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Charles Gaba's blog

Yesterday the Obama administration announced several new modifications to ACA implementation. The one that's getting the most attention is a 2-year extension on non-compliant, pre-ACA healthcare plans. After getting criticized for "lying" about his "if you like your plan you can keep it" statement last fall, Pres. Obama gave individual states the option of extending existing plans by 1 year if they wanted; this just extends that period further, out to pretty much the end of Obama's term of office:

Americans with health coverage that predates Obamacare can stay on their plans for two more years, insurers will have an extra month to enroll customers next winter and states will get more time to decide whether to manage the law themselves, officials said. Also, a program aimed at covering financial losses for insurers will be adjusted to help ensure it doesn’t cost taxpayers, the Obama administration said.

Another nice find by contributor Denver11. Family Health Hawaii is a new insurance company that is apparently not on the Hawaii exchange, meaning that any enrollments they sign are off-exchange by definition. The article doesn't give a specific number of ACA-compliant plans, leaving it an amorphous "most" out of 3,400. I'm figuring 60%, which would be 2,040 employees. Using my standard (and very conservative) 1.8x people-per-household (per employee) ratio, that comes to around 3,672 total individuals covered.

If I'm not missing something, this brand-new startup company has single-handedly enrolled 80% as many Hawaii residents as the state exchange has. Not sure if this says more about the company or the exchange.

He [Family Health Hawaii CEO JP Schmidt] estimated that around 3,400 employees are enrolled to date, with the goal of enrolling 50,000 employees by the insurer’s five-year mark in 2018. And while the insurer offers some grandmothered 2013 plans, most seem to be opting for the new Affordable Care Act 2014 plans, he noticed.

Nice find by contributor deaconblues; Arizona's Medicaid tally was at around 98,000 on January 10, so this represents a 37% increase to 134,674 total. The "coverage restored" note is a bit confusing, but it sounds like this includes a mixture of "woodworkers" and "baseline churn" while the 3,042 number appears to be part of "pure expansion". However, note that I'm still only counting 20% of the grand total (of which this is just a portion) as "woodworkers" and 50% as "expansion".

If any Arizona Medicaid expert wants to help sort this out, feel free to contact me.

As of February, nearly 64,000 adults eligible for AHCCCS under Arizona voter mandate Prop 204 had their AHCCCS coverage restored. (In total, there are 131,632 Arizonans enrolled in this eligibility category.)

An additional 3,042 adults who were without health insurance were able to access health insurance in the “expansion” eligibility category (those earning between 100-133 percent FPL.)

There hasn't been any sort of press release yet, but the total enrollment figure on the home page of the New York health exchange shot up over 11% today, from 501,205 up to 557,840, a jump of over 56,000 people.

I don't have the Private QHP/Medicaid breakdown yet, but the ratio has quickly shifted from 60 private/40 public through early February to a 23/77 split in favor of Medicaid a couple of weeks ago. I'm going to error on the side of caution and assume that this trend has continued, so I'm going with a 20/80 split for the new additions until the actual numbers are released. I'll be more than happy to be overly cautious on this if the breakout is more favorable to private QHPs,  however.

In any event, a 20/80 split would mean the 56,635 additional enrollees break out as 11,327 Private QHPs and 45,308 Medicaid/CHIP, for totals of 288,008 & 269,832 respectively.

For months now, I've been pointing out that while the CBO's original 7 million overall Private QHP projection seemed reasonable at the time, the CMS's state-by-state projections to achieve that 7 million goal never made any sense, and in some cases were flat-out ludicrious. States like New York and Kentucky were assigned the same enrollment target even though NY's population is 4.5x the size of KY's, and so on.

Even within individual states this made no sense--Vermont was expected to have 57,000 people enroll in QHPs even though they only have around 47,000 uninsured residents. Sure, there'll be some overlap due to the "5 million policies cancelled!!" debacle (ie, people switching from a non-ACA compliant plan to a compliant one, including my own family), but it still made little sense, and in fact the odds are very high that someone simply copied & pasted Utah's projection numbers onto Vermont, right below it.

I know Hawaii has a small population to begin with, and a very small number of uninsured residents out of those, but this is still a bit underwhelming: Private QHPs are up less than 200 from 2/22 to 3/01, to 4,661.

Total since October 1, 2013

20,018 Applications completed in the Individual Marketplace
4,661 Enrollments in the Individual Marketplace

Using my new (upcoming) "potential pool" methodology, after removing undocumented immigrants and assuming that 60% of QHP enrollees were previously uninsured, Hawaii is now at:

  • 2,797 out of 35,000 potential QHP enrollees (8%)
  • 14,746 out of 58,000 potential Medicaid/CHIP enrollees (25.4%)

Colorado continues to be one of the more smoothly-running state exchanges, adding 5,102 Private QHPs and 7,341 new Medicaid enrollees in the 2nd half of February. These represent a 6.4% and 5.7% increase respectively. Unfortunately, their daily QHP rate for February, which had looked to be slightly higher than January, was actually down about 8% per day. As always, in CO, the Medicaid number listed only includes actual ACA expansion (woodworkers are included separately in the CMS reports; there are no renewals or churn the number below).

