Beyond 3/31 (Will HHS shorten March to 29 days?)

Well, first of all, I've gone ahead and increased my official 3/31 projection to 6.5 million exchange QHPs.

This may go up a bit more, but we're really into uncharted territory at this point. This is where I really am not the "Nate Silver of..." anything. I don't run 10,000 simulations across a complex computer model or anything like that, I can only rely on the existing data, and things are ramping up a bit more quickly than I figured a few days ago, so a lot of this is going to be "back of the envelope" guesswork going into the final weekend.

There's another huge factor to consider as well: The post-3/31 QHP enrollments.

These impact things in several ways:

First of all, since at least 43 states (I think...possibly more) are now doing the "as long as you start by 3/31 you have until 4/15 to complete" thing, some people who otherwise would have scrambled this weekend may ease up, start the process this weekend and then come back to finish the first week of April.

However, this may have the opposite effect. I could also imagine a lot of people planning on doing that, but then getting halfway done and then saying, "what the hell, as long as I'm this far along..." and going ahead and getting it out of the way by the 31st after all. I guess that depends on whether the websites have a meltdown/sluggish performance or not.

So...I dunno. It might cancel itself out and not be a factor at all.

The other way it impacts things, of course, is the "final number". The reality is there is no final number.

Medicaid has no 3/31 deadline. SHOP enrollments have no 3/31 deadline. Native Americans have no 3/31 deadline. If you have a major life event (such as getting married, giving birth, moving to a different state, losing a job, etc) you don't have a 3/31 deadline.

Secondly, the "final number" doesn't just mean exchange-based QHP enrollments.

You don't want to "include" the 6.4 Million+ Medicaid/CHIP enrollments? OK, fine. I guess from an actuarial table/private enterprise POV, I can see that, since they don't figure into the private insurance company "risk pool". So...fine. For purposes of this measurement, let's set them aside for the moment.

HOWEVER, at the VERY least, you DO also have to include:

  • 66K+ SHOP enrollments (not sure if these are part of the same risk pool or not, but these are still private, paid insurance policies)
  • The 558K MINIMUM (and my guess is a good 4 million or more actual) OFF-EXCHANGE QHP ENROLLMENTS.

However, yes, I fully understand what that refers to, since that's a major focus of this site. The question that people want answered at the moment is:

"How many people will be enrolled in QHPs via the federal/state exchanges as of 3/31/14?"

Well...here's the thing: "Should" those who fall into the "in line by 3/31, enrolled by 4/15" people count?

Of course they should.

However, will they be included in the official HHS report for March, released sometime in April?

Probably not. How could they be? HHS will be writing up their big, detailed March report while the April late enrollments are still happening.

So, those from 4/01 - 4/15 will probably have to wait until the April report...released sometime in May.

Which is a purely political spin issue, not an actual issue...but it WILL come up.

The GOP will magically dismiss anyone who enrolls after 3/31 as "not counting" because...well, because they say so. Just like they're already "subtracting" anyone who hasn't paid their first premium yet...even the ones who haven't even been billed yet, or whose payments haven't happened to clear the company billing system, or who's invoices aren't even due yet.

However, from a pure "data projection" perspective, it is an interesting question: How many people do I, personally now project will have completed the enrollment process for an exchange QHP as of March 31st (whether they've paid or not, except for Massachusetts and Washington State, which only report paid enrollments anyway)?

In other words, what you're really asking is this: What total QHP number do I think is GOING TO APPEAR IN THE HHS REPORT?

And the answer to that is this:

First, I'm ASSUMING that HHS is NOT going to CUT OFF SUNDAY AND MONDAY.

Why the hell would they do this?

Because the prior HHS reports only run through the Saturday that's closest to the end of that month.

That's right:

  • The October report actually ran from 10/01 - 11/02.
  • The November report ran from 11/03 - 11/30.
  • The December report ran from 12/01 - 12/28. <<< (yes, it cut off the last 3 days of the year!)
  • The January report ran from 12/29 - 2/01 <<< (yes, THAT'S why it was so impressive...it included 3 of the "December surge" days!)
  • The February report ran from 02/02 - 03/01 <<< (that's why it seemed so weak compared to January...35 days vs. only 28 days, a "built-in" 20% disadvantage)

So, what about the March report?

Well, if they hadn't extended the deadline, I figured HHS would make an exception and tack Sunday & Monday (30th/31st) onto the March report.

However, with the 4/15 extension, this gets a bit trickier. If they do decide to move Sun/Mon onto the April report, it won't count the last 2 days of the enrollment period, just like what happened in the December report.

Politically, this would be incredibly stupid, but policy-wise, HHS may be required to move 3/30 - 3/31 over to April.

If so, please keep that in mind, OK?

Now, assuming that they do include the last 2 days on the March report, what do I expect that number to be?

Well, I'm very, very tired now, so I'm gonna take a pass on that until tonight. Hopefully a few more details will have rolled in by then. All I can say for now is that at this point, I'm fairly confident that the exchange QHP total including Sunday & Monday will at least squeak over the 6.5 million mark...if it includes March 30th and 31st.