WOODWORKERS: OK, perhaps not so surprising after all... ;)
2018 MIDTERM ELECTION
Time: D H M S
Finally, on the Medicaid spreadsheet, I've gotten as close as possible to an accurate count of the number of new Medicaid/CHIP enrollees which are PURELY due to ACA Expansion. To achieve this number, I took the total number of new enrollees and first removed the 25 states which haven't expanded Medicaid at all. This leaves 26 states (including DC). Then, I used Washington State as a guideline for the split between "ACA Expansion Only" and "Out of the Woodwork" enrollees (ie, people who were previously eligible pre-ACA but didn't enroll until after October 1st for various reasons). Washington has had a pretty consistent ratio of 2/3 Expansion Only to 1/3 "Woodworkers". I have no idea if that's representative of the other 25 states, but it's the best I can do for now. Note that this still also includes those who are newly eligible...but under the old Medicaid rules (ie, someone who simply fell on hard times after October 1st).
...Now again, I personally think that the "Out of the Woodwork" enrollees should be counted as well, since a substantial number of them are only enrolling now because of the massive promotional/outreach programs being enacted thanks to the ACA and the exchanges, but that's a matter of philosophy, which is why I've broken them out here the best I could.
"Woodworkers", in ACA Medicaid parlance, refers to people who were already eligible for Medicaid coverage prior to the ACA expansion (in states which have done so), but who didn't actually enroll in Medicaid until after October 1st for a variety of reasons, ranging from not being aware that they qualified, to finding the enrollment process too difficult, to not even knowing what Medicaid was before the ACA exchanges launched.
...So, for this one state, about 1/3 of the total new enrollments are "woodworkers". If this applied across all 50 states (+DC), it would make things easy to calculate.
Unfortunately, it's not that easy. Washington may or may not be representative; it could easily be an outlier. In addition, the impact of "woodworkers" is going to be very different in states which have expanded Medicaid vs. those which haven't.
If I just went with South Carolina as a base for woodworkers in non-expansion states (16% of total new enrollments) and Washington as a base for woodworkers in expansion states (33%), the numbers would be fairly easy to calculate:
- NON-expansion states: Total new enrollments = about 2.31 million; 16% of those = 370,000 "woodworkers"
- EXPANSION states: Total new enrollments = about 4.81 million; 33% of those = about 1.59 million "woodworkers"
Add these up and you get about 1.96 million "woodworkers" nationwide.
- 7.08 Million Exchange-based QHPs (estimate)
- + 71,000 SHOP QHPs
- + 9.0 Million total OFF-Exchange QHPs (estimate from the Rand Corp.)
- + 4.71 Million New "Strict Expansion" Medicaid enrollees
- + 1.80 Million New "Woodworker" Medicaid enrollees (estimate)
- + 3.10 Million 19-26 Year Olds on their Parent's Plans (estimate)
- - 3.70 Million Cancelled Non-Compliant Policies
Yesterday I posted a poll asking whether people found the term "woodworker" (used to describe new Medicaid enrollees who were already eligible to be enrolled even without the expansion provisions of the ACA) to be offensive. The thinking is that "woodworker" makes it sound like you're an insect creeping around under the floorboards and so forth; not the prettiest image.
Anyway, the poll is now closed, and the results are in...out of 505 votes total:
- 83% felt that I should keep using the term "woodworker" enrollees
- 10% felt that I should switch to the friendlier-sounding "welcome mat" enrollees
- 7% felt that I should use some other term
Federal health officials recently reported that more than 91,000 Georgians were identified through the health insurance exchange as eligible for Medicaid or PeachCare.
This enrollment growth of already eligible people is known as the “woodwork” or “welcome mat” effect. Experts had forecast earlier that the Affordable Care Act would lead many people who were already eligible for Medicaid and CHIP (known as PeachCare in Georgia) but had never enrolled to “come out of the woodwork” and finally sign up.
As for the remaining 122,000, the article above also specifies that these appear to be Woodworkers--people who already qualified for Medicaid even without ACA expansion, but only followed through with enrolling thanks to the streamlined process provided for by HC.gov (along with the massive outreach/awareness program that accompanied it).
