Charles Gaba's blog

This morning I introduced an all-new, cleaned-up version of The Graph which only includes commercial policy enrollments via the ACA (exchange QHPs, plus references to off-exchange QHPs, ACA-enabled ESIs and sub26er enrollees), projected out through Nov. 15th (when the whole process starts all over again).

Now I've added the other half of the revamped graph: ACA-enabled Medicaid/CHIP enrollments.  Like the QHP graph, there are 3 color-coded sections, but in this case they represent "Strict ACA Expansion" (people who are only eligible for Medicaid/CHIP due to the income provisions within the law in half the states); "Bulk Transfers" (ie, transferred from existing state-run programs such as LIHP in California, Commonwealth Care in Massachusetts, etc. due to ACA provisions) and "Woodworkers" (people who were already eligible for Medicaid prior to the expansion provisions, but who never enrolled before due to either being unaware of their eligibility, not understanding the process, etc). "Woodworkers" are folks who have been "drawn out of the woodwork" since last October thanks to a robust outreach program by the government and affiliated nonprofits, as well as a streamlined enrollment process and other measures.

As we approach the 2nd Open Enrollment period, and as The Graph has become far too unwieldy to keep laid out in its current format, I've decided to break out the commercial plans (Exchange-based QHPs, plus references to the off-exchange QHPs, ESIs via SHOP exchanges/etc. and "sub26ers") onto their own graph. As you can see, this allows me to add another important new feature: My projection of the currently enrolled/paid up figure at any given time. We're also close enough to Year Two now (and my projections to date have proven accurate enough so far) that I'm comfortable projecting the QHP graph forward through November 15th (at which point Year Two starts up).

The 11/15 projections (as well as the "currently enrolled" line) assume a 9,000 new enrollments per day, a 90% payment rate, and a 2% average monthly attrition rate. This lines up almost precisely with the recent CMS announcement that 7.3 million people were currently enrolled & paying as of August 15th.

When I last checked in on New Mexico's Medicaid expansion program, they were at around 55% of the total eligible. As of late August (judging by the Sept. 1st byline on the article), that number was up to 71%:

New Mexico projected that Medicaid expansion would sign up 219,000 new enrollees over a six-year period. In the first year alone (2014), they have already signed up 155,000, 71% of the best-case six-year estimate. 

According to this article, WV's uninsured rate in 2013 stood at rougly 255K, of which 150K were eligible for the ACA's Medicaid expansion provision. Apparently they hit 145K as of 2 weeks ago...or 97% of the total eligible.

Now, the way the article words it, it's conceivable that the 145K figure could include some renewals and/or "woodworkers", which would mean that the actual percent of newly eligible WV residents is somewhat lower.

However, according to the Kaiser Family Foundation estimates, as of last fall WV actually had around 267K uninsured, of which only 143K were eligible for Medicaid expansion. Furthermore, as of mid-July, the number of Medicaid enrolles specifically designated as "due to ACA expansion" already stood at 132,556, which means that we're talking about some number between 132K - 145K...out of some other number between 143K - 150K.

In other words, West Virginia has now enrolled a minimum of 88% of those eligible for Medicaid expansion...up to a maximum of 101%!!

GAH!! That's three "solid numbers but vague definitions attached to them" articles in a row this evening:

Braley also used the debate as an opportunity to show that he has worked with Republicans such as Iowa Gov. Terry Branstad. The two worked together to expand Medicaid, giving more than 80,000 people health coverage who didn’t have it before. 

OK, that makes it sound like 80K newly added to Medicaid via ACA expansion. However, in an earlier Iowa update, it made it sound like IA has some sort of Arkansas-like "private option" thing going on which had 20,000 enrolled at that time. So...is the 80K referred to above in addition to those 20K, or are they included in it?

