Estimated Exchange QHPs as of 7/14/14: 7.85M PAID (8.87M Total)

Estimated Total, all sources: (24 Million - 29 Million)

Exchange + Off-Exchange QHPs: 15.7M  •  Medicaid/CHIP (7.1M - 9.9M)

ESIs (156K confirmed; up to 8M more possible)  •  Sub26ers (1.6M - 3.1M)

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When I posted my dumb-simple solution/workaround to resolve the Halbig decision back on July 2nd (assuming that it's upheld, which is by no means guaranteed), I meant it seriously, but figured that no one else would. I mean, really...the salvation of the most important healthcare law of the past 50 years and the single most important accomplishment of the Obama administration could end up being as simple as registering 3 dozen domain names and putting up a splashpage?

After yesterday's flood of updates, I'm taking a moment to give a shout-out to Chris Savage. He's currently running a fundraiser to help support Eclectablog, the Michigan-centric political site which deserves far more attention than this one. Eclectablog isn't primarily healthcare-related (although there are occasional ACA-related pieces by Amy Lynn Smith and LOLGOP from time to time), but it would mean a lot to me if readers of this site would lend a hand to that one.

Full disclosure: Not only is Chris a friend and colleague, he also happens to be one of my hosting clients, so in that sense this may be a bit self-serving.

Normally this would be a lengthy entry, but given that there have already been 4 other major national surveys saying the same thing, the latest news is just locking things down.

The New England Journal of Medicine just published a new report which concludes (shocker) that there's been a net reduction in the number of uninsured U.S. adults by around 10.3 million since the ACA exchanges went into effect:

As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

OK, I've had a chance to download the actual Excel file with the raw data and a handy graph already set up; I've cleaned up and color-coded the graph, and it's fascinating to look at, both during open enrollment as well as since it ended The things which stand out the most:

  • The obvious dead zone in October and most of November, finally coming to live around Thanksgiving time
  • The gradual rise in December, culminating in a large spike on Christmas Eve (the "official" deadline for January 1st coverage, although that varied in some states)
  • The massive spike in late March, culminating in a nearly off-the-chart peak on the "official" open enrollment deadline of March 31st, which saw over 200,000 transactions by itself

Yes, I'm quoted in this breaking story; Mr. Ornstein contacted me earlier today to ask my thoughts on his scoop, and I agreed to keep mum until it went public:

For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using Healthcare.gov by April 19, the end of the open-enrollment period.

But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.

Now, before everyone jumps on the "1 million" figure, a few important things:

First, remember the news from yesterday that the ACA had lopped California's uninsured rate in half, from 22% down to 11% as of June? 22% of 38 million people = about 8.36 million; half of that is 4.18 million.

Next, remember that massive backlog of 900,000 new Medicaid (aka Medi-Cal) enrollees that California was working with as of the end of May?

Well, guess what?

For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems.

Regular readers of this site know that I have a checkered history with Forbes writer Chris Conover. It's been mostly on the hostile side, but he's also occasionally brought up a valid point which I've incorporated into my estimates; in particular, the "Sub26er" estimate has been changed from a flat 3.1 million to a range between 1.6 - 3.1 million in part due to his information (as well as Glenn Kesslers'). I believe the term which applies on both of our parts is "grudging respect" though I could be wrong at his end.

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