2018 MIDTERM ELECTION

Time: D H M S

"Bad" News: 8 States are Underperforming. Good News: 12 States are OVERperforming (UPDATED)

Those who follow this site regularly know that back on November 14th (the day before the enrollment period started), I originally projected 12.0 million even. I bumped this up by another half million on December 12th, after a particularly stellar 3rd week, and that's where it stood ever since: 12.5 million.

Earlier today I posted "Do I Hear 10 Million?", which served as both my estimated of HC.gov enrollments through today (7.45M), as well as noting that total QHP enrollments will likely cross the 10 million mark tomorrow (Saturday, Jan. 31st)...and I also threw in a reiteration of my projections through the end of the 2015 open enrollment period: 12.5 million as of February 15th.

Tomorrow night we'll be 84% of the way through the enrollment period. Yes, there will be a significant last-minute surge the 2nd week of February; I'm certain of that. Last year, out of the 7.1 million who enrolled by the official deadline of March 31st (remember, the other 900K were tacked on during the "extension period"), 2.1 million of them showed up in the last 2 weeks; so yes, there's absolutely precedent for hitting at least 12.1 million or more by 2/15. All of the exchanges have improved their websites, cleaned up their systems, beefed up bandwidth and server capacity, etc etc, so 12.5 million is not an issue in terms of crashing the system. And with an additional 18 million people out there who are eligible for exchange QHPs, there's plenty of potential enrollees to nab 2.5 million more from.

So...first, the "bad" news:

NOTE: It's important to note that "bad news" and "concerned" in this context simply means that I'll be bummed if they don't hit my personal goals. In some cases, the reason why a given state comes up short may very well turn out to be because they're in the midst of a huge hiring boom by companies providing employer-sponsored insurance!! If that's the case, it's certainly not a BAD thing!!

Here's the states I'm getting concerned about, in reverse order:

  • Minnesota (59%), Rhode Island (60%) and Vermont (58%) are all at under 60% of my target number. Fortunately, all 3 combined only make up 1.3% of my national target, so none of these will impact things much no matter what their final totals end up being.
  • Michigan (71%): My home state is actually not doing that badly; in fact, they're doing the best relative to my target of any state on this list. It's here more because it's performing the worst of any of the 37 states running off of Healthcare.Gov this year (yes, even transplants Oregon and Nevada are doing better than MI so far). It's also here because it makes up 3.4% of my national target.
  • Colorado (59%): Also under 60%...although to be fair, their official target (194K) is actually 55% higher than last year, essentially the same as my target for most other states. However...they're still only at 63% of that target anyway. It's a mid-sized state making up 1.6% of my national target.
  • Washington State (47%): Ouch. Not onlly are they below 50% of my target, they've only hit 55% of their own (215K), and are only at 72% of last year's enrollment number. It's also a mid-sized state, making up 2% of my national target. The WA exchange has had serious technical bugs this year--one of the only exchanges to still be having them (at least in a way that seriously screws up their enrollments, anyway), and it's showing here. Washington makes up 2% of my national target.
  • Massachusetts (36%): OK, as awful as this looks, it's actually my fault, not theirs. Massachusetts has always been a special case given the unique nature of their horrible technical problems last time around; they're phasing a couple hundred thousand "temporary coverage" people into the system each month and they're actually performing by far the best relative to 2014 (over 3.6x as many to date!). The exchange itself is expecting perhaps 175K to enroll, and it looks very likely that they'll hit that goal. The problem is that I vastly overestimated how many of those "temporary coverage" people were eligible for QHPs--up to 1/3 of the 300K total are apparently being placed in Medicaid this year, not private plans, which means that I screwed up to the tune of 100,000 people in MA alone. Ouch. MA is 2.4% of my total.

UPDATE 2/2/15: In retrospect, I shouldn't even have included Massachusetts as "underperforming" at all; as I noted, this was a case of my grossly screwing up on my original target in the first place. Apologies to the MA Health Connector.

  • New York (62%): For a good 6 weeks, I was waiting and hoping that NY and CA's renewal numbers would, if they were ever released, come in at around 320K and 960K respectively. In New York's case, I was sorely disappointed: Only 274K renewals, and it turns out that a few of the "new" enrollees may actually turn out to be "1 month" 2014 enrollments only. The "good" news here is that NY is the only state where my target is lower than the exchange itself...but even so, at 4.6% of my national total, that's cause for concern.

And finally, the biggest problem:

  • California (62%): Yikes. Unlike New York, California's renewal number came in very close to what I was expecting (944K), and they may have up to an additional 80K renewals to come. In their case the problem (so far, anyway) is that the number of new enrollees, which I was expecting to reach around 600K by now, is only at around 275K. I just don't see any way of CA racking up another 725K in 20 days (their data is current through 1/26 at the moment). As the largest state and the largest exchange outside of HC.gov, of course, CA makes up 15.5% of my national target all by itself. That stings.

One other noteworthy item: Only 1 of these states, Michigan, is operating on Healthcare.Gov (which is otherwise pretty much right where it should be (last week's misread notwithstanding). The other 8 7 are all state-based exchanges, for whatever that's worth.

Anyway if you add all of the above up, these states represent about 31% of my national target...and something like 820,000 people which (assuming these states don't up their game bigtime in the final 2 weeks) would have to be made up for in other states.

Here's the good news:

There are 12 medium-sized or larger states which are (so far) overperforming by my standards (for my purposes I'm defining "medium sized" as ones where my target is 200K or higher, and "overperforming" as states which had already reached 80% or more of my target as of 1/23):

  • Florida (87%)
  • Georgia (87%)
  • Illinois (84%)
  • Indiana (91%)
  • Missouri (90%)
  • New Jersey (85%)
  • North Carolina (83%)
  • Ohio (82%)
  • Pennsylvania (86%)
  • Texas (82%)
  • Virginia (95%)
  • Wisconsin (82%)

Combine all 12 and you have 48% of my total projection.

In short, if the the first 8 states can rally in the final 2 weeks and the second 12 states continue to overperform, 12.5 million should be more than doable.

If, however, the first 8 states continue to putter along and the second 12 states stall out, it might turn out that I would've been better off sticking with my original estimate of 12 million even.