(sigh) Again, not sure how to handle this. Anyone familiar with the Iowa Medicaid situation, please feel free to chime in below. Either way, it sounds like I can safely bump Iowa's "strict expansion" tally up from 20K to at least 80K, anyway...

Hmmm....like Hawaii, this enrollment update is a) tiny (small state) and b) confusing, since it means that either not a single additional person has enrolled in Delaware since April 30th (which I highly doubt), or it means that the number of people dropping out has precisely matched the number added since then (which I also highly doubt), or it means that the reporter got their numbers and dates mixed up by mashing up the 4/30 QHP total with the 8/31 Medicaid total:

As of Aug. 31, a total of 22,340 Delawareans have enrolled in coverage since Oct. 1, 2013, which Rita Landgraf, secretary of Delaware Health and Social Services, said came as a pleasant surprise to the commission.

...Of the enrollees in the health-care marketplace over the past 11 months, 7,943 individuals enrolled as part of the Medicaid expansion, an 8 percent increase from the month of July.

As deaconblues notes, if you subtract the 7,943 Medicaid additions from the 22,340 total above, you get...14,397...the exact same number that was reported as of May 1st.

For all of the flaws with their implementation of an ACA exchange, Hawaii had at least one thing going for it during the off-season: They kept providing enrollment updates (as small as the numbers were) on a regular basis...through the end of July, that is. Since July 26th I haven't heard a peep out of HI before today:

The exchange, created by the Affordable Care Act, also known as Obama­care, has struggled with participation over the past year, attracting just two medical insurers -- Hawaii Medical Service Association and Kaiser Permanente Hawaii -- and signing up just 10,750 individuals, the lowest in the nation.

Hmmm...on the one hand, 10,750 is actually a reasonably decent increase since July (1,087 people added over about 2 months, or 18/day). On the other hand, it's entirely possible that this number includes the 1,057 SHOP plan enrollees...in which case it isn't an update at all, or (scarier) it would mean Hawaii has only added 30 people to QHPs since 7/26.

OK, all of this is moot if the new software platform proves to be as much of a mess as last years was, but assuming the new setup works properly, this sounds like a fairly smart way of cleaning up the mess:

Open enrollment begins November 15, but individuals’ deadlines to enroll may vary.

A total of 285,000 people who currently have temporary coverage will need to re-enroll, but a proposal is in the state’s hands to do that enrollment in three waves, with three different deadlines– Jan. 15th for wave one, Jan. 31st for wave two, and Feb. 15th for wave three.

For those of you currently enrolled in a non-subsidized Affordable Care Act Plan, your deadline to re-enroll is by the end of this year, December 31st. Missing that deadline will cause you to have a gap in your coverage.

Thanks to top contributor deaconblues for jumping back into the game and providing me with a whole batch of updates this evening. First up, the DC exchange, which posted their first update in 2 months:

From October 1, 2013 to September 9, 201457,883 people have enrolled through DC Health Link in private health plans or Medicaid:

 14,402 people enrolled in private health plans through the DC Health Link individual and family marketplace.
 14,289 people enrolled through the DC Health Link small business marketplace.
 29,192 people were determined eligible for Medicaid coverage through DC Health Link.

That's an increase of 1,872 QHPs, 510 new SHOP enrollees and 4,472 more Medicaid additions to date.

Hmmm...looks like I may have to dust off my "$360.00 GoDaddy Solution" after all...

A federal judge in Oklahoma ruled Tuesday that Obamacare subsidies provided on the federal HealthCare.gov exchange are invalid, agreeing with a ruling by a three-judge D.C. Circuit Court of Appeals panel against the subsidies.

The ruling, along with the fallout from the D.C. Circuit decision, could be a potentially significant defeat for the Obama administration.

On the one hand, this development probably makes it more likely that the SCOTUS will end up taking on the Halbig case (from the DC Circuit Court) after all (and/or the King case from the 4th Circuit...all three appear to focus on pretty much the same "federal exchange vs. state exchange" issue).

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