Caveat: This may have changed significantly in the past year or so, and just because someone identifies with one party or the other (or neither) doesn't tell us their actual voting record or frequency)
Then, let's sort the states by their red/blue lean, making some adjustments for states which don't seem to match up in practice with their "on paper" party lean (for instance, Viriginia has been trending blue recently, while Ohio, Wisconsin, West Virginia and Florida, which officially have more self-identified Democrats than Republicans, sure as hell seem to be on the red side in recent years (the same could be said of Michigan, but there's too strong a Dem advantage there to ignore).
As for other states like Florida, Texas and Louisiana, consider the following attack ad, modelled on Mark Totten's press release above:
"Tens of thousands of Louisianans will have to pay hundreds of dollars in higher taxes...all because Bobby Jindal is too petty to shell out $10 bucks for a domain name!!"
The Republicans in two dozen states thought they were playing smart politics (with people's lives, but screw them, right?) when they denied Medicaid expansion, but this has since blown up in their faces, and has now become a potent issue for Democrats in several GOP-held states. I think I know why they thought this...and why it didn't work out the way they figured.
As far as I can tell, the Republican mindset was this: Poor people don't vote. Therefore, screwing over poor people = brownie points from the GOP base without any potential downside.
This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).
The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.
As I noted earlier, I've been expecting final #OE2 numbers from at least two states, Massachusetts & Minnesota. MA has just come through with an extremely detailed report.
In addition, they've given me a partial answer to my earlier question: Yes, they do plan on releasing off-season enrollment data at least monthly (via their board meetings), and possibly weekly (I'm guessing daily would be too much to ask during the off-season). So, I can count on off-season data from at least 1 state...49+DC to go...
They also said that they don't know about a Tax Season Special Enrollment Period yet, and did not have any SHOP data or Medicaid expansion-vs-woodworker data yet.
Finally, one interesting MA-specific quirk: "ConnectorCare" enrollees...which are QHP enrollees but are heavily subsidized by the state as well (I think this is sort of like Arkansas' Medicaid "private option"?)...can be enrolled in year-round. This could be significant during the off-season, espeically since this makes up 64% of the total QHP number to date.
With that, in the end, Massachusetts final official numbers are:
UPDATE: I've confirmed that Maryland and Massachusetts do both plan on continuing to issue at least monthly reports during the off season (I'd prefer weekly but I'll take what I can get).
As of today (February 27th), the 2015 Open Enrollment Period has ended in 47 states (KY, MD, NY & WA states are still allowing "In Line by Midnight" extensions through tomorrow night or all the way out until April, and CO, CT, DC & HI have taken a sort of "case by case basis" approach with no specific hard deadline).
I'm expecting final official #OE2 enrollment reports from Massachusetts and Minnesota later today, but otherwise have to catch up on a bunch of my actual day job work. Here's three quick things to note:
MARYLAND: The Maryland Health Connection has released a big slideshow PDF with a mountain of demographic info. The only gripe I have is that it only runs through 2/15, so doesn't include the extra folks who signed up during the #ACAOvertime period. Data nerds, rejoice!!
Mazel Tov to HealthSourceRI for being the first of the state-based exchanges to release their full 2015 Open Enrollment Period (with #ACAOvertime included) results. HC.gov released their collective total yesterday, but haven't broken it out by state yet; Kentucky released data through 2/19 but their extension period isn't over until Saturday; and I have a rough estimate for Massachusetts, but they won't release their official tally until tomorrow.
PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Monday, February 23, 2015, for Open Enrollment and the Special Enrollment Period (due to previous weather closings at the contact center and walk-in locations).
Yesterday, with the final HC.gov "weekly snapshot" report released, I was able to put together almost all of the puzzle pieces for 2015 open enrollment (there's still a few small pieces left...a month of Idaho data, plus the "overtime" data for California, Massachusetts and the other 12 state-run exchanges). My takeaway was that when the dust settles, the grand total of exchange-based QHP selections will be around 11.74 million people.
*(I really, really hope this isn't the final one...)
“More than half of the 4.17 million people who re-enrolled in coverage during Open Enrollment came back and actively selected a plan and more than half of those consumers selected a new plan,” said Andy Slavitt, Principal Deputy Administrator of CMS. “Based on my experience looking at enrollment trends with employer-sponsored coverage and Medicare, it is clear that Marketplace consumers are more active, engaged, and eager to shop for the coverage that's right for them.”
Important: Technically this is not the "final" comparison of 2015 (full year) vs. 2014 (full year), since there's still the upcoming "Tax Season" enrollment period, along with additional enrollments/policy cancellations throughout the rest of the year via qualifying life events (marriage, divorce, giving birth, losing/gaining a job, moving to a new state, etc).
However, in terms of the 6-month-plus-2-week 2014 period and the 3-month-plus-1-week 2015 period, this is as close as I can get to an apples-to-apples comparison.
The HHS Dept. projected roughly a 30% enrollment increase this year (10.4 million QHP selections, 9.1 million actual paid enrollments). I projected roughly a 56% increase (12.5 million selections, 11.0 million paid).
In the end, it split the difference towards the high end: Over 11.7 million selected, of which around 10.3 million either have or are about to pay for at least their first monthly premium. This corresponds to roughly a 46% increase over 2014.
It may sound strange for me to call this the "final" graph...after all, there's still data missing from the "overtime" period from all 14 of the state-based exchanges, including big ones like California and New York. Massachusetts and Rhode Island were even still allowing full open enrollment until Monday night. A few other states are still allowing "wait in line" enrollments through this Saturday.Plus, what about the special Tax Season enrollment period coming up (or even already started in a few states)? Finally, what about Idaho? Their data hasn't been updated since way back on January 17th!
MARYLAND HEALTH CONNECTION ADDING ENROLLMENT PERIOD FOR MARYLANDERS UNAWARE THEY WOULD OWE TAX PENALTY WITHOUT COVERAGE
Special Enrollment Period will run March 15 through April 30
BALTIMORE (Feb. 25, 2015) — Maryland Health Connection is allowing consumers who owe a tax penalty for not having health coverage in 2014 to still enroll for 2015 coverage through a special enrollment period that will run March 15 through April 30.
Consumers who owe or have paid a tax penalty for not having coverage in 2014 would pay a higher penalty for this year if they also did not enroll for 2015. The open enrollment period to buy a Qualified Health Plan for 2015 ended Feb. 15.
The special enrollment period is for Marylanders who must pay the penalty for lacking health insurance in 2014 and who attest that they became aware of the penalty during this income tax filing season after the Feb. 15 close of open enrollment for 2015 coverage.
OK, these weekly estimates of HC.gov QHP enrollments probably don't mean much now that we're out of the official enrollment period, but what the heck.
On Wednesday the HHS Dept. should release the first post-deadline enrollment report, which should run through Friday, February 20th. Assuming this is the case, I'm estimating that there should have been roughly 9.0 million QHP selections even. However, the last report stated that the roughly 200,000 people who are being kicked off of their policies due to problems with their legal residency verification will be removed "in future reports after their coverage ends on February 28."
That sounds like they'll probably be included in tomorrow's report (with a similar caveat/footnote), but subtracted after that. Assuming that they yank them tomorrow after all, the "official" QHP selection total should be more like 8.8 million.
Recently, the House Republicans sent an incredibly "CHOOTZ-PAH" filled letter to HHS Secretary Sylvia Burwell in which they demanded that she tell them what the HHS Dept's "contingency plan" would be in the event that the Supreme Court ends up doing their bidding by tearing away federal tax credits from up to 7.8 million people this summer.
Today, Sec. Burwell responded in the only rational way possible: By pointing out that if they're absolutely determined to destroy the lives of millions of likely voters across 37 states (including swing states like Florida, Ohio, Michigan and Wisconsin) while simultaneously forcing insurance premiums up an additional 35% or more for everyone else in those states, when it would literally take about 5 minutes for them to "fix" the very issue that they ginned up as the "problem" in the first place, there's not a hell of a lot that she can do to stop them.
Remember last week when the HHS Dept. announced that someone had sent out 800,000 screwed-up 1095-A tax forms? Those are the ones that those receiving ACA tax credits have to fill out to make sure that they don't have to pay anything back (or, conversely, that the IRS doesn't owe them a higher subsidy).
Out of around 4 million of these forms sent out nationally, about 20% (800K) had some sort of error regarding the benchmark policy used to calculate their correct subsidy. Of those 800K, about 50,000 people had already filed their 2014 taxes before the error was found, and originally the Treasury Dept. had said that they were going to contact each of those 50K to resolve the issue.
WASHINGTON — Taxpayers who've filed their 2014 returns only to learn that the government provided them with erroneous information on health care subsidies won't be required to submit corrected returns, the Treasury Department said Tuesday.
Long-time readers know that I've been a little obsessed with the so-called "healthcare exchange" called Florida Health Choices since last August, having posted 3-4 entries on this huge pile of Republican FAIL since then.
The short version is that before he was elected a U.S. Senator, Marco Rubio, then a member of the Florida House of Representatives, convinced his colleagues in the Florida state legislature to pony up $900,000 of taxpayer money to set up their own "healthcare exchange" to show that Republicans can outdo the Democrats when it comes to selling health insurance online, dagnabbit! Once the ACA was signed into law, "Florida Health Choices" became essentially a protest project against the Evils of All Things Obamacare.