Here's a bonus data tidbit that's also a precursor to a new feature that I'm adding later this week: Out of the total uninsured in the state, Colorado has a potential QHP pool of around 

325,000 residents, and a potential Medicaid pool of around 332,000 people, once you remove undocumented immigrants.

Assuming 60% of QHP enrollees were previously uninsured, this means Colorado has enrolled:

In an unofficial update, MNsure's CEO has confirmed the total number of exchange-based enrollments as "more than 109,000" total through March 2nd (the PR was issued on the 3rd). In the previous update (thru 2/24) had QHPs at 31,522 and Medicaid at 73,271 new enrollees (104,793 total), so the combined total has gone up at least 4,208. Assuming the current 30/70 split between private QHPs and Medicaid holds true, this brings Minnesota up to 32,784 and 76,217 respectively.

“Since October 1, more than 109,000 Minnesotans have secured affordable health insurance coverage through MNsure,” said MNsure’s interim Chief Executive Officer Scott Leitz

Small update out of Nevada: Between 2/22 and 3/01,paid QHPs went up 698 from 19,142 to 19,840 while unpaid QHPs increased from 7,893 to 8,695, for a total increase of 1,500 even. Nevada's Paid percentage remains at around 70%.

Update as of 3/1: 28,535 Nevadans have confirmed Qualified Health Plan selections with Nevada Health Link, 19,840 have paid.

— Nevada Health Link (@NVHealthLink) March 4, 2014

Hmmm...I'm hoping that either this weeks or last weeks press release from the Washington exchange contains a clerical error, because if both are accurate, it means that private QHP enrollments in Washington State all but dried up in the last week of February. They're showing an increase of paid enrollments from 101,857 (as of 2/20) to 106,281 (as of 2/27), which isn't bad (about 4,400 more)...but a decrease of unpaid enrollments from 82,249 to 78,041. This means that the total number of enrollees only went up by 216 during that week; the rest were all conversions of unpaid to paid. The good news is that this improves WA's paid percentage from 55% to 58%.

Meanwhile, WA's Medicaid expansion increased at a more reasonable rate, from 202,168 expansion-only + 102,238 woodworkers (304,406 total) to 212,633 expansion + 108,886 woodworkers (321,519 total), or by about 17,000 people.

Another way of looking at it: According to the Kaiser Family Foundation, prior to the ACA, WA had a total of around 959,000 uninsured residents, of which around 449,000 are supposedly eligible for Medicaid.

*(when each is corrected for certain factors...read for explanation)

A month ago, Avalere Health released an analysis of the Medicaid/CHIP data released by the HHS and CMS for the first 3 months of the ACA enrollment period, October through December. At the time, they estimated that the number of new Medicaid/CHIP enrollments due to ACA expansion as being somewhere between 1.1 million - 1.8 million. I questioned some of their methodology (counting households instead of individuals for some states, not clarifying whether the figures included "woodworkers" or not, not accounting for seasonal variations in enrollment patterns, and not including any January data at all). They acknowledged some of these points, but also pointed out a few valid flaws in my own methodology (primarily forgetting to correct for "baseline churn").

Originally, our respective Medicaid tallies at the time came in at:

For months I've been talking about the "holy grail" of missing ACA data: Direct, or Off-Exchange enrollments: People buying ACA-compliant health insurance policies directly via the insurance companies without bothering to do so via the Federal or State exchanges. I've documented nearly a half-million of these already from just a handful of companies (and 1 state, Washington), and over the weekend launched a new effort to try and crowdsource the missing data.

Until I have that information, however, the question is just how many of these are there out there? I know that around 4.2 million have enrolled via the exchanges, and I already know of at least 456,000 off-exchange enrollments, or around 4.7 million total. Even if every single exchange-based enrollee already had insurance (and that's absolutely not the case), there should still be several million people out there who have either switched from one private plan to another (directly) or enrolled in a policy for the first time (directly).

Oregon continues to slowly drag their still-crippled exchange along, adding another 2,859 private QHPs and 22,564 Medicaid/CHIP enrollees (17,474 + 5,090 via the "Fast Track" program) over the past few weeks.

March 1, 2014 Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon and Oregon Health Authority

Total: 123,797 
Private insurance: 38,806
Oregon Health Plan: 84,991
Oregon Health Authority “Fast Track”
Oregon Health Plan: 128,434

Since October, dozens of you have been assisting with the ACA Signups project by providing press releases, reports and news items containing data about exchange-based enrollments in both private and publicly-funded healthcare plans. Once in awhile, you've also provided stories about interesting related topics, and I'm eternally grateful for all of it. Now I'm going to ask for help in tackling the Holy Grail of ACA enrollment data.

(I posted a version of this a week ago, but figured I should repost it now that we're actually into the final month)

This morning I posted my final projection for February enrollments of 902K Private QHPs, for a total of 4.2 million as of March 1st.

Along with this, the enrollment projection model also gives a range of possible final QHP tallies through the end of March, ranging from 5 to 7 million depending on a variety of factors:

As you can see, the possibilities are pretty clean: