Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

Well slap my ass and call me Susan. Remember that pissing match between Avik Roy and I back in late March over the now-infamous "McKinsey Study" which claimed that only 27% of individual market enrollees since the start of Open Enrollment were "previously uninsured"?

McKinsey itself stated no less than seven times throughout that it included both ON- and OFF-exchange enrollees, and therefore was pretty much useless for trying to figure out how many of the exchange-based QHP enrollees were "previously uninsured", since there was no separation between the two in the data. For all anyone knew at the time, there could have been twice as many off-exchange QHPs as exchange-based ones, and even if it was a 50/50 split, for all anyone knew, it could have been 0% prev. uninsured OFF exchange and 54% prev. uninsured ON the exchange. Basically, it was meaningless for that purpose.

This didn't stop Roy from insisting that...

Yesterday I posted an entry which noted a story published by Avik Roy over at Forbes about an extensive study by the Manhattan Institute which compared the average insurance policy premiums last year vs. the average premiums this year, after the first ACA open enrollment period. Roy's piece breathlessly claims "Obamacare Increased 2014 Individual-Market Premiums By Average Of 49%"

I wrote a response piece which also included the HHS report about ACA subsidies covering an average of 76% of the premium cost for the Federal marketplace, but I didn't really have time to do a full analysis of the Forbes piece. However, I did note 4 major points which lept out at me right off the bat:

As of the end of the open enrollment period (4/19), New Jersey's exchange QHP total stood at 161,775; this hasn't been updated officially since. Their Medicaid enrollee tally was updated to 201,095 as of 5/30. That means that the combined total is up around 37,000.

The QHP/Medicaid ratio is tricky to estimate, not just because it isn't provided but because of the differing dates. However, I'll assume for now that NJ's off-season QHP rate has been running at around 20% of the total enrollment period rate of about 800 per day; that would make it 160/day, or 9,400 QHPs plus another 27,600 Medicaid enrollees:

The federal government reported in May that 161,775 Jerseyans bought insurance policies on the Marketplace since HealthCare.gov launched Oct. 1. The health insurers, however, are reporting enrollment numbers that exceed the government’s numbers. And experts predict those numbers will rise, since individuals whose health insurance policies don’t comply with ACA rules will be able to buy new policies on HealthCare.gov through 2014 as their old policies expire.

Total since October 1, 2013

  • 32,654 Applications completed in the Individual Marketplace
  • 9,528 Individuals and families enrolled in the Individual Marketplace
  • 637 Employers applied to SHOP Marketplace
  • 861 Employees and dependents enrolled via SHOP Marketplace

The DC exchange has always been a bit of an anomaly: It's one of only 2 exchanges where SHOP enrollments exceed QHPs (the other is Vermont), mainly because the ACA requires Congressional staffers to enroll via the DC SHOP exchange instead of their home states or even the DC QHP side. As a result, as of April 30th (the most recent update), the breakdown was 11,106 QHP's (25%), 13,230 SHOP (30%) and 20,497 Medicaid enrollees (45%). Add them up and you get 44,833 total.

As contributor deaconblues notes, the QHP number seems to be almost identical, so the bulk of the 3,200 additional enrollments are broken out between Medicaid and SHOP enrollees. I'll assume a 70/30 split until better data is made available.

A spokeswoman for DC Health Link said this week that reports of problems, “if true, were isolated incidents.” She noted that the exchange has enrolled more than 48,000 individuals and families; about 11,000 are enrolled in private plans.

In my previous entry, I added a comparison of my own families' old & new policy costs as an addition at the bottom of the article. However, I decided to move it to a new one for two reasons: First, after discussing the provisions of both policies with my wife some more, it turns out I was wrong about a few things; secondly, I've had quite a few people asking about my own experience (especially given my recent shingles outbreak), so I figured it was worthy of a separate entry.

The Washington Post reports today about a new report issued by the HHS Dept. which states that the average premium rate for those who enrolled via the Federal ACA exchange were cut by 76% thanks to the subsidies in the law:

The Americans who qualify for tax credits through the new federal insurance exchange are paying an average of $82 a month in premiums for their coverage — about one-fourth the bill they would have faced without such financial help, according to a new government analysis.

OK, I don't do business endorsements or paid promotions, but this is kind of a special case: 15 years ago today I co-founded my "day job" running Brainwrap Web Design.

By website development standards, that makes me an Old Man in the industry. I ran Brainwrap with an old college friend for the first year; we hit a slow patch and he decided to move on to a more stable corporate position elsewhere, selling his half of the business to me.

I ran the company by myself for another 13 years, until my wife (who had 20+ years of experience in corporate IT programming and management) started working with me. Her assistance was especially helpful during the ACA open enrollment period and my bout with Shingles, during which she took some of our normal site development work off my hands while I scrambled to keep up with the ever-changing enrollment data, so she deserves a lot of the credit for this site as well.

I debated whether I should bundle this point in with the prior Kentucky post, but decided it was worthy of a separate entry.

As I noted there, Kentucky has now enrolled around 335,000 people in Medicaid via the Kynect ACA exchange; an impressive number.

