2018 MIDTERM ELECTION

Time: D H M S

Which Mystery States have dropped their exchanges when I wasn't looking?

I was poring over a bunch of ACA-related stories last night, many of which have to do with last week's announcement that the Hawaii ACA exchange is very close to having to shut down in 2016 just as both Oregon's and Nevada's already did in 2015.

Don't get me wrong, there's no putting a positive spin on this development (other than to say that it's not a done deal; HI Gov. Ige is still negotiating with the Federal government and a way to save the exchange may come through at the last minute). However, one curious thing jumped out at me in not one, but two different stories about the Hawaii exchange.

First up is Sarah Ferris at The Hill:

Hawaii’s move to the federal exchange would leave only 13 states with state-based marketplaces. Already, about a half-dozen states, including Oregon and Nevada, have had to scrap their exchanges and move to the federal system because of funding and technological issues.

Hmmm...actually, only the two states listed (Oregon and Nevada) have had to do this so far. A third state, New Mexico, was already on HealthCare.gov both last year and this year; they had been planning to move off onto their own full exchange for 2016 but abandoned that effort after their Governor, Susana Martinez, basically blew nearly $100 million in federal funds by being extremely rude to the CMS Dept. when asking for it. Seriously.

Aside from that, a fourth state (Idaho) was also in the same position as New Mexico for 2014, but they did successfully move off of the federal exchange onto their own this year, with virtually zero controversy, drama or technical issues to speak of. Finally, Arkansas has been planning on moving off of HC.gov starting in 2017 for quite some time now.

So...what are the other 4 Mystery States which Ferris is referring to here (or 3, assuming that she's accepted Hawaii's move as a done deal)? I asked her; she seemed puzzled herself and said that she'd get back to me, so we'll see.

Normally I wouldn't have devoted a full post to this question, but check out this other article by Sean Williams at the Motley Fool, posted 1 day earlier:

Recently, Hawaii became the seventh state to throw in the towel on its state exchange, the Hawaii Health Connector, and announced it'd be joining Healthcare.gov's network. Over two enrollment periods, Hawaii's marketplace exchange managed to enroll just over 37,000 people when at least 70,000 were needed to make the exchange profitable.

This article includes not one, but two mystery numbers. In addition to claiming that not six, but seven states have "thrown in the towel" on their exchanges so far (as opposed to 3 if you include OR and NV as well as Hawaii), the MF article also repeats the very perplexing 37,000 HI enrollee figure...even though according to both the HHS Dept's ASPE report and my own estimates, Hawaii actually only enrolled around 13,000 people in private QHP policies via their exchange.

I still haven't figured out the 37K vs. 13K discrepancy, but for this entry I'm more focused on the six (or seven?) states which have supposedly already abandoned their exchanges, according to two prominent sources.

The Motley Fool article seems to be talking about the 7 states referred to in the article's title:

  • Oregon (check)
  • Nevada (check)
  • Hawaii (probably, although it's not written in stone quite yet)
  • Vermont (Wrong. They may very well be about to drop their exchange over both technical and funding issues, but they haven't done so yet)
  • Massachusetts (Wrong. They replaced their original platform with an all-new one, but did not move to HC.gov)
  • Maryland (Wrong. They replaced their original platform with an all-new one, but did not move to HC.gov)
  • New Mexico (Wrong. As noted above, they never moved off of HC.gov in the first place)

Don't get me wrong; both articles are well-written and fair assessments otherwise. I'm not accusing anyone of anything; it's just very strange that two fairly prominent healthcare writers would make the exact same error just a day apart, especially one which doesn't seem to have come from anywhere in particular.