OK, Republicans: NOW you can ask ALL of the insurance companies "How many have PAID???"

Way back on March 21st (wow, that seems like forever ago, doesn't it?), I posted the following towards the end of "The Paid/Unpaid Brouhaha":

So, I'll say this here and now:

Whatever percentage of total exchange-based QHP enrollments still haven't been paid by the policyholder as of May 31st should indeed be subtracted from the official HHS total number, assuming that those non-payments are due to either a) the policyholder bailing/refusing to pay or b) the government-run exchange (not the insurance company's billing system) screwing up.

If the total number ends up being 6.2 million but the non-payments fitting these criteria are 7% as of May 31st, I'll gladly subtract 434,000 from the total. If the total number is 6.5M and the non-payments are 10% as of 5/15, I'll subtract 650,000, and so on.

Well, it's not quite May 31st, but I wanted to make sure to get this blog entry off my chest before June 1st, so I'm giving the Republican Party a 4-day lead time.

At this point, yes, it is quite reasonable to ask the question which Republicans, conservatives, Tea Party nutbags and so forth have been blathering about since the moment they realized that hey, a shitload of people actually are enrolling in QHPs via the assorted ACA healthcare exchanges after all! Namely: Out of the 8.02 million people who enrolled in exchange-based QHPs between 10/1/13 and 4/19/14 (wow! look at how tame my sample projections seemed a couple of months earlier!), just how many of them have actually completed the process by paying for their first month's premium?

Now, for some states that's easy. Washington and Massachusetts didn't even report their QHP enrollees to the HHS Dept. unless they were paid up, so that's 100% apiece.

In other states, it's easy to get a rough idea: Connecticut and Oregon "purged" several thousand of their earlier unpaid enrollees (those whose policies would have otherwise started in January, February or March), but still included those who weren't set to start until April or May.

In yet other states, such as Nevada, California, Minnesota, Rhode Island and Vermont, the exchange reported the total number (whether paid or not) to HHS, but also has given out either a hard paid number or a hard percentage...although some of these are quite out of date by now (California, in particular, reported 85% paid, but that was a month ago, on 4/27; presumably this number has shot up a few more percentage points since then).

Finally, there's a handful of states running on the federal exchange (Alabama, Maine, North Carolina, South Carolina, West Virginia and Wyoming) which have actual percent paid figures available due to either statements/interviews with the state insurance commissioners or, in a few cases where only one insurance company was operating on the exchange, by the insurance company itself releasing their paid enrollee data. However, again, some of these numbers are weeks or a month out of date by now.

Out of all of the states listed above, the paid percentages ranged anywhere from 71% - 100%, with an average of 88.4%. However, obviously the raw numbers varied greatly from state to state (85% of 1.4 million in California carries a lot more weight than 100% of 164K in Washington State). And, again, some of these percentages are as much as a month out of date (again, California in particular).

This is why after estimating the "paid/will pay" percentage at around 93% for over a month, I dropped back my overall estimate to an even 90% for states which haven't issued any hard numbers, which is where it currently stands (this means an 89% payment estimate nationally on my spreadsheet). However, again, that's just an estimate. The time has, indeed, come to try and lock down the actual number.


Now, back on April 30, the House Republicans, in a rather desperate and sloppy attempt to try and torpedo the Obama administration's "over 8 million enrolled!" news, issued a press release claiming that only 67% of those enrollees had paid their premiums as of April 15.

The response was swift and universal (even from plenty of right-wing sources): It was a big pile of crap, for several reasons. First of all, the cut-off date was April 15, even though almost 40% of the enrollee policies didn't even start until May 1st (ie, the first payment wasn't even due yet for anywhere from 2-4 weeks depending on the company). Secondly, they only surveyed 160 of the companies on the exchanges instead of all 300+ which participated, and didn't state which of those companies they surveyed (was it the big guys like Blue Cross and Aetna, or was it a bunch of little outfits? No one knows). Third, they actually sent out the survey letters back in mid-March (when less than 5 million of the 8M total had even enrolled, much less had their premiums due), and they didn't give any indication of what the actual "thru dates" of any of the responses were.

In other words, they sent the letter out on March 13. Presumably the companies sent them back anywhere between 3/14 - 4/30. However, we haven't a clue what date any of the company enrollment data was accurate through. Some companies might have given data through April 15...in which case they couldn't have sent their response until after that date. Others might have only given payment data as of the date of the request (3/13) or some point between then and 4/15. We don't know. The GOP report never gave out that information, making it beyond useless. Even the accompanying state-by-state breakdown only listed percentages, not hard numbers, nor did it list the companies or the thru dates. It was an utter joke.


SO, that brings us to today.

Since only a dozen states or so track or report their paid percentages, it does appear that the only way to get a comprehensive national answer to "How many have PAID???" is to indeed survey the insurance companies themselves, and yes, the end of May is a reasonable time to do so for those who enrolled through 4/15 (since any later enrollees wouldn't start their policies until June anyway).

HOWEVER, the ONLY way that such a survey would be meaningful would be if it met the following criteria:

1. Results from every company on all 16 exchanges covering all 50 states + DC has to be included. None of this half-the-companies-and-we-won't-say-which-ones nonsense.

2. The responses from the companies must state how many of their exchange QHP enrollees had paid their 1st month's premium as of the last week of May. None of this mid-April crap.

3. Give the actual NUMBER of enrollees paid/total, not just the percentages.

4. This is something I've addressed before, if not on my response to the earlier GOP survey--the companies should also answer how many of those non-payments are due to their own backlogged or screwed-up billing systems. I know plenty of people who either never had their payment recorded by the company, or who didn't even receive their bill for weeks or months after they enrolled in a QHP (including my own family). If someone "hasn't paid" because the insurance company lost the payment or never issued the invoice, that sure as hell can't be counted against either the enrollee or the Affordable Care Act!

5. Oh, I almost forgot: For the companies which operate in more than one state, ask them to break down their paid/unpaid enrollee numbers by state. This shouldn't be a problem; you guys claim to have done this with your ludicrious "67%" survey (you had to, since you list the alleged "percent paid" for every state for the 160 companies that you supposedly surveyed).

If and when the GOP House Energy and Commerce Committee agrees to these conditions, I'll be more than happy to take a look at their results, and will be the first to publish it. If a few companies refuse to participate, fine; I'll take a look at how many QHPs (and which states those missing QHPs are spread across), and if the missing data is minor and doesn't have an impact on the proportional/representative nature of the rest of it, fine. If everything checks out, I'll also be the first one to lop off however many unpaid enrollees there are, as stated at the top of this piece. My guess is that there will still be over 7 million fully-paid exchange QHPs left, but let's find out.

Otherwise, forget it. I'll stick with a simple 90% paid and call it a day until more data is forthcoming.

UPDATE 10/16/14: OK, California has now corrected their repeated "85%" rate from last spring and now says that their payment rate was actually more like 82%. Based on this, I've dropped the national estimate to 88% overall.