END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Charles Gaba's blog

4 different people brought Minnesota's latest update to my attention...their exchange QHPs are up another 651 from 47,046 since 3/31, while their Medicaid tally is up another 5,655 from 128,005:

ST.PAUL, Minn. – Today, MNsure announced 181,357 Minnesotans have enrolled in quality, affordable coverage through MNsure, the state’s health insurance marketplace. The growing numbers come from continued processing of “in line” applications, as well as Medical Assistance and MinnesotaCare enrollments.

...To date, MNsure has enrolled 47,697 Minnesotans in a Qualified Health Plan, 37,050 in MinnesotaCare and 96,610 in Medical Assistance.

Until today, I had The Graph broken into 7 distinct categories:

  1. Exchange-Based Individual QHPs (Paid or To Be Paid Soon)
  2. Exchange-Based Individual QHPs (Unpaid or May Not Pay)
  3. OFF-Exchange Individual QHPs
  4. Exchange-Based SHOP (Sm. Biz) QHPs
  5. Medicaid/CHIP (Strict Expansion)
  6. Medicaid/CHIP (Woodworkers)
  7. Sub26ers (Low Est. / High Est.)

Yesterday, however, the release of the RAND Corp. Survey made me realize that I was handling the 3rd category (OFF-Exchange Individual QHPs) the wrong way.

You see, in the rare cases where I had access to the off-exchange enrollments for a particular company, I mushed their individual and group policies together. The numbers weren't huge--only about 34,000 people--but the potential numbers, as the RAND survey indicated, could potentially be massive.

This is great news for two reasons...not only has the Michigan Medicaid expansion already shot up another 5K in just the past day or two, but at least 20,000 ("tens of thousands") more people have been added to the Medicaid tally due to bulk transfers (similar to the 650K LIHP transfers in CA, 107K Commonwealth Care transfers in MA and so on):

The Healthy Michigan program has received nearly 55,000 applications since April first. 32,000 Michiganders have already had their applications approved. And tens of thousands more have been moved into the expanded Medicaid program from a different state health assistance program.

Thanks to deaconblues for all three of these items:

Avalere Health, with whom I've both clashed and agreed with on ACA-enabled Medicaid enrollments in the past, is projecting as high as a net gain of 4.3M Medicaid enrollees through the end of March:

700K to 1.3M Additional Medicaid Enrollees through March, If Current Trends Continue.

However, March and April figures could bring more dramatic increases if outreach and enrollment efforts targeting the end of exchange open enrollment translate into new Medicaid enrollees. Specifically, if Medicaid sign-ups follow a similar pattern as exchanges, new Medicaid enrollees could reach 4.3 million by the end of March. In addition, recent figures released by CMS do not account for individuals assessed eligible for Medicaid through HealthCare.gov who have yet to be determined eligible by states.

For anyone interested, I'm scheduled to appear on the Craig Fahle Show tomorrow (Tuesday) morning at around 10:00am. The show is broadcast from WDET, 101.9 FM in Detroit. No idea what the rebroadcast schedule is but I assume it'll be available as a podcast archive at some point.

Meanwhile, my appearance on Left Jab Radio on Sunday night, complete with my son bursting into the room in the middle of the broadcast, is now available via their website. My segment kicks in around 14:45 in and lasts about 20 minutes, I think.

Finally, I've been hesitant about posting this publicly since there may be copyright issues involved (I'll take it down if necessary), but this strikes me as a reasonable/fair use situation (besides, I tried contacting the producer and no one ever got back to me); my apperance on America Tonight from about 2 weeks ago is now available via YouTube:

Urban, Gallup, and RAND all say the number of uninsured is declining since the ACA went into effect. Now we can debate why and by how much.

— Larry Levitt (@larry_levitt) April 8, 2014

Everything else is secondary. Larry Levitt of the Kaiser Family Foundation wins the day.

Having said that, I'm still not understanding this "3.9 million now covered" number, however, when the number covered thru "mid-March" was actually around 4.9 million:

By our estimate, 3.9 million people are now covered through the state and federal marketplaces. This number is lower than current estimates of marketplace enrollment through the end of March from the Department of Health and Human Services (DHHS), perhaps because some of the HROS data were collected in early March. All HROS data collection reported here ended on March 28, and therefore missed the last three days of the open enrollment period, during which time there was a surge in enrollment.

As noted earlier, the only way 3.9M makes sense to me is if they assumed an 80% Paid rate, which would have been about right at that time.

At last, the big RAND Survey that everyone was freaking out about (and in some cases, completely misinterpreting) has actually been released!

The key numbers:

Using a survey fielded by the RAND American Life Panel, we estimate a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.

The net result, according to RAND? An overall drop in the adult uninsured rate from 20.5% to 15.8%, or around 9.3M people nationally.

Put another way, the survey estimates that the share of uninsured American adults has dropped over the measured period from 20.5 percent to 15.8 percent. Among those gaining coverage, most enrolled through employer-sponsored coverage or Medicaid.

Assuming the RAND study is accurate (and most people from both sides of the aisle seem to think it's a pretty solid source), we may finally have an answer to the question "How many of them were UNINSURED???" Answer? Around 36%...of the first 3.9 million enrolled! That's right: Their study doesn't even include the 3.2 million more people who enrolled in individual QHPs via the exchanges after the survey concluded!

