Charles Gaba's blog

2018 MIDTERM ELECTION

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A few days ago, several people sent me a link to this story from the Philadelphia Inquirer which discussed the impact of the ACA on Medicaid enrollment in the 26 states which expanded the program vs. the 24 which haven't done so (including Pennsylvania), and the positive impact it would have on PA's uninsured rate if they were to do so.

However, the following passage seemed rather strange to me, and I didn't want to post anything about it until I cleared up the mystery:

Pennsylvania and the 23 other states that haven't expanded Medicaid have signed up fewer than three million people for the program. That's in sharp contrast to the almost 10 million people enrolled by the 26 states and District of Columbia that expanded Medicaid when the marketplace opened November.

Hot on the heels of this morning's Commonwealth Study survey, which pegs the reduction of the number of uninsured adults at 5% (around 9.5 million, plus perhaps 2.5 million children under 18, for a total reduction of around 12 million) comes another study by the Urban Institute, which gives a slightly smaller reduction (4% of all adults nationally, or around 8 million...or around 10.5 million or so if you add children in).

The Commonwealth Fund study which is causing such a buzz today contains a lot of interesting data points. The one which is the most bothersome is this:

It's not terribly surprising that expansion states saw their uninsured rate drop more than non-expansion states, but this seems like too much of a difference (11% vs. 2%)...until you remember that this only applies to people in poverty...that is to say, only the Medicaid/CHIP data is relevant here, as noted by Jeffrey Young in his Huffington Post piece.

The actual Commonwealth Fund brief makes this clear:

A wonderful new survey by the Commonwealth Fund was released today, chock full of all sorts of data-nuggety goodness:

We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases.

The survey, from the Commonwealth Fund, a research group, came to similar conclusions as other surveys about the expansion of health insurance. It found that about 15 percent of adults younger than 65 now lack health insurance, down from 20 percent before the Affordable Care Act rolled out in January.

What was more surprising is that people who got the new coverage were generally happy with the product. Overall, 73 percent of people who bought health plans and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with their new health insurance. Seventy-four percent of newly insured Republicans liked their plans. Even 77 percent of people who had insurance before — including members of the much-publicized group whose plans got canceled last year — were happy with their new coverage.

I'm sure most of you have already seen this photo from President Obama's "border crisis" meeting with Texas Governor Rick Perry yesterday.

While I find Perry's "Grumpy Cat / Just Swallowed a Bug" face to be as hilarious as anyone else (made even better by Pres. Obama's laughter), there's something else in this photo which I find a bit strange: The name tags.

The QHP number is identical to what it was a week or so ago; I assume this is just a data entry issue. Meanwhile, both forms of Medicaid enrollment have gone up, by a combined 6,537.

latest enrollment numbers

July 8, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 152,041
MinnesotaCare 53,855
Qualified Health Plan (QHP) 52,233
TOTAL 258,129

As an aside, according to KFF, there were around 259,000 uninsured Minnesota residents eligible for Medicaid (pre-ACA + expansion) prior to January 1st. Assuming none of the 205,896 people who enrolled via the MNSure exchange were renewals (and they shouldn't be, according to the prior monthly CMS reports), that suggests that MN has now enrolled nearly 80% of all eligible residents who weren't already on Medicaid, leaving just 52,000 people to go, give or take.

Investor's Business Daily published a story today by someone named John Merline which references an Inspector General report stating that the enrollment data from HC.gov isn't being reconciled properly with the data from the insurance companies on the federal exchange, something which is apparently required by the ACA law itself. Now, if this is true then that's certainly an issue which needs to be resolved. However, my problem with the article comes a bit further down, where my site and data are referenced repeatedly:

The administration hasn't released updated enrollment numbers since May, which covered the entire open enrollment period at the federal exchange. An update would shed light on how many are keeping up with premium payments.

But 15 states have separately reported paid enrollment numbers, and according to data compiled by ACASignups.net, paid enrollment is 322,000 fewer than the last official White House count — which means nearly 13% of those counted haven't paid their premiums.

Several folks have inquired, so yes, I will indeed be attending the 2014 Netroots Nation convention at Cobo Hall next week (July 17 - 20).

No, I don't have a panel; I'm not a guest speaker or anything along those lines, just a regular attendee, but if any site regulars plan on attending, I'd love to meet you. I'll most likely be found either hanging out with the Motor City Kossacks crowd or