It's important to stress that this is not the final enrollment report for Massachusetts; it's the final daily report, which only includes the number of people determined eligible to purchase a private policy (Medicaid enrollees, however, are instant-activation; the number listed here is the number actually enrolled as of that day).
For most of the open enrollment period, QHP selections were running around 45-50% of the total QHP determinations; the other half are people who hadn't actually completed the process or who accidentally submitted 2 applications or whatever.
However, for the final week, it's pretty safe to assume that anyone who bothered to create an account, fill out their info and submit their application was pretty likely to actually put a policy in their shopping cart and check out (as well as paying their first premium on the spot), since yesterday was the (extended) deadline to do so. Therefore, it's a pretty safe bet that all 2,816 of those listed below (of the 7,057 total, which also includes MassHealth), at a minimum, can be added to the total.
However, the actual percentage drop nationally noted in the survey caught my eye. According to Gallup:
Nationwide, the uninsured rate dropped 3.5 percentage points last year, from 17.3% to 13.8%, the lowest annualized rate across the seven years of Well-Being Index measurement. No state reported a statistically significant increase in the percentage of uninsured in 2014 compared with 2013.
Yesterday, the New York Times posted an infographic depicting the breakout of insurance coverage for everyone in the country, based entirely on my data. The grand total of ACA-specific health insurance coverage topped out at around 31.4 million, but left out close to a million people due to rounding and to deliberately leaving out a few items (such as people enrolled in small business coverage via the SHOP exchanges, which I estimate to be around 220,000 people nationally).
The 51 states (including the District of Columbia) that provided enrollment data for December 2014 reported nearly 69.7 million individuals were enrolled in Medicaid and CHIP. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.
547,263 additional people were enrolled in December 2014 as compared to November 2014 in the 51 states that reported comparable December and November data.
(And yes, the "51 states" wording is CMS's, not mine)
On Friday, the MA Health Connector confirmed 134,000 QHP selections out of 237,000 people determined eligible for QHPs as of 2/18. Since then they've added another 6,614 QHP determinations.
For most of the 2015 open enrollment period, the number of people actually selecting a plan has hovered between 45-50% of the total determinations. However, as of last Thursday it had shot up to over 56%, and given that today is the final day to enroll for most people, it's a pretty safe bet that anyone who has bothered going through the trouble of creating an account, logging in, plugging in all of their info and submitting an application is also going to complete the process by actually checking out a policy (and presumably paying their first premium, since today's the deadline for that as well).
Therefore, I'm pretty sure that the total is well above 140K by now, and likely somewhat higher than that (since that would still leave another 103,600 people who had previously submitted an application but not completed the process as well).
On Sunday, February 22nd, the "Waiting in Line by Midnight" enrollment extension period officially ended for residents of 38 states (all 37 on Healthcare.Gov, plus California). The overtime period ended on Friday in Minnesota, on Saturday in Idaho and on Monday in Massachusetts, Rhode Island & Vermont.
That leaves 7 states (plus DC) still accepting some or all enrollments as of today:
IMPORTANT!! The table and graph below make several important assumptions about how the rest of 2015 will play out:
First, this assumes that another 1.8 million people nationally take advantage of the special "Tax Season" enrollment period recently announced by the HHS Dept. The exact date ranges differ for many of the state exchanges (from as early as February 17th in Washington State to as late as May 30th in Vermont), but for the most part we're talking about March 15th - April 30th. 1.8 million is complete dart-throwing on my part; the number of people nationally who are eligible to enroll during this period is somewhere between 0 - 6 million, so there's no way of knowing. 1.8 million just sounded reasonable to me.
As always, I'm assuming that roughly 88% of those who select QHP policies end up paying at least the first month's premium.
This morning, The New York Times ran an Op-Ed by Steven Rattner, including an impressive infographic (the type that represents the U.S. population as lines of silhouette icons representing 1 million people apiece), breaking out the entire country by what type of healthcare coverage they currently have. The point, of course, was to demonstrate just how many people either have healthcare coverage at all thanks to the ACA or how many have improved coverage thanks to it. Every data point presented is credited directly to this website.
I'm not saying this to brag (although it is pretty nifty...my mom is pretty geeked about her kid's work showing up in the Sunday New York Times). I'm mentioning it because I was expecting to receive a flood of attacks on the data and my credibility. There's a bunch of numbers listed there, and the "these are rough estimates" disclaimer at the bottom is pretty innoucuous. Instead...crickets.
I know I've been #humblebragging re. media attention lately. Part of that was to explain the server slowdown a few days ago; part of it is that I'm terribly insecure, and with the open enrollment period wrapping up, I suppose I'm starting to get a bit anxious about my relevance again, bla bla bla. My apologies for that.
Of course, with the recent #ACAOvertime extensions, followed up almost immediately by the #ACATaxTime enrollment periods, it sounds like my lease on relevance has been extended (again) by another couple of months (Vermont is extending their tax period all the way out until the end of May, for heaven's sake!). Plus, of course, the King v. Burwell SCOTUS case will be smack in between the two, and the decision on that isn't expected until June, so I guess there'll be plenty of material for this site for a few more months yet...
Having said that, there are a couple of items to note:
Over the past 2 days, enrollment data updates were released through at least the official February 15th deadline by DC, Vermont, Colorado, Massachusetts and Kentucky (Massachusetts and Rhode Island's new full deadline is now 2/23). In addition, Connecticut released a partial update which ran through Friday the 13th (not including the final surge weekend).
That means that aside from the 2 days in Connecticut, there's only 1 state which is missing significant enrollment data prior to the 2/15 deadline: Idaho. Idaho hasn't issued a full enrollment update report since January 13th, and their QHP tally hasn't been updated since the 2nd monthly ASPE report on January 27th, which brought their data up through January 17th (90,567 QHP selections).
As noted in prior Oregon updates, the exchange QHP total over at the state insurance division website always lags a few days behind the actual HC.gov numbers, but it's the best source for off-exchange QHP enrollments.
As of 2/15/15, exchange QHP selections totalled 110,228 (vs. the 104,201 on the state site), while off-exchange QHPs totalled 98,332...slipping behind for the first time, but still making up over 47% of the total:
The Insurance Division will collect enrollment information from carriers each week throughout 2015 open enrollment. Updated numbers will be posted each week on this web page.
Nov. 15-Feb. 15
On Healthcare.gov 104,201 Outside of Healthcare.gov 98,332
About the data: Enrolled means a person has selected a plan. Consumers must pay the first month's premium for their coverage to become effective. These numbers do not identify whether the first month's premium has been paid. These numbers do not include Oregonians enrolled in the Oregon Health Plan (Medicaid).
Once the ball started rolling on #ACAOvertime extension periods, there was no stopping it; within a few days, all 50 states (+DC) had announced either full or "waiting in line" enrollment extension periods.
The same thing seems to be happening with additional "Tax Season" enrollment periods for people who didn't realize they owed/will owe a tax penalty for not having proper health insurance coverage. Washington was the first to make their announcement; Minnesota and Vermont quickly followed; this morning Healthcare.Gov (which covers 37 states) made it official; a few hours ago, California joined the club, and just now, New York chimed in:
"Regular as clockwork...or a time lock..."
(bonus points if you can guess the movie)
COVERED CALIFORNIA OFFERS CONSUMERS A CHANCE TO MINIMIZE THEIR TAX PENALTY BY ENROLLING IN A HEALTH INSURANCE PLAN
New Category Created for Special Enrollment Allows Those Unaware of a Tax Penalty for Being Uninsured to Sign up for Coverage by April 30
SACRAMENTO, Calif. — Covered California is offering a special enrollment opportunity for consumers who did not know or understand there was a tax penalty for being uninsured in 2014 or who learned they may face a penalty for 2015.
“For the first time, health care and taxes now are linked arm in arm,” Covered California Executive Director Peter V. Lee said. “The law requires everyone to be insured, and if you’re not, you may face a significant financial penalty when you file your taxes this year.”
From Feb. 23 until April 30, 2015, consumers are eligible to apply for health coverage during special enrollment by attesting that they did not realize there was a tax penalty. To attest to this fact, they can select “Informed of Tax Penalty Risk” when filling out an application at CoveredCA.com.
Last Sunday I decided to round up all of the different "overtime period" policies onto a single page, which has been linked to as a resource by a bunch of media outlets. Today I'm doing the same thing for the Tax Filing Season Special Enrollment Period (SEP), which has already been announced for 4041424344454648 states as of 3/11. The other 3 states (CO, ID & MA) have specifically stated that they won't be offering such a SEP:
Here we go...I was actually pretty much dead-on target with MA this week; 134,037 QHP selections, of which 108,168 have paid their first premium (81%). Again, remember that something like 25% of these folks aren't starting coverage until March 1st, so their payments aren't due until Monday night, so the payment rate is fine for the moment.
In addition, Massachusetts has extended their full enrollment period out through Monday, there will still be new folks who submit an application over the next 4 days. On top of that, there's potentiallyanother 103,000 approved applications already waiting for people to pull the trigger (6,707 of whom already have a plan in their shopping cart waiting to check out). Obviously not all of these will follow through, but if they did, that would shoot MA's total up to nearly 237K.