This is really just a cleaned-up version of my earlier NM update from this morning, but it's worth having an official source now:

The New Mexico Health Insurance Exchange (NMHIX) reported a total of 26,412 New Mexicans had enrolled in qualified health plans as of March 31, 2014, according to the Office of the Superintendent of Insurance. This figure represents a 76 percent growth rate from the 15,012 enrollments confirmed at the end of February 2014.

In addition, as noted this morning, NM reports 11K OFF-exchange individual QHPs and another 13,500 off-exchange SHOP QHPs! The 11K are part of the alleged "9M" RAND QHPs, not sure how to handle the 13.5K SHOP QHPs, not that it makes much of a difference vs. 9M...

Oregon's Medicaid figure hasn't changed, but the exchange QHP tally is now up to an unspecific 59K (assuming this is as of yesterday):

Cruse said he became a full-fledged enrollee on a Moda plan in February. He’s now one of 59,000 people in Oregon who enrolled in private insurance after successfully navigating through the often cumbersome Cover Oregon process. Another 140,000 enrolled through the site on the Oregon Health Plan. 

UPDATE: OK, scratch that. Looks like this article was quoting the 58,833 "total" QHP figure from the most recent official press release instead of the "net" figure which was exactly 3K less: 55,833.

Leaving this up since it's already posted but sorry about the mixup.

Now that my home state of Michigan has finally joined the Medicaid expansion program, the numbers are starting to come out, and are pretty impressive right out of the gate:

The Department of Community Health says that as of 12 a.m. Monday, roughly 27,000 individuals had been enrolled in Healthy Michigan, which is intended to provide health insurance for hundreds of thousands more low-income adults.

Ah, at last...the Federal exchange state data is starting to trickle in now...

Nearly 100,000 South Carolinians enrolled in a health insurance policy on HealthCare.govbetween Oct. 1 and March 31, the director of the state's insurance department said Monday.

But only some of those 97,387 individuals - about 57 percent - have paid their first month's premium, Director Ray Farmer said.

The number of people actually enrolled may go up or down through May 1 - the deadline by which that first payment must be made.

Data released Monday by the S.C. Department of Insurance shows a sharp increase in Obamacare enrollment in South Carolina during the second half of March. Approximately 30,000 people in this state signed up for a plan during the last two weeks of open enrollment.

It's nice to be able to plug in SC's data, but the "How many have PAID???" thing is more amusing. 31% of the enrollees don't have their policy start until May 1st, so it's only 69% who you would even expect to have paid yet. Presumably the bulk of the 11% in between will pay over the next few weeks, and the 31% May-starts will start paying in increasing numbers as well.

I was recently contacted by someone representing one insurance company who wanted me to attempt to find out specialized enrollment data about one of their competitors.

I don't blame them for giving this a shot; the insurance industry is, no doubt, a highly competitive business.

However, get this straight: If you want inside info on one of your competitors, go elsewhere. If your competitor happens to provide enrollment data for me, the odds are that it will be published publicly, which means that you'll will be able to view it by simply visiting the website just like anyone else.

As a courtesy, I am not going to identify either the person/company who made the request (nor the company they were trying to get information about).

However, I cannot guarantee that I won't do so if this happens again.

That is all.

In the past 2 days, there have been two very flattering profile pieces published about ACASignups.net and myself. Both are pretty in-depth and involve interviews with others as well as myself, and they're both very well-written, but I do feel a need to clear up a few things:

1. I don’t “hate” being compared to Nate Silver; It’s incredibly flattering. I just think it’s a bit of an insult to HIM. That isn't false modesty...I really don't know anything about "probability distribution" or "loglinear regression" (in fact, I had to look those terms up just now).

2. I didn’t expect HHS to release the full, 30-page report every week, I just figured they'd release the top-line numbers (X in QHPs, Y in Medicaid or whatever) on a weekly basis (and hope they decide to do so the next time around).

3. I didn’t know that Aaron Strauss was a data consultant or that he was in charge of the Analyst Institute; I figured he was a regular schmoe like myself.

The 3 largest states with their own exchanges are California, New York and Washington State. WA did not allow an extension period, so that leaves CA & NY...the latter of which has just issued it's first post-3/11 update:

N.Y. latest breakdown Medicaid: 486,689 Private: 421,883 @charlesornstein @charles_gaba

— Dan Goldberg (@DanGoldbergCNY) April 7, 2014

OK, NY was at 453,386 Medicaid and 412,101 QHPs as of 3/31, so this means they've added 9,782 QHPs and 33,303 Medicaid enrollees in the 6 days since then.

That's 1,630 QHPs per day, which is actually very close (97%) to the 1,683/day that they averaged back in February.

IF that's typical nationally (and that's a huge if), then that would suggest around 32K/day or around half a million total by 4/15...which is right at the low end of my new, lowered projection of 7.6M.

OK, so I may have gotten people's hopes up a bit too much with the 8M by 4/15 thing. Still, 7.6M or higher would still be awesome, and the two reports which were sent my way this AM should more than make up for my lowered projection.

First up is this from the Motley Fool, regarding hospital readmission rates, especially among Medicare recipients:

After hovering around 19% for years, hospital readmission rates began dropping beginning in 2012 and continued to do so into 2013. (The above chart reflects data through August of last year.) The national rate appears to still be falling considerably this year based on the latest data from the Centers for Medicare and Medicaid Services, or CMS. 

Readmissions cost U.S. taxpayers a pretty penny. The federal government estimated that hospital readmissions for just Medicare patients has historically added up to $26 billion annually -- $17 billion of which could be avoided. 

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