2018 MIDTERM ELECTION

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Charles Gaba's blog

Last week I took an uncharacteristic gamble by not trusting my instincts about the off-hand "7,000/day in January" comment made by the Deputy Director of NY State of Health; her claim seemed quite a bit off-base compared with the official press release a few days earlier, but I decided that she must know the numbers better than I did, so I went with it.

Today, the newest official numbers were released, and as it happens, I should have trusted my instincts--while the totals are still impressively higher than the prior numbers, they're still lower than the "7K/day" number indicated. In any event, NY is up to 222K private QHPs and about 107K Medicaid/CHIP, which still pushes them above 100% of their CMS projection for the enrollment period.

The newest figures show that as of 9 a.m. Monday, 587,486 people had completed their applications on the insurance exchange and 328,796 went on to enroll in some sort of coverage. 

Well, this is a nice bit of good Medicaid-related news after the recent setback: It looks like after dragging their heels, Arizona authorities finally started processing new Medicaid applications, resulting in the number of enrollments skyrocketing. They're now up to over 98,000 from about 40,000 as of December 28th.

As of January 10, 2014, 98,203 adults have been approved for AHCCCS health insurance coverage: 96,834 are childless adults between 0-100% FPL and 1,369 are adults in the new category frin 100-133% FPL.

I have some good news and some bad news regarding my recent exclusive analysis of the ACA Medicaid/CHIP enrollment numbers.

The good news is that there are now 3 states (Washington, Colorado and Maryland) which have started breaking out Medicaid renewals from new enrollments (well, Washington lists them separately; Colorado doesn't include renewals in their report at all, and Maryland appears to be "backing out" prior numbers to separate renewals out from new enrollments).

What this means is that for at least 3 out of 51 state exchanges (including DC), the Medicaid numbers going forward should reflect "true" ACA enrollments instead of mixing together renewals.

Very slight number bumps; 800 private QHPs and about 1,300 more Medicaid, but an update is an update.

To date, [acting Cover Oregon directory Bruce] Goldberg said, 65,932 people have enrolled in health insurance through the marketplace. About 23,800 of those are enrolled in commercial health plans. There are almost 30,000 people who have been approved to select their plan but have chosen not to move on in the process, Goldberg said.

The latest Colorado update is significant not just because of the solid numbers (private QHP enrollments up 20% from 12/31 through 01/15, to 63,407; Medicaid/CHIP enrollments up 17.6% to 101,730), but also because the second report devoted to Medicaid expansion specifically states that the 101K does not include redeterminations (ie, renewals of existing Medicaid recipients).

Also note that these Medicaid applications may include more than one person each.

Colorado is now at about 69% of their CMS projection number with 59% of the enrollment period passed.

And from the Medicaid Expansion Report:

**These are new applications for Medicaid or Child Health Plan Plus (CHP+) and do not include redeterminations. An application can include multiple individuals.

Maryland's private QHP enrollments went up about 10% in the first part of January, to 22,512, but the Medicaid numbers are confusing. According to the HHS report, as of 12/28 Maryland had 43,065 people enrolled in Medicaid via the exchange, but this update from the Maryland Health Connection states the number as only 29,517. However, they did also enroll a couple thousand more people via the automatic Primary Adult Care program, which cancels out some of this loss.

I'm not positive what to make of the 60,000 number, but the footnote certainly makes it look like this may be the true number of new Medicaid enrollees after separating out Medicaid renewals. This appears to account for the drop of 13,548, and suggests that (not including the PAC transfers), roughly 32% of all Medicaid enrollees were renewals. Assuming this is the case, these have now been separated out, and like Washington State, Maryland's Medicaid numbers should now be "clean" going forward (I think).

Not much to say here, just steady improvement. Kentucky's Private QHP Enrollments have gone up from 33,289 to 39,771, a 19% increase since January 2nd. Medicaid Enrollments are up from 100,359 to 122,328, a 22% increase. Kentucky is now up to 18% of their absurdly high CMS projection level.

122,328 have enrolled in Medicaid and

39,771 have enrolled in a qualified health plan (QHP).

Nearly 44% of the enrollees in Medicaid or qualified health plans are under 35 years old.

Last night I posted an exclusive analysis of the ACA Medicaid/CHIP enrollment numbers (supported by, if not actually confirmed by an official at the Centers for Medicare & Medicaid Services) which concluded that rather than the 3.9 million that the HHS and Obama administration have been touting, or even the 4.5 million or so that has been on the ACA Signups spreadsheet for the past week or so, that the actual number could be closer to 6.4 million.