I actually wasn't expecting this to be announced formally until the next "weekly snapshot" report this Wednesday, but being past the official 2/15 deadline anyway and with 3 of the state exchanges already having made their announcement, I guess HHS/CMS figured there was no point in holding off.
Besides, there's another, slightly embarrassing reason to make the announcement as soon as possible, which I'll get to in a moment.
First, yep, HHS/CMS announced today that all 37 states operating via Healthcare.Gov will indeed have a special "Tax Filing Season" enrollment period, running from March 15th through April 30th.
Important caveat: This is officially only for people who 1) didn't enroll in coverage by 2/15/15; 2) had to pay the penalty for 2014 and 3) "only became aware of their penalty after 2/15/15". They'll have to check off boxes attesting to these things. Of course, the third item isn't the sort of thing that you can prove one way or the other, but whatever.
OK, strike that...Colorado has released their newest data as well as DC and Vermont, leaving just 3 states to go (Connecticut (data since 2/13), Kentucky (data since 2/12) and Idaho, which hasn't posted any updates since way back on January 17th...over a month ago.
DENVER, CO – Between Nov. 15 and Feb. 15, nearly 220,000 Coloradans enrolled in healthcare coverage for 2015, either in private plans purchased through the health insurance Marketplace, or with Medicaid or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.
During the three-month open enrollment period, 139,652 people enrolled in private coverage through Connect for Health Colorado; another 76,194 in Medicaid and 3,720 in CHP+. Connect for Health Colorado also enrolled 24,884 individuals in dental plans.
WIth the DC and Vermont updates this evening, there are now only 4 states which haven't brought their enrollment data up through the end of open enrollment: CO, CT, ID and KY:
Vermont Health Connect Open Enrollment and Renewal Update
The following numbers are up-to-date as of 11:59pm Sunday, February 15, 2015.
New Vermont Health Connect Customers
15,422 individuals have checked out a 2015 health plan. This includes 6,211 individuals in Qualified Health Plans (private health insurance) and 9,211 individuals in Medicaid or Dr. Dynasaur plans.
After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 15,422 individuals who checked out, 11,704 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment). Of those who completed the process, 3,471 are on a Qualified Health Plan and 8,233 are on Medicaid or Dr. Dynasaur.
The good news is that the DC exchange has released their official enrollment data through 2/15. The bad news is that it's slightly lower than I had previously thought, for exactly the reason that bothered me a few weeks back...they kept listing the cumulative enrollments since October 2013, mixing in those who never paid or who didn't renew for 2014. Fortunately, the difference is pretty minor:
Today, the DC Health Benefit Exchange Authority (HBX) released individual marketplace data for the second open enrollment period for DCHealthLink.com, the District’s online health insurance marketplace for individuals, families and small businesses.
Last week I posted an exclusive piece over at healthinsurance.org called "Hating ‘Obama’ but loving the ‘Care’ which noted an ongoing irony: The very red/red-leaning states which tend to "hate" the ACA the most are actually the ones signing up for it in droves. At the time, by grouping the states into one category or the other (using judgment calls for some states...I put Michigan in the blue column but Wisconsin in the red, for instance), I noted that the red states had a dramatically higher number of enrollments, even when the total populations are nearly identical in each group.
Today I've updated this data with the most recent numbers, and the difference is even more striking.
The numbers are starting to quetly ramp up again as we approach the MA Health Connector's extended enrollment deadline (February 23rd): 1,247 QHP determinations on Monday; 1,678 on Tuesday and 2,366 yesterday. Assuming at least 70% of these went on to actually enroll (I can't imagine it'd be any lower than that at this point...who would bother applying this late in the game if they don't plan on following through??), actual QHP selections should be up to 132.5K or higher at this point.
Medicaid in Massachusetts is now up to over 260,000.
The Medicaid number is a bit misleading; I'm almost certain that 433K figure refers to everyone in Medicaid state-wide, not just via ACA expansion. The state only has 3.6 million people total; I find it difficult to believe that 12% of the population falls into the expansion range specifically.
They also threw in the SHOP tally:
Dental plans & the SHOP program continues to show solid gains. Over 1,100 SHOP members enrolled. #AHCTBoDMeeting
Open enrollment with kynect ended this past weekend on February 15, 2015. If Kentuckians make a good faith effort to complete their enrollments with kynect prior to the February 15, 2015 deadline but were unable to do so due to technical difficulties with the application process or problems reaching the call center, we will work with applicants to secure that coverage through February 28, 2015.
Please contact the call center at 1-855-4kynect and ask to be transferred to the Kentucky Health Benefit Exchange (KHBE) Tier II staff for assistance with these applications.
Kentucky was the last state to announce some sort of of "In Line by Midnight"/Overtime extension period.
I'm not at all surprised that the exchanges are starting to announce "tax season" enrollment periods already. The only thing I'm surprised by is the length of these special periods. I figured they'd do something like April 1st - 15th...instead, all 3 (Washington, Minnesota and now Vermont) are going for 2-month periods or even longer:
WA: 2/17 - 4/17 (effectively just extending the enrollment period by 2 months)
MN: 3/01 - 4/30
VT: 2/16 - 5/31 (a full 3 1/2 months...with the caveat that it has to be "within 60 days of discovering" that they have to pay the fee, which isn't exactly the sort of thing that one can prove one way or the other, y'know?)
Again, it's important to keep in mind that there are 3 main reasons for having a deadline/cut-off at all: First, prevents people from gaming the system by waiting until they're sick to enroll. Secondly, it allows the insurance companies ample time for their actuaries to crunch the numbers for the next year. Finally, it acts as a great motivator, as evidenced by the huge surges in December and again last week (even if the 2nd surge wasn't quite as large as I was expecting).
UPDATED 2/19/15 11:55pm: New data from Colorado, DC and Vermont added! UPDATED 2/20/15 10:10PM: New data from Massachusetts, Connecticut & Kentucky
OK, hopefully there will be at least another 400K+ to plug into these tables, but with the official deadline out of the way, we have a pretty solid picture of where the states stand now.
Again, it's important to remember that the 2014 numbers included the 2-week "overtime" period, when 900K additional people selected a plan, while the 2015 numbers only include the official enrollment period.
In fact, there's still up to a solid month of data missing from several states for this year!!
Why? Because it's a rolling average. The million-plus people who selected a plan in the final 9 days of open enrollment don't even start their policy coverage until March 1st. Many of their premium payments aren't due for another week. Most people tend to wait until just a few days before the due date to pay their cable, gas, phone bills...and with automated billing, in many cases the payment will go through automatically on the due date itself anyway.
But by February 18, the exchange was offering an extension to people who tried to enroll by February 15 but were unable to do so by the deadline. This has not been published on the exchange website, but an exchange representative confirmed that the extension runs through February 23, and that the call center (855-899-9600) will help enrollees complete the process between now and then.
Another 1,678 QHP determinations yesterday. At this point, I think it's safe to say that pretty much anyone who's bothering to go through the trouble of setting up an account and submitting an application is also following through and selecting a plan, but for the moment I'll just go with 60% and figure 1,000 people actually did so, for 131K or more total.
Meanwhile, Medicaid enrollment is up to over 256K.
The grand total: 30,744 QHPs, of which 27,487 have paid their first premium (89.4%). The payment rate has gone down because a huge number of those 30,744 just enrolled in the past week or so, and thus their payments aren't due for another week yet.
SHOP enrollments now stand at 3,349.
HEALTHSOURCE RI RELEASES ENROLLMENT, DEMOGRAPHIC AND VOLUME DATA THROUGH FEBRUARY 15, 2015
Posted on February 18, 2015 | By HealthSource RI
PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Sunday, February 15, 2015, the last day of Open Enrollment.
Press Release: NY State of Health Ends Second Open Enrollment with More Than 2.1 Million Enrollees
Feb 18, 2015
ALBANY, N.Y. (February 18, 2015)—New York State of Health, the state’s official health plan Marketplace, today announced that more than 2.1 million people signed up for health insurance by the end of the second open enrollment period, which began on November 15, 2014 and ended on February 15, 2015. Eighty-eight percent of Marketplace enrollees reported that they were uninsured at the time they enrolled. New Yorkers who have enrolled in coverage through the Marketplace have overwhelmingly reported that they are satisfied with their health insurance (92 percent) and are using their coverage to access care (84 percent).
Of the 11.4 million, 8.6 million consumers selected a plan or were automatically re-enrolled in the 37 states that use the HealthCare.gov platform. In addition, preliminary analyses of data provided by State-Based Marketplaces show that about 2.8 million consumers selected plans or were automatically re-enrolled between November 15 and February 15 in those states. Further details about plan selections from State-Based Marketplaces may be announced by the states and will be included within the upcoming monthly enrollment report.
You Have Until Feb. 22 to Get Across the Finish Line for Health Coverage
Open enrollment for private health coverage through Covered California in 2015 is now over, but Medi-Cal enrollment is year-round (read more below). If you started the process of enrolling in a Covered California plan by Feb. 15 but did not complete your application, you may complete it by Feb. 22 with the assistance of a certified enroller, and you need to pay your first premium payment on that same day in order for your coverage to take effect March 1, 2015.