I honestly don't know why the CMS report has the total number listed as only 765K in April; even with the "preliminary" caveat, that seems like a pretty big margin to be off by. However, the AP/WTVA article seems pretty damned confident about the "1M+ in March/April/May" statement, so it sounds like AL has indeed added 122K woodworkers.
It's been over 3 months since I've been able to check in on the status of Ohio's implementation of ACA Medicaid expansion. As of mid-June, OH had racked up 243,230 people newly eligible thanks to the Affordable Care Act out of around 563,000 state residents who were eligible.
As of the end of August, that number has grown to 367,395 people, or over 65% of the total eligible:
Ohio Medicaid enrollment under Gov. John Kasich’s Obamacare expansion hit 367,395 in August, passing the Republican governor’s projection for July 2015.
Kasich told taxpayers and the Ohio General Assembly that an estimated 366,000 Ohioans would be enrolled in Medicaid under Obamacare at the start of the state’s 2016 fiscal year. This projection is reflected in a Governor’s Office of Health Transformation chart released in February 2013.
I should also note that a minimum of 124,000 additional "woodworkers" had already enrolled in Medicaid as of early May, bringing the total added to Medicaid due to the ACA in Ohio up to over 490K.
MEDICAID ENROLLEES (9.3 million newly added)
- 3.8 million Newly Eligible (NEWLY INSURED)
- 1.2 million Newly Eligible (previously insured, likely paying through the nose or via "junk" policies)
- 1.9 million woodworkers (NEWLY INSURED)
- 1.1 million woodworkers (previously "insured" likely via "junk" policies)
- 1.2 million previously insured (bulk transfers from various existing programs)
If I'm reading this story correctly, it actually sounds like there were a lot more "woodworkers" who signed up in New York than I had estimated (525K vs. 200K), in addition to 575,000 "true expansion" enrollees...almost a 50/50 split. This flies in the face of the 2:1 or 3:1 expansion/woodworker ratio I've seen in other states so far.
It's also nice to see some recognition of the other reason why I tend to include "woodworkers" as being enrolled "due to" the Affordable Care Act--not only did the ACA include a massive education/outreach effort to encourage people who were already eligible for the program to sign up, but it also included funds to improve/streamline the enrollment process to make it faster and more efficient...which appears to be paying off now.
...In any event, between NY and CA, it looks like total Medicaid/CHIP enrollment is up nearly 400,000 more people than even I had estimated until now!
This updated information, coming from two such large states, also means that my estimate of the ratio between "expansion" and "woodworkers" has apparently been off by quite a bit as well. Until now I had it at roughly 3:1 nationally, which was likely the case last year. As we've moved into the 2nd year, however, it now looks like it might be closer to 2:1 overall.
Medicaid/CHIP Woodworkers: 3.0 million
The official November 2015 CMS Medicaid/CHIP report shows that the total number is up about 14.1 million over what it was pre-expansion. However, as I've noted many, many times before, around 25-30% of these are actually "woodworkers"...people who were already eligible for Medicaid/CHIP pre-expansion but either didn't realize it, didn't know the process for enrolling or were too embarrassed to do so...yet were encouraged to do so thanks to the ACA's outreach/education efforts. The recently-released CBO report puts the official "expansion only" number at 11 million, which sounds about right to me, leaving about 3 million Woodworkers.
Which brings me to yesterday...
Millions of poor Americans have signed up for no-cost health insurance that they could have gotten even without the passage of Obamacare.
These Americans already were eligible for Medicaid, a government-funded program that provides medical coverage at little or no cost, but they didn't sign up for it because they didn’t have to or because they didn’t realize they could.
In recent years, however, the publicity of Obamacare has driven them to sign up in droves, so much so that economists and health policy wonks have dubbed the phenomenon the “woodwork effect,” or the “welcome mat” population. This group turned out to be larger than anyone anticipated.
A working paper released Monday in the National Bureau of Economic Research finds that 43 percent of those who gained insurance in 2014 came out of the woodwork. According to MIT economics professor Jonathan Gruber, one of the authors of the paper, this population totalled roughly 2 million people – not counting those who enrolled in 2015.
“The fact that it is the single largest policy lever in the [law’s] first year is somewhat surprising,” authors of the report wrote.
As Leonard noted yesterday evening:
— Kimberly Leonard (@leonardkl) May 3, 2016