I should also note as an aside that after I pointed his error out in my entry last night, Glenn Kessler at the Washington Post Fact Checker changed his incorrect "750K" number for Oct/Nov HC.gov enrollments to 270K; I had noted that you have to include December to hit the 750K figure. I don't know whether he corrected it based on my story or not, but I'll assume he did for my own ego's sake :)

Two quick 'n simple updates: Oregon's "direct" Medicaid enrollments are up another 3,000, while the 86,000 total enrollments in Connecticut now have precise numbers (instead of ones based on percentages the other day). This knocks their private tally down by 880 while increasing the Medicaid number by the same amount.

More than three months after it was supposed to launch, Cover Oregon's website still can't enroll anyone from start to finish. Using a backup process that requires workers to process applications by hand, the state has managed to enroll 65,000 people in health coverage, about 23,000 of them in private insurance and the rest in the Oregon Health Plan, the state's version of Medicaid.

Another 118,000 have enrolled in Medicaid through a separate process that bypasses the exchange.

Access Health CT has signed up more than 86,001 customers by the end of Wednesday, which includes 43,840 people in private plans and 42,161 who learned they are income eligible for government-funded Medicaid.

For those who just want the capsule version, here it is:

The official ACA Medicaid/CHIP enrollment number that the HHS Dept. has been touting up until now has been 3.9 Million. The number that I've been claiming on the spreadsheet is currently around 4.5 Million. However, based on a very detailed analysis of the first 3 HHS reports, as well as the 2 CMS reports issued last fall, I've concluded that the actual grand total of Medicaid/CHIP enrollments since the ACA exchanges launched on October 1st is actually even higher, possibly as many as 6.4 Million. While they can't officially confirm my numbers and some caveats apply (described below), a CMS official did review my work and concluded that "the methodology appears to be accurate".

Now, before everyone starts freaking out about this claim--and it's an admittedly major one--I want to make two VERY important caveats:

...and, just like that, we're back up above the 10M grand total mark again. Connecticut's private QHP enrollment tally just increased from 40,000 to 44,720, cancelling out the 3,702 that we just "lost" from Nevada a few moments ago. Medicaid/CHIP enrollments also went up by several thousand.

As of Thursday morning, Access Health CT had enrolled a total of 86,000 people, said Kevin Counihan, the marketplace's chief executive. He said about 500 to 1,000 enrollees are being added a day. That means the marketplace, also called an exchange, is on track to meet or exceed its goal of enrolling 100,000 people once the open enrollment period ends on March 31, he said.

Of those 86,000 people, Counihan said 52 percent signed up for private coverage and 48 percent for government-funded Medicaid.

Yesterday I posted an entry on Nevada's enrollment numbers which was a problem because the Nevada Health Link claimed to have lower enrollment figures as of 1/11 than the official HHS report had them at as of 12/28.

I asked them to clarify why HHS had them at 22,566 Private QHP enrollments on 12/28 when they were claiming only 18,864 as of 1/11 (of which only 11,409 were paid).

Today, they responded in a pretty to-the-point fashion:

@charles_gaba Nevada Health Link provides HHS and the public the same stats on a weekly basis. We do not know why the HHS # is incorrect.

— Nevada Health Link (@NVHealthLink) January 16, 2014

Huh.

OK, then...I guess the total just dropped by 3,702, temporarily knocking us back below the 10M total line.

Three updates today, two of which are minor, one is significant; combine all three and we've hit 10 Million altogether (with caveats):

These 3 updates push the Private QHP enrollment tally up to about 2.4 million; add about 4.5 million Medicaid/CHIP enrollments and 3.1 million "sub-26'ers" added to their parents plan thanks to the ACA, and you hit just over 10 million total.

*So, why the asterisk in the title?

Well, it should be noted that:

A few days ago the New York exchange released an oddly-worded press release which mixed some numbers through December 24 with other numbers through January 12. My reading of it at the time was that the state had added roughly 53,000 (private QHP + Medicaid/CHIP combined) since 12/30.

However, today, the Deputy Director of the NY exchange stated that they've been enrolling "about 7,000 per day" total in January...which adds up to 98,000 if you assume that runs through yesterday, the 14th. Even subtracting the extra 2 days, this means her number is 31,000 higher than yesterday's press release, but I'm not about to argue with the Deputy Director of the exchange, so another 98K it is. Assuming this breaks down roughly 72% Private QHP to 28% Medicaid/CHIP (as prior numbers have in NY), that comes to about 70.6K private and 27.4K public.

In addition, this pushes New York over the top in terms of their original CMS projection of 218,000 private QHP enrollments by March 31st. They should easily double that number by the end of the enrollment period, and could potentially hit 2.5x at this rate.

I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).

As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.

Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.

As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.

Qualified Health Plans: 73,098

Medicaid Newly Eligible Adults: 134,700

Medicaid Previously Eligible but not Enrolled: 63,070

Qualified Health Plan Applicants – Need to Pay   76,058

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