Many people have asked me why I kept using 10.4 million QHP selections as the HHS Dept's official 2015 projection instead of the 9.1 million enrollments which most media outlets have been touting.
In the same press conference/press release where the "9.1 million" figure came out, the HHS Dept. elaborated with a range of 9.0 - 9.9 million paid/effectuated enrollees...but also stated, during a follow-up Q&A, that they were expecting 10.3 - 11.2 million QHP selections. In order to narrow this down to a single number to measure against last spring's 8.0 million selections, it's a simple matter of dividing the low and high end of this range:
Low-end range: 9.0 million / 10.3 million = 87%
High-end range: 9.9 million / 11.2 million = 88%
What have I been saying all along? That around 88% of QHP selections end up paying at least the first month's premium. It seems that the HHS Dept. agrees with me on this point.
OK, it's very important to note that the ratio of QHP selections to QHP determinations, which was consistently hovering between 45-50% throughout the entire Open Enrollment Period, likely shot up significantly over the final weekend. On the other hand, MA has bumped their deadline out by 8 extra days on account of the massive snowstorms, so perhaps not.
With that in mind, assuming at least a 50% ratio since Friday's official numbers (9,109 additional QHP determinations), that would mean a minimum of 4,600 additional selections, for a grand total of at least 130K to date.
In theory, it could be as high as 233,000 if every single person who has been determined eligible to enroll in a QHP has gone back and finished the process. Somehow I doubt it's that high, but that at least gives an idea of the potential ceiling here (and don't forget, there's still another full week for MA residents to start the process).
Meanwhile, Medicaid (MassHealth) has broken the 250K milestone.
264,000 Marylanders enrolled through Maryland Health Connection for 2015 Qualified Health Plan enrollments top 119,000
Enrollments “in the pipeline” can be completed by Feb. 28
Overview: 264,245 Marylanders enrolled through Maryland Health Connection from Nov. 15, 2014 to Feb. 15, 2015. That includes 119,096 people enrolled in private Qualified Health Plans (QHP) and 145,149 enrolled in Medicaid.
Due to high demand during the final weekend of open enrollment, Maryland Health Benefit Exchange is allowing people who started an application at MarylandHealthConnection.gov or contacted the call center by Feb. 15 to complete the process by Feb. 28. Figures for open enrollment will be revised after Feb . 28 to account for those completed enrollments.
The Republican Chair of the House Ways & Means Committee, Paul Ryan (who was also Mitt "Grandfather of Obamacare" Romney's running mate just 2 1/2 years ago, you might recall), has made it official:
(Bloomberg) -- House Republicans won’t agree to fix Obamacare if the U.S. Supreme Court rules that the law bars health-insurance subsidies for millions of people, said House Ways and Means Committee Chairman Paul Ryan.
Republicans are developing a “contingency plan” to address the states whose residents would lose subsidies while lawmakers work on a full replacement for the Affordable Care Act, Ryan, a Wisconsin Republican, told reporters Friday in Washington.
The enrollment data from Hawaii has been sporatic and a bit squirrelly, with the few numbers being thrown around sometimes including the cumulative plan selections including 2014 enrollees whether they renewed for 2015 or not. When I posted my last Hawaii update, I was suspicious (at 16.1K, it was nearly twice last year's tally), but the article seemed pretty confident about the numbers, so I went with it.
An hour ago I wrote about the WA HealthplanFinder re-launching a special Tax Season enrollment period which effectively just extends the enrollment period out by an extra 2 months. However, the press release wasn't posted openly on their site.
MNsure Announces Special Enrollment Period for Consumers "In Line" to Enroll at Midnight February 15
Special Enrollment Period planned to ensure all Minnesotans have the ability to get covered
ST. PAUL, Minn.—Today MNsure announced a plan to ensure all Minnesotans “in line” have the ability to obtain affordable, comprehensive coverage. The Special Enrollment Period will make certain that Minnesotans who were “in line” to enroll—those who began the enrollment process but experienced difficulty, preventing enrollment in time to beat the February 15 deadline—will have their enrollments processed during a special enrollment period.
“In line” is defined as anyone who took any of the following steps with the MNsure system:
This is the first year residents who are filing their 2014 federal taxes may incur a penalty through the IRS on their tax return if they failed to have health insurance for more than three consecutive months in 2014. Given that some residents may become aware of the penalty for the first time this year, Washington Healthplanfinder will open a Special Enrollment Period for these individuals so they can get coverage and avoid the penalty for not having coverage in 2015. These individuals as well as those who were unable to meet the Feb. 15 deadline can apply for the Spring 2015 Special Enrollment Period.
As I noted last night, I've had to restructure my national projections due to the IRS verification issue on Saturday, the massive snowstorms in the northeast and other odds & ends which have led practically every state (except for HI, KY, MN & VT) to announce some sort of enrollment extension period. A few are "full" extensions (ie, you don't have to have already started the process yet); most are "waiting in line" extensions (you have to have already started your application as of midnight Sunday).
The cut-off dates also vary widely, from as soon as Friday the 20th (California) to as late as Saturday the 28th (Maryland & New York). A few haven't given any hard date, although the 28th is the most practical cut-off point (at least for coverage to start the next day, that is).
Anyway, here's my revised estimates of how the final week of the official Open Enrollment Period played out...and how I expect the "overtime" period to look:
Yesterday I poked fun at many of the ACA exchanges for issuing vaguely-worded, non-specific statements about "making sure that everyone who tried" to enroll by midnight would be assisted, without any particular deadlines being given or other specifics.
OK, the HHS/CMS Dept. has issued the following...the cut-off date for the "overtime" period is 1 week (Sunday, February 22):
“We are pleased that the vast majority of consumers were able to apply and pick a plan through HealthCare.gov or its call center without a problem. For those consumers who were unable to complete their enrollment because of longer than normal wait times at the call center in the last three days or because of a technical issue such as being unable to submit an application because their income could not be verified, we will provide them with a time-limited special enrollment period for March 1 coverage."
Addition background information from CMS:
This special enrollment period (SEP) will start on February 16, 2015, and end on February 22, 2015.
Enrollments completed during the SEP will have an effective date of March 1, 2015, to align with the coverage effective date the consumer would have received had they been able to complete the enrollment process by February 15, 2015.
The main thing to notice is that although I've made some significant adjustments to my individual state projections, my overall final projections haven't really changed at all (aside from nudging the HC.gov/State Exchange split from 9.4M/3.1M to 9.5M/3.0M). I'm still calling for around 12.5 million QHP selections in the end (possibly a bit less than that); I've just bumped out the target date from 2/15 to 2/28.
MARYLAND HEALTH CONNECTION ALLOWING PEOPLE WHO HAVE BEGUN ENROLLMENT APPLICATIONS TO COMPLETE THEM UNTIL FEB. 28
BALTIMORE (Feb. 15, 2015) — Due to high demand during this final weekend of open enrollment for 2015, Maryland Health Connection is allowing people to complete their enrollments until Feb. 28, 2015. Marylanders need to have started an enrollment application at MarylandHealthConnection.gov or have contacted the call center at 855-642-8572 before midnight Sunday, Feb. 15 to be able to complete the process by Feb. 28.
After midnight Sunday, MarylandHealthConnection.gov will include the message: "Open enrollment for 2015 has ended. If you began to enroll by the February 15 deadline but were not successful, please check the box below and you may go ahead and complete your enrollment. You must finish your enrollment no later than February 28. … [ ] I started an application or called the call center to enroll by the February 15 deadline but was not able to complete my enrollment.”
I've confirmed that Rhode Island's weather-induced enrollment extension is indeed state-wide and is of the "full" variety (ie, people can start the application process, not just finish it), through February 23rd. This is exactly the same policy that the Massachusetts exchange announced the other day.
This morning, in light of yesterday's major income verification outage at the IRS, HHS Sec. Burwell's comments from the other day, the massive snowstorm impact in Massachusetts, Rhode Island and DC, and a series of "waiting in line" extension period announcements by various state exchanges, I revised my QHP selection projections:
11.7 - 12.0 million by midnight tonight (EST)
12.2 - 12.5 million by 2/28 (that's the final "waiting in line" date given by New York)
Since I'm not a big fan of "ranges", I'm going to pin down my final call more closely:
11.9 million by midnight Eastern
12.4 - 12.5 million by 2/28, and for good measure...
9.5 million via Healthcare.Gov + 3.0 million via the state exchanges
Yesterday, Tami Luhby of CNN Money posted an article focusing on people who received a federal tax credit for part of all of 2014, but who will now have to pay some or all of it back to the IRS when they do their taxes because their household income ended up being higher than they had anticipated:
Janice Riddle got a nasty surprise when she filled out her tax return this year.
The Los Angeles resident had applied for Obamacare in late 2013, when she was unemployed. She qualified for a hefty subsidy of $470 a month, leaving her with a monthly premium of $1 for the cheapest plan available.
Riddle landed a job in early 2014 at a life insurance agency, but since her new employer didn't offer health benefits, she kept her Obamacare plan. However, she didn't update her income with the California exchange, which she acknowledges was her mistake.
