write much about Medicare here, partly because I just don't have time to cover every aspect of the healthcare system, partly because Medicare is only impacted by the ACA indirectly for the most part. However, there's been two recent developments which are worth noting:

First, that "indirect impact" I just mentioned has resulted in the Medicare Hospital Insurance Trust Fund, previously expected to run out of money just 2 years from now, now being expected to be solvent through 2030 thanks to the ACA bending the cost curve:

The slowing growth of healthcare costs has extended Medicare's projected lifespan 13 years beyond projections made in 2009, the last report issued before the passage of the Patient Protection and Affordable Care Act.

The Medicare Hospital Insurance Trust Fund will have "sufficient funds to cover its obligations until 2030," the Medicare Board of Trustees said Wednesday in its annual financial review of the $613 billion program.

The CMS Dept. has quietly released their latest monthly Medicaid/CHIP enrollment report through the end of May...which happens to line up almost perfectly with what I was expecting:

  • Over 71.6 million individuals were enrolled in Medicaid and CHIP in May 2015. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.
  • 509,082 additional people were enrolled in May 2015 as compared to April 2015 in the 51 states that reported comparable May and April 2015 data.
  • Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both May 2015 enrollment data and data from July-September of 2013, more than 12.8 million additional individuals are enrolled in Medicaid and CHIP as of May 2015, more than a 22 percent increase over the average monthly enrollment for July through September of 2013. (Connecticut and Maine are not included in this count.)

This may seem a bit antlclimactic after today's big California news...unless you happen to live in Maine.

A big shout-out to Amy Fried for the heads up re. this story about Maine's 2016 rate requests:

Most Mainers buying Affordable Care Act insurance will see modest increases in their premiums for 2016, below the national average and much lower than the double-digit increases projected in some cities by a recent study of initial rate filings.

About 80 percent of the 75,000 Mainers purchasing ACA marketplace insurance have a plan through Lewiston-based Community Health Options – formerly Maine Community Health Options. The ACA marketplace, operated on the Web as, is where those without insurance – often part-time or self-employed workers – can obtain subsidized benefits.

This Just In...

FOR IMMEDIATE RELEASE Media Line: (916) 206-7777 July 27, 2015


Average Increase Is 4 Percent; Consumers Who Shop Can Lower Their Premium by an Average of 4.5 Percent

SACRAMENTO, Calif. — Covered California announced its rates for 2016 and unveiled which health insurance companies will be offering plans through the marketplace. The statewide weighted average increase will be 4 percent, which is lower than last year’s increase of 4.2 percent and represents a dramatic change from the trends that individuals faced in the years before the Patient Protection and Affordable Care Act.

When I last checked in on Pennsylvania's year-late-but-certainly-welcome addition to the ACA Medicaid expansion club, newly inaugurated Governor Tom Wolf was in the process of replacing his predecessor's poorly-conceived, overly-complicated "Conservative version" of the expansion program with "official" Medicaid expansion to up to 600,000 state residents. At the time (early May), they had hit roughly 250,000 people.

I'm happy to report that according to today's Pittsburgh Post-Gazette, the dust has settled on the transition, and enrollment has bee on a tear, with the tally now standing at roughly 439,000 Pennsylavnians.

About 439,000 Pennsylvanians have enrolled in expanded Medicaid, which provides health insurance coverage to the poor and disabled, since the beginning of the year, according to figures released last week by the state’s Department of Human Services.