The thing is, according to the Kaiser Family Foundation, only about 350,000 Kentuckians who weren't insured prior to January qualified for Medicaid in the first place (including both woodworkers as well as ACA expansion). This means that theoretically up to 96% of all Kentuckians eligible for Medicaid have now been enrolled!

This isn't an official update; it doesn't give an exact number, and there's no QHP/Medicaid breakout, but it's better than nothing:

WASHINGTON – Kentucky Gov. Steve Beshear charged Tuesday that Senate Minority Leader Mitch McConnell and other critics of the federal health care law are being "disingenuous," attempting to be for a state program that is no different from Obamacare.

The governor called the state health care exchange known as kynect "highly successful," enrolling 421,000 Kentuckians — with 75 percent of them receiving coverage for the first time in their lives.

The final enrollment period breakdown was 82,792 QHPs and 330,615 Medicaid enrollees, or 413,407 total, so this represents an increase since 4/19 of 7,593 total.

If we were still in the open enrollment period, of course, I'd just use the same 20/80 ratio that the existing numbers suggest, but since we're in the "off season" for QHPs this is trickier. I'll assume a 10/90 ratio until I hear otherwise, which would mean that KY's QHP total is now up by 759 and Medicaid is up 6,834.

First, take a look at my most recent Michigan Medicaid expansion update from a week ago:

Michigan is now up to over 57% of the 500,000 residents eligible for Medicaid/CHIP under the Affordable Care Act:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 287,281
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of June 9, 2014 
*Updated every Monday at 3 p.m.

That was it. That was the entire entry.

As a follow-up to yesterday's 200K - 300K monthly exchange QHP estimate post, here's where things stand for all of the exchanges:

  • Healthcare.Gov (Federal Exchange): Current thru 4/19; No Updates until November
  • CoveredCA: Current thru 4/19; NEW DATA TO BE RELEASED "SOON"
  • Connect for Health Colorado: Current thru 5/31
  • DC Health Connect: Current thru 4/30; left message
  • Access Health CT: Current thru 5/22 (paid) / 3/31 (total)
  • Hawaii Health Connector: UPDATED WEEKLY
  • KYnect: Current thru 4/19; left message
  • Maryland Health Connection: Current thru 5/10; NEXT UPDATE: 6/27
  • Massachusetts Health Connector: Current thru 5/07
  • MNsure: Current thru 6/15; UPDATED DAILY (!)
  • Nevada Health Link: Current thru 5/28 (paid) / 5/10 (total)
  • New York State of Health: Current thru 4/19; No Updates until November
  • Cover Oregon: Current thru 6/12; UPDATED WEEKLY
  • HealthSource RI: Current thru 4/30; left message
  • Vermont Health Connect: Current thru 6/12 (paid)
  • Washington HealthPlan Finder: Current thru 5/27; left message

The good news: Illinois ACA Medicaid expansion is up to 350K, a 20K increase from 2 weeks ago. This represents 44% of the 800K eligible for the expansion program in the state.

The bad news (or good news, depending on your POV): There's nother 250K still in the hopper to be processed. Assuming the same 70% approval rate, that should increase the enrollment number by another 175K.

As of last week, Illinois' backlog of unprocessed Medicaid applications stood at 250,000, up from about 200,000 state officials reported in mid-March, but down from a peak of nearly 500,000 in early April, according to state data.

Since Oct. 1, the start of open enrollment in an expanded Medicaid program authorized by the federal health law, the state has received nearly 900,000 applications for public aid, most of which included Medicaid. Thus far, it has processed about 650,000 of them, granting coverage to about 450,000.

Roughly 350,000 gained Medicaid coverage under the health law, which expanded eligibility to all adults who make less than about $15,500 a year. The remainder gained coverage under old Medicaid parameters, which generally covered children, families and a category of older, sicker patients.

OK, the Medicaid number is a bit squirrelly since it isn't broken out by expansion/woodworkers/churn; the official number as of 4/19 was 27,268, so I'm estimating it at an even 30K.

Otherwise, the QHP total is for paid enrollees, up from 27,221, and the SHOP number is up from 33,614.

Vermont Health Connect has helped 144,500 Vermonters get health coverage. More than half, 80,400, were enrolled in Medicaid, many as a result of the program’s expansion under the Affordable Care Act.

However, the website was launched with significant problems, and eight months later it is still incomplete. State officials said this week that they will continue to rely on the two participating insurance carriers to enroll small businesses throughout the upcoming open enrollment period that begins Nov. 15. There are currently 34,800 people in that group.

There are also 29,300 people in the individual market who purchased commercial insurance. More than half, 62 percent, qualified for subsidies that lower the cost of those plans, though advocates say they are often still difficult to afford.

Minnesota is posting updates almost daily (ironic given that both the federal exchange as well as NY State of Health are officially not posting any updates until November).

In addition to the QHP daily rate (about 24% of what it was during the normal enrollment period), MN's Medicaid total is up another 3,587 in just the past 6 days.

enrollment update

latest enrollment numbers

June 15, 2014 

Health Coverage Type Total Enrollments 
Medical Assistance 139,214
MinnesotaCare 49,618
Qualified Health Plan (QHP) 51,809
TOTAL 240,641

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