Now, she has to pay back the entire subsidy, which is forcing her to dip into her savings.
Janice Riddle has to pay back her entire Obamacare subsidy.
Last spring, in light of the massive last-minute crush of enrollees, caused partially by the even more massive early technical issues at HC.gov and various state exchanges, the administration announced a 15-day "waiting in line" extension period which allowed anyone who had started the process as of midnight on March 31st, 2014 to have until April 15th to complete their enrollment checkout. It was a huge success, and resulted in an additional 900,000 people selecting a plan.
A few of the individual state exchanges even went beyond that, with either "full" or "waiting in line" extensions that bumped all the way out to the end of April or even May, in the case of Nevada...but at least there were specific dates given.
Yesterday, in response to a devastating 9-hour income verification system outage which prevented an unknown number of people from getting through the system, the HHS Dept. gave a vague announcement that:
...If you can’t submit your completed application, just save it. If you do, we'll make sure you can return later to finish and enroll for March 1 coverage.
I've stressed, over and over again, that my 12.5 million "by midnight February 15th" national QHP selection estimate assumed that there would be no further significant technical problems at Healthcare.Gov or the other exchanges.
As it happens, a couple of states (Washington in particular) have been having "significant technical problems" throughout the enrollment period after all, but nothing that would impact the overall numbers by more than perhaps 100K total...and HC.gov has been smooth sailing the entire way.
Consumers had difficulty submitting their applications for health insurance on Healthcare.gov just one day before this year's deadline, a Health Department official said Saturday.
"Some consumers have been unable to submit their application because their income is unable to be verified as a result of intermittent issues with external verification sources," the Department of Health and Human Services official said.
OK, CoveredCA had hit 1.314M as of Wednesday, and added about 46,000 more on Thursday & Friday (21K & 25K respectively) to reach 1.36 million as of last night.
That means they'd have to enroll a whopping 340K today and tomorrow, or 170K each day, to reach their 1.7M target. To reach my own just-lowered target of 1.6 million, they'd have to enroll 120K/day, which might be feasible.
Of course, with the extra 5 day "waiting in line" extension, they might be able to pull off one or the other.
As of last Monday, Colorado reported 128,000 enrollments in 2015. About three-fourths of those are returning customers , with about a fourth being new customers.
OK, so that's an increase of around 2,622. However, the "...as of last Monday" bit is confusing. To me, saying "last Monday" on a Friday refers to the prior Monday (ie, 2/02 in this case). However, that would suggest that CO enrolled over 1,300 per day for 2 days in a row. The state was only averaging 233/day over the prior couple of weeks, which means they'd have to have ramped up over 5.5x, which is possible (a few other states have pulled this off).
And so, the Open Enrollment Period extensions are officially underway. I was expecting underperforming states like Washington and Minnesota to be the first out of the gate, but instead, the first three states to make formal announcements are California, Massachusetts and now, New York:
California: Yesterday, CoveredCA announced a 5-day "Waiting in Line" extension policy (ie, as long as you've started the enrollment process as of midnight on Sunday 2/15, you'll have until Friday, 2/20 to complete the process.
Massachusetts: Just a few hours ago, the MA Health Connector announced that due to getting slammed with 3 massive snowstorms in the past few weeks, as well as a 4th major one sweeping in right now, they're bumping out the full enrollment period (ie, no "have to be in line already" caveat) by a full 8 days, until February 23rd.
And just this moment, the New York State of Health has announced that like California, they're going the "Waiting in Line" route: Anyone who starts the process by midnight Sunday will have until February 28th to actually select a plan and check out. It's important to note that NY residents who enroll between 2/16 - 2/28 won't have their policy kick in until April 1st, however.
Not as dramatic of a surge as some other states, but then again, with today's update, Maryland is already 2% higher than my target number (105K), which was in turn 19% higher than the HHS Dept's target number (88K), which itself was 30% higher than their 2014 total (67,757).
OK, first, the official data updates: The MA Health Connector issued their weekly report, confirming 125,651 QHP selections to date, of which 82.2% have paid their first premium. The payment rate hasgone down as expected, since the denominator (March 1st enrollments) has started shooting up while the numerator (payments made) has gone up more slowly...since those payments aren't even due until the 23rd anyway.
Compared to the past 2 weeks, you can see the final surge has definitely kicked in:
Hmm...well, things are starting to pick up heading into the final weekend of Open Enrollment in Minnesota...
Latest Enrollment Numbers
February 13, 2015
MNsure will release 2015 enrollment metrics weekly, and will present a more robust metrics summary to the MNsure Board of Directors at each regularly-scheduled board meeting. During weeks that MNsure is closed on Friday, the enrollment metrics update will be released earlier in the week.
Health Coverage Type Cumulative Enrollments
Medical Assistance 66,538
MinnesotaCare 24,457 Qualified Health Plan (QHP) 49,238
Last night I noted, in an entry about CoveredCA announcing a 5-day "start by 2/15, finish by 2/20" Open Enrollment extension period and the potential for a separate "Tax Season" enrollment period), that according to the director of advocacy group Health Access, the Affordable Care Act doesn't regulate any specific time window regarding Open Enrollment Periods.
I found this fascinating, because until that point, I had assumed that there was some sort of language in the ACA specifying, if not the exact dates, at least the total number of days (ie, something along the lines of "...not to exceed 200 days in the first calendar year, not to exceed 100 days in subsequent calendar years"). I also assumed that there would be some sort of clause allowing for the limited enrollment the rest of the year for people who have Qualifying Life Events (marriage, divorce, childbirth, loss of income, etc).
Two late-breaking news items, one negative, the other potentially positive:
Arkansas:The good news a few weeks ago was that newly-elected Republican Governor Asa Hutchinson did not kill off AR's unique "private option" Medicaid expansion program as many had feared; instead, he actually proposed extending it pretty much as is for another 2 years, to the relief of decent folks, and the state legislature seemed to be OK with that (another surprise).
LITTLE ROCK, Ark. (Reuters) - Governor Asa Hutchinson of Arkansas has signed legislation that will end by 2017 the state’s innovative but controversial adaptation of the Affordable Care Act, which has provided nearly 190,000 residents with health coverage.
Yes, lame I know, but it's the best I could think of. Assuming my final week projections are playing out accurately, total exchange QHP selections should cross the 11 Million mark by midnight tonight.
There's only been one actual data update so far today, but it's a big one: California just got bumped up by 66K. Tomorrow should bring several final updates before the final weekend, from the 3 M's: Maryland, Massachusetts and Minnesota. A few other states may chime in as well, probably tossing a rounded number out there in the middle of a final deadline press release (the way that California and Washington just did).
At this point, I'd say the odds of hitting given marks are:
11.0 million: 99.999% (nothing is certain...what if there's a national blackout starting RIGHT NOW which lasts for the next 4 days?)
12.5 million: 75% (this has been my official projection since Dec. 12th)
13.0 million: 25% (?)
13.5 million: 5% (???)
On the other hand, even if the demand is there, anything beyond 13 million would probably crash several of the servers/overload the phone lines, requiring an official "extension period" like they added last April, in which case all bets are off.
Here's what things should look like as of tonight:
Since open enrollment began on Nov. 15, more than 354,000 people have selected a plan, including 13,000 people on Tuesday — the second-highest single day of enrollment after the rush to meet the deadline on Dec. 15 to have coverage start on Jan. 1. They join the 944,000 consumers who signed up for coverage for 2014 and began the process of renewing their coverage for 2015.
Let's see how California has ramped up the past week or two:
This is the last time I'll be running a full comparison of how all 50 states (+DC) are doing before the final weekend surge; it'll be interesting to run before/after comparisons. Some important caveats, however:
1) While most of the states are current through at least February 2nd, 4 of them (CO, DC, HI & ID) haven't been updated since mid- to late January. Then again, both DC and Hawaii are already well over the top anyway.
2) For Massachusetts, I've dropped my personal target from 300K to 200K. Yes, it's lame to change my "predictions" so close to the finish, but in MA's case I completely botched my methodology in the first place; I thought they had a lot more people in their special "temporary coverage" who were eligible for QHPs than actually were. It would be a bit unfair to rank them at the bottom for failing to meet a completely unrealistic goal.
3) For Rhode Island and Washington, I'm using a different number than the other states; RI is the QHP selections, but after past-due non-paid ones have been purged from the total; in WA, they're only reporting the paid QHPs at all, so I don't know what the total selections are to begin with.
There's two issues here: First, is the demand going to be there? Second, can the system handle the strain if it's there?
According to Andy Slavitt of CMS:
Right now, we're focused on the next few days on being there for our consumers and to help them select the best plans for their families and the final days of open enrollment. As expected over the last couple of days, interest in signing up for coverage in the final week of open enrollment is beginning to increase and we're seeing a really nice ramp.
Amid today's otherwise excellent news out of HC.gov, WA, MA, RI & VT, there was one other unexpected bit of news from the Centers for Medicare & Medicaid Services:
The Marketplace is constantly changing with new consumers coming in each day and others leaving because of career changes, getting married or other life status changes. We have a responsibility to make sure people who are eligible stay covered and that those who are not eligible for Marketplace coverage do not. Up to 200,000 Marketplace consumers who had 2014 coverage cannot continue Marketplace coverage in 2015 because they did not provide the necessary documentation of their citizenship or immigration status. They will be notified in the coming days that their coverage ends on February 28. This is the same process that started last year and will continue on a regular basis.
D'oh! OK, one more late-breaking number today, out of Vermont:
Vermont Health Connect Open Enrollment and Renewal Update
The following numbers are up-to-date as of 11:59pm Monday, February 9, 2015.
New Vermont Health Connect Customers
12,344 individuals have checked out a 2015 health plan. This includes 4,786 individuals in Qualified Health Plans (private health insurance) and 7,558 individuals in Medicaid or Dr. Dynasaur plans.
After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 12,344 individuals who checked out, 10,678 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment). Of those who completed the process, 3,293 are on a Qualified Health Plan and 7,385 are on Medicaid or Dr. Dynasaur.
MA's number starts with the 119K confirmed as of last Thursday, then adds 50% of those determined eligible for QHPs since then (this has proven to be a pretty accurate rule of thumb to date).
RI actually provides the hard paid enrollment number, and even provides the total QHP selections...but only after having purged an estimated 1,800 or so who didn't pay by the due date. I'm glad that they're purging those folks, but it makes it a bit tricky since most other states are being based on their total selections, whether paid or not.
WA, like Rhode Island, provides the paid enrollment number, but doesn't provide total selections at all.
In the cases of RI & WA, I'm assuming that their hard paid number represents 88% of the total selections, which means their estimated QHP selections are 30.7K & 158K respectively.
OK, with that out of the way, here's where things stand (and remember, while most of the states are current through 2/06, a few of the State Exchange states haven't been updated since as far back as January 15th, so the picture could be quite different once those are updated):
As I noted last week, Washington State is doing things a bit backwards from just about every other state...instead of reporting the total number of QHP selections and then, in a few cases, also reporting the number of enrollees who have actually paid their first premium, the WA HealthBenefit Exchange is only reporting enrollments after they've made their first payment.
On the one hand, I wish every state was reporting this number. On the other hand, unlike MA & VT (which report both numbers) or Rhode Island (which is reporting both, but only including the total selections after subtracting those who are past-due on their payments), WA isn't including the total selections at all. This makes things a bit tricky for me, since I'm trying to report both numbers.
HEALTHSOURCE RI RELEASES ENROLLMENT, DEMOGRAPHIC AND VOLUME DATA THROUGH FEBRUARY 7, 2015
Posted on February 11, 2015 | By HealthSource RI
PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Saturday, February 7, 2015, for Open Enrollment.
As of February 7, 2015, 79% of Year One customers have renewed (selected a plan) for 2015
(77% of renewing customers paid the first month’s premium).
Total New Customers: 8,547 (7,372 paid)
Total Renewed Customers: 20,240 (19,617 paid) Total HealthSource RI enrollments for 2015 coverage: 28,787 (26,989 paid)
*Note: Individuals who have selected a plan but not paid by their selected coverage effective date become cancelled; reported enrollment values (plan selections, paid and unpaid) will fluctuate with potential net decrease due to plan selection cancellation, as of the passage of the January coverage payment deadline.
Considering that VP Biden was caught on tape referring to the signing of the Affordable Care Act as a "Big F*cking Deal", I'm not quite sure I understand why Boehner saying "ass" is newsworthy, but what the hell: Here's my own connection to that "story": About 1:20 into this Al Jazeera America segment from March 26th, Boehner says "What the hell is this, a joke??" referring to the 2-week "extension period" tacked onto the end of last spring's Open Enrollment Period.
Oh, yeah...immediately after he rhetorically asks, "What the hell is this, a joke??", the segment turns to...me! (This has been, to date, my only televised appearance):
As of last Thursday, total QHP selections on the Massachusetts exchange were up to just shy of 119K. Between the weekend and the massive snowstorm that MA is digging out of, they went 5 days without a dashboard report, until today:
As always, I only have the QHP determinations to go by between their weekly reports. As of yesterday, those stood at 221,877, Subtract the 214,027 as of 2/05 and that's another 7,850 QHP determinations. Assuming 50% of those followed through with selecting a plan (a reasonable assumption at this point) and that's another 3,900 QHPs, or at least 122,600 QHPs to date.
Of course, that means that there's also another 99,000 people who started the process and have been approved for a private policy, but who may--or may not--have actually completed the process. Heading into the final 5 days, I presume that more and more of this enrollee pool will be scratched off the list; if, say, 80% of these folks follow through, Massachusetts would hit at least 200,000 QHPs by Sunday night.
Last year, I started out tracking just 2 numbers: Exchange-based QHPs and Medicaid via official ACA expansion provisions. As time went on, I gradually added other types of Obamacare-specific healthcare policy enrollments:
Off-exchange policies which were compliant with the new law;
People who were already eligible for traditional Medicaid prior to expansion (and in non-expansion states) but who were only "drawn out of the woodwork" to sign up thanks to outreach efforts, educational programs and streamlining of the enrollment process in many states
People who were transferred over from other existing low-income state-run healthcare programs (often with shaky funding) into Medicaid proper;
Enrollees in small business policies via the ACA's SHOP program (granted, this never ended up being more than a rounding error...less than 80K total)
Young adults aged 19 - 25 who were allowed to stay on their parent's plan thanks specifically to the ACA
Nov. 15-Feb. 1
On Healthcare.gov 86,606 Outside of Healthcare.gov 95,859
Last week the off-exchange total was 92,872, so that's about a 3,000 enrollee increase, for whatever that's worth.
According to the HC.gov weekly snapshot report, as of 2 days earlier (1/30), Oregon's exchange-based total was 94,126...slightly less than the off-exchange number. It'll be interesting to see if that ratio holds steady next week after the final deadline surge goes through.
Remember "Florida Health Choices", the brainchild of Republican Senator Marco Rubio which was supposed to be the Florida GOP's response to the Affordable Care Act health insurance exchanges?
The Florida Republican Party flushed $900,000 in startup funds into a website/"exchange" which signed up a whopping 30 paying customers in 6 months, at a cost of $30,000 apiece...or between 46x - 81x as much per enrollee as the "wasteful" HealthCare.Gov.
Connecticut's official 2015 QHP target is an even 100K. They were 99% of the way there as of last night, with no technical problems to speak of gumming up the works:
As of Jan. 30, 95,700 people had signed up for private insurance through Access Health, including about 66,700 repeat customers from 2014. (On Monday, officials said more than 99,000 people had signed up for private insurance plans through the exchange.) By comparison, last year, slightly more than 80,000 people bought insurance through the exchange (though a few thousand dropped out as the year went on).
My own target for CT is 114K. To reach that, they'll have to enroll just 2,100/day for the final week, or less than twice the rate they've averaged so far. This shouldn't be a problem; nationally, I'm expecting QHP enrollments to average around 286K/day all this week, which is around 2.33x more than the average to date, and Connecticut has one of the most solid operations of any state.
Sen. Richard Burr (R-N.C.) said Thursday that Republicans might not be able to pass an alternative to ObamaCare until 2017.
Burr, along with Sen. Orrin Hatch (R-Utah) and Rep. Fred Upton (R-Mich.) unveiled a GOP replacement plan for ObamaCare on Wednesday. But, appearing the next evening on Fox News's "Special Report with Bret Baier," Burr said no single idea is likely to generate consensus.
"I don't think so," he said. "I think that there are going to be a lot of ideas not only in Congress but around the think tanks here in Washington and around the country."
Some positive news to cushion the blow of the CoOportunity meltdown...
Y'know, there's all sorts of ways to spin formal press releases.
For instance: Moments ago, the HHS Dept. of the United States sent out this press release, touting the fact that about 6.5 million people who selected private policies via Healthcare.Gov for 2015 (about 87% of the 7.5 million total confirmed via the federal exchange) qualify to receive tax credits to help cover the cost of their health insurance premiums. The average tax credit for those 6.5 million people is $268/month, or $3,216 per year:
FOR IMMEDIATE RELEASE
Monday, Feb. 09, 2015
Almost 6.5 million consumers qualify for an average tax credit of $268 per month through the Health Insurance Marketplaces
The Feb. 15 deadline is just six days away; 8 in 10 consumers can get coverage for $100 or less
Outgoing Republican Pennsylvania Governor Tom Corbett tried a desperate hail mary play to save his job: Expanding Medicaid via the Affordable Care Act, but doing it in an absurdly complicated and confusing way in order to appease his Republican base. It didn't work; he lost to Democrat Tom Wolf, one of the few bright spots for the Dems in an otherwise lousy 2014 election.
I'm not a lawyer, but I've always understood that in order for a case to be brought to court, there generally has to be, you know, a plaintiff. That is, as far as I know, a lawyer can't just file a suit and have it taken up by the Supreme Court of the United States just because they don't happen to approve of a law; there has to be someone who can claim that they were actually harmed by it (or at least by a particular provision of the law as enacted or enforced). Alternately, they have to at the very least have "standing" to challenge the law under the legal definition of such, no matter how thin the argument may be.
In December, Tennessee Gov. Bill Haslam, a Republican, got the deal he wanted from the Obama administration: Tennessee would accept more than $1 billion in federal funding to expand Medicaid, as allowed for in the Affordable Care Act, but Obama aides would allow Haslam to essentially write staunchly conservative ideas into the program's rules for the state. He dubbed the reformed Medicaid program "Insure Tennessee."
But the state's chapter of Americans for Prosperity, the national conservative group whose foundation is chaired by controversial billionaire David Koch, argued Haslam was just trying to trick conservatives into implementing Obamacare in their state by giving it a new name. AFP campaigned aggressively Haslam's plans for the next six weeks, even running radio ads blasting GOP state legislators who said they might vote for it.
On Wednesday, Haslam's bill died in a committee of the Tennessee state senate. The vote was one of the clearest illustrations of the increasing power of AFP and other conservative groups funded in part by the Koch brothers.
Technically speaking, there could be one more "weekly snapshot" after this Wednesday's, since those reports run through the previous Friday...except that would be kind of silly, since Sunday the 15th is the final day of the open enrollment period anyway. I find it difficult to believe that HHS would issue a report next Wednesday which leaves off the final 2 days of the period (which are also likely to be the busiest yet).
Anyway, on Wednesday the 11th, HHS should issue a report including all HC.gov QHP selections as of Friday the 6th. I'm expecting the total to be roughly 7.75 million, or about 276K for the week.
National QHP selections, including all 14 state-based exchanges, should have been roughly 10.32 million as of Friday, and should have started to ramp up significantly over this weekend. In fact, I'm anticipating hitting around 10.48 million by midnight Sunday...which should mean roughly 9.2 million paid enrollees.
In other words, we've finally broken through the HHS Dept's official exchange-based private policy enrollment projection for 2015.
Today's update brings these numbers up to 95,927 QHPs and 46,422 added to Medicaid, increases of 3,041 and 7,875 respectively (through yesterday).
That's 217/day on the private side, during a the slow patch. In order to reach the HHS target of 107K QHP selections, they'll have to average 1,100 per day. With the expected deadline surge, this will be tough but doable. Reaching my KY target of 130K, on the other hand, would need 3,400/day, which doesn't seem to be in the cards.
2014/2015 Open Enrollment stats as of Thursday 2/5/2015:
The last MNsure update was 1/25, when they had 44,331 QHP selections. Since then, they've added just 1,642 more...or about 150/day. In order to reach their lowered target of 67K by 2/15, they'll need to add 2,100/day for 10 days straight. I just don't see them pulling that off.
Still, if they can reach, say, half of that, they'll add another 11K, which would bring their total up to perhaps 57,000, which isn't unreasonable.
Meanwhile, Minnesota's Medicaid/MinnesotaCare tally is up to 78,863 combined.
February 6, 2015
MNsure will release 2015 enrollment metrics weekly, and will present a more robust metrics summary to the MNsure Board of Directors at each regularly-scheduled board meeting. During weeks that MNsure is closed on Friday, the enrollment metrics update will be released earlier in the week.
Health Coverage Type Cumulative Enrollments
Medical Assistance 57,593
MinnesotaCare 21,270 Qualified Health Plan (QHP) 45,973
As of January 26th, California's 2015 QHP selection total was at least 1.217 million people. I say "at least" because the actual renewal number is a bit fuzzy (it's either 944K or 947K depending on whether you go by the CoveredCA or HHS/ASPE report). Anyway, today they issued a press release which at least updates the new enrollee number...if you do the math:
(etc etc...too long to post the whole list)
Add them all up and you get 288,568 new enrollees for 2015. Add those to the 944K (minimum) renewals from 2014 and you get 1,232,568 or more through Feb. 2nd.
Since the prior number was 1,217,111 as of 1/26, that's an average of around 2,200/day over the course of the slowest patch of the enrollment period.
Yesterday I lamented the fact that the Washington State ACA exchange seemed to be seriously lagging behind just about every other state in terms of achieving their 2015 QHP selection target, with only 132K QHPs to date vs. the 215K that they were hoping to reach this year (not to mention my personal target of 250K, which turns out to have been way out of line).
I figured that they're on track to only end up with perhaps 180-190K by 2/15, coming up 25K - 35K short of their goal.
However, IBD's Jed Graham (who has been on fire lately; this is the 2nd important point he's brought to my attention this week) reminded me that last year, unlike every other state except Massachusetts, Washington only reported paid enrollments, not total plan selections. If that's true this year as well, he noted, then I've been missing roughly 12% of WA's total all along (put another way, I should be plugging that 132K number into the paid column, not the total column).
OK, looks like my QHP estimate over the past week was fairly close, but a bit conservative...actual QHPs selected are up to nearly 119K, with just shy of 100K even having paid their first premium (thus completeing their enrollment).
100K / 119K = an 84% payment rate, but remember that anyone who has enrolled since 1/23 doesn't have to pay their first premium for over 2 weeks, so this isn't cause for concern.
Meanwhile, they have another 95,000 people who have been determined eligible for QHP selections waiting in the queue, of which nearly 6,000 have a plan in their shopping cart but just haven't pulled the trigger.
MA will have to have 51,274 more QHP selections to reach the 170K target (which, admittedly, was my interpretation of their target, not necessarily their target itself). That'd be 4,600/day, vs. the 1,447/day they've averaged so far.
In 1972, Harlan Ellison edited an anthology of sci-fi short stories called Again, Dangerous Visions (a sequel to "Dangerous Visions", naturally). One of the stories, by Edward Bryant, is called "The 10:00 Report Is Brought to You by..."
The premise of the story is a cynical, burnt-out TV news reporter who discovers, to his disgust, that the network that he's working for has figured out a foolproof way of getting exclusive coverage of breaking news stories...by creating them (and yes, a similar plot device was used in the James Bond film, Tomorrow Never Dies).
Specifically, the reporter discovers that the network has set up a bunch of remote camera units throughout a small town and then paid a local biker gang to actually invade the town and loot/pillage/terrorize the place, so that they'll have juicy, compelling live footage of actual arson, robbery and looting taking place.
The Washington State ACA exchange released updated 2015 enrollment numbers today, broken out by county, current through January 31st. They've even broken each county out between renewals from 2014 and new additions for 2015. The grand totals?
With yesterday's 1,737 QHP determinations, Massachusetts has likely tacked on another 800 QHPs or so, bringing them up to around 117.5K. In order to reach the 170K target I've estimated, they'll have to enroll about 52K in just 11 days, or a whopping 4,700/day.
I won't know until their weekly report tomorrow whether my "45% of determinations" ratio still stands. At this point the other half of the lingering QHP determinations should start to be kicking in...there's over 214K total; if 117.5K have already selected a plan, that means there's still another 96K people who have gone through about 2/3 of the process already; most of them should be coming back to complete the job now.
For comparison, in 2014, with their broken exchange system, they only averaged 158/day. For the current period, they averaged 1,950 through the January deadline (11/15 - 12/23), and 999/day during the February period (12/24 - 1/22), though that was missing the crucial deadline day of 1/23. Since then they seem to have averaged about 726/day, though that's mostly durign the slowest part of the enrollment period.
Regular readers know that I've been a bit obsessed with hunting down the Mysterious World of OFF-exchange QHPs®...enrollees in fully ACA-compliant individual policies which aren't run through the exchanges (ie, no tax credits), but directly through the insurance companies themselves (Blue Cross, Aetna, whatever).
As I noted in my recent piece for healthinsurance.org, last year off-exchange QHPs ended up being a bit higher than as on-exchange: Around 8 million, give or take. However, this was just a rough estimate patched together from various data points, and even then it's likely that some number of those were the so-called "grandfathered" plans (which can continue indefinitely until the enrollee dies or cancels/stops payment) or the "transitional" (aka "grandmothered") plans, which are the ones which were supposed to be discontinued on 12/31/13, but were given up to a 3-year extension period depending on the state and insurance company.
A couple of weeks ago, Maryland blew past the HHS Dept's target for the state (88K QHPs) and hit 94K as of 1/22. I noted that they were on their way towards easily hitting my personal, higher target of 105K by 2/15.
In response, a few days ago I went through all 50 states (+DC) and adjusted my own projections, lowering them in 9 states while bumping them up in 26 others, including Maryland. I tacked another 10K onto MD to 115,000 QHP selections. (Note that I'm leaving my original projections in the actual spreadsheets to avoid confusion; the revisions are more just to confirm that I recognized where the trendlines would be and where my earlier logic fails were).
I've slightly modified the State-Level Goals graph, with color-coded lines at 80% and 90% of the target numbers. As always, the blue lines represent the percent of the official HHS/State Exchange target achieved; the green lines represent the percent of my target achieved. In every state (except New York), the green line is shorter because my target is higher than the HHS/Exchange goal.
Important: The other day I lowered my personal targets for 9 states and raised them for 26 others. However, I'm not changing these on my actual spreadsheet or any of my graphs; I'm curious to see how far off my original targets end up being.
This isn't a formal press release, but according to NBC Connecticut, Access Health CT has enrolled "more than 96,000" people into Qualified Health Plans (QHPs). The article ran yesterday, so presumably the number is current as of February 2nd at the latest:
Connecticut residents signing up for health insurance through Access Health CT must enroll by Feb. 15 or face a potential tax penalty from the federal government.
"We're on track to hit our [enrollment] goals," said Access Health CT's acting CEO, Jim Wadleigh.
The state's health care marketplace aims to sign up 100,000 private citizens during the current enrollment period. With less than two weeks left, more than 96,000 residents have signed up for qualifying health plans.
About 30,000 of them are new sign-ups, Wadleigh said, adding that all avenues for enrollment have been successful.
Huge enrollment news day--this is unexpected but welcome on top of the HC.gov report:
Press Release: Governor Cuomo Announces NY State of Health Hits Benchmark of Two Million Enrollees
Governor Andrew M. Cuomo today announced that the New York State of Health (NYSOH) Marketplace has enrolled more than two million New Yorkers in affordable health insurance coverage. This is the latest record enrollment for New York’s health exchange, and 89 percent of enrollees have reported that they had no coverage at the time they joined the Marketplace. New Yorkers who have enrolled in coverage through the Marketplace have overwhelmingly reported that they are satisfied with their health insurance (92 percent) and are using their coverage to access care (84 percent).
Latest enrollment breakdown:
· Total cumulative enrollment: 2,004,827 · Total Medicaid enrollment: 1,491,859
· Total private coverage: 512,968
· Total new 2015 enrollment: 429,972
· Total new 2015 Medicaid enrollment: 297,423
· Total new private coverage: 132,549
· Renewal rate in private coverage: 85 percent
It's one thing to know that the 10 million mark was broken over the weekend; it's something else to have it confirmed. Today's weekly HC.gov report brought the confirmed total up to 9.917 million nationally...but it was followed almost immediately by a surprise New York State of Health press release stating that NY has ramped up their QHP total to nearly 513,000*...a whopping 156K increase in just the past 17 days, which is rather astonishing.
UPDATE 5/19pm: OK, just received confirmation from the NY State of Health that yes, today's 513K "private coverage" figure does indeed include Child Health Plus enrollees. They didn't have the exact number, but I'm fairly certain that it should be somewhere around 58-60K of the total.
As I noted last week, Rhode Island is doing exactly what every state exchange (as well as HC.gov) should be doing, assuming they have the technical capability to do so: They're updating their "enrollment" data weekly by purging those who didn't pay by the payment deadline, thus keeping their enrollment data as "clean" as possible. As a result, their "total" enrollment tally has actually dropped over the past 2 weeks as they cull unpaid enrollees from the official count. This is a good thing.
Unfortunately, since they're the only state doing this so far (both VT and MA are also tracking payment rates, but they're not lowering the "total" number accordingly), it also means that their "total" data is out of sync with everyone else's. This skews my national payment rate calculation a bit, but RI's numbers are so low anyway that it shouldn't have much of an impact one way or the other.
In any event, as of January 31st:
As of January 31, 2015, 78% of Year One customers have renewed (selected a plan) for 2015 (77% of renewing customers paid the first month’s premium).
I'm assuming that "nearly 10M" only runs through Friday the 30th (the weekly HHS reports always run through the previous Friday). I projected crossing the 10M path the following day (Saturday). The 7.5M and 2.4M figures (9.9M total) are obviously rounded off, so the total could be as high as 7.54M + 2.44M, or 9.98M total. Plus, of course, it's possible that they're missing a few days of data for some of the state exchanges. Tack on another 25K or so for Saturday and you're at 10M (at worst it looks like I was off by 1 day).
New Surgeon General Dr. Vivek Murthy: Measles vaccine is safe and effective
FEBRUARY 4, 2015, 8:02 AM|Dr. Vivek Murthy is making history as the first surgeon general of Indian descent and the youngest. Murthy joins "CBS This Morning" from Washington for his first on-camera interview since being confirmed as surgeon general and discusses the safety of the vaccine. He also touches on his views on the legalization of marijuana.
Shifting to public exchanges… We are pleased with our first year execution, particularly in light of the well-publicized challenges with the initial launch of the public exchanges. We ended the year with approximately 560 thousand on-exchange members, modestly ahead of our most recent projections. Additionally, while the open enrollment period is still on-going, we are on track to exceed our initial enrollment projections for 2015. Further, we have successfully transitioned the vast majority of our off-exchange membership to ACA-compliant plans, consistent with our previous projections. As we look at our total individual business, we now project that we will end the first quarter with approximately 1.1 million members, including up to 800 thousand on-exchange members.
There's a lot of great lines in the 1988 semi-autobiographical movie/play "Biloxi Blues" by Neil Simon. Most are funny, some are poignant. To me, one of the most powerful scenes is when Jerome/Simon's (played by Matthew Broderick) diary is found and read by his boot camp bunkmates. Among the private thoughts he has about them being revealed, one of his friends, Arnold Epstein, discovers that Jerome thinks that he (Epstein) is gay. Since the story is set in the World War II-era U.S. Army, this obviously has much bigger implications than it would today.
After the scene plays out, Jerome/Simon/Broderick's voiceover notes that:
"Something magical happens when people read something on paper...they have a tendency to believe it. They figure no one would have bothered to write it down if it wasn't true." (that's a paraphrase...I can't find the video clip or transcript for Biloxi Blues online).
Jerome concludes by noting that this incident taught him to be more careful about what he writes.
OK, kind of a stupid title, I know, but it's been a really long day...spent 3 hours clearing our driveway/porch/roof/etc. after a snowstorm (and my kid had a snow day as well, of course, making it difficult to get any work done even after I was done shoveling...)
Anyway, there were four ACA-related stories today which are all worthy of a full entry, but I'm too exhausted to do a full writeup on any of them:
How is Obamacare ruining your life today? Fox News host Tucker Carlson thinks that he knows how Obamacare is ruining your life if you live in Colorado, let’s see if he is correct! Colorado’s health care exchange, Connect for Health Colorado, glitched out last week and cancelled the health insurance of 3,600 Coloradans who went on the state’s exchange to shop for another plan. Tucker Carlson invited perfect Fox News victim Steven Roussel, an articulate white guy, to describe the absolute horror of this bureaucratic glitch, or, as Tucker Carlson put it, “Kafka comes to Colorado!” Indeed!
Two days ago, after seeing that the White House (and President Obama specifically) had come out with an official (if utterly obvious) statement stating that vaccinating children is absolutely recommended in response to the insanity of the past few years, I snarkily tweeted the following:
In response to this post on both Twitter and Facebook, 3 friends of mine (one a Republican, one an otherwise sensible Democrat and one with whom I've never discussed politics one way or the other) posted the following comments:
As I noted a week or so ago, there's a slight discrepancy between Healthcare.Gov's ON-exchange QHP tally for Oregon (currently 92,059 as of 1/23) and the state insurance division's record (85,912 through 1/25). This turns out to be due to a combination of lag time between HC.gov recording new enrollments & the state insurance dept. receiving them, plus the fact that one of the companies is only reporting paid enrollees, not total, which skews the numbers. As such, I'm using HC.gov's data for the on-exchange QHPs.
However, for off-exchange QHPs, the only source is the Oregon Dept. of Insurance, and this has gone up a couple thousand people over the past week or so:
The Insurance Division will collect enrollment information from carriers each week throughout 2015 open enrollment. Updated numbers will be posted each week on this web page.
Nov. 15-Jan. 25
On Healthcare.gov 85,912 Outside of Healthcare.gov 92,872
Connect for Health Colorado has released their end-of-month enrollment update. Since the 1/15 deadline for February coverage, they've added another 3,728 QHP enrollees, or 233/day. At that rate they'd only add another 3,500 by 2/15, or less than 130K total (vs. their target of 194K or mine of 208K). Of course, that's an extremely unfair comparison, as 1/16 - 1/31 covers the slowest portion of the open enrollment period (immediately after a monthly deadline).
Even so, there's no realistic way that CO can hit their target at this point--they'd have to average 4,600/day just to hit theirs (and over 5,500 to hit mine). For comparison, last year Colorado averaged 627 enrollees per day throughout the entire open enrollment period (and that included the huge surges in December and March). This year they've averaged 1,607/day, and that includes all of the renewals from 2014. Even with a massive final surge, I just don't see any way of CO hitting more than 160,000 QHPs at this point, although I'll obviously be happy to be proven wrong.
The "quiet period" continues this week, with just 2,673 QHP determinations over the past 3 days. Assuming 45% followed through and selected a plan, that means roughly 115,100 QHPs to date. Meanwhile, Medicaid enrollments have reached 218,587.
The 51 states (including the District of Columbia) that provided enrollment data for November 2014 reported nearly 69 million individuals were enrolled in Medicaid and CHIP. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.
444,324 additional people were enrolled in November 2014 as compared to October 2014 in the 51 states that reported comparable October and September data.
(And yes, the "51 states" wording is CMS's, not mine)
I woke up this morning to learn that Paul Krugman has given me another shout-out this A.M. This is about the 8th or 9th time he's linked to me, but only the 2nd time that he's mentioned me by name (usually it's just a text link to the relevant entry). The first time was last March, when he compared me favorably to the Lord of the Data Nerds, Nate Silver; this time my name is mentioned in the same paragraphs as Ezra Klein and Andrew Sullivan. Needless to say, I'm flattered and honored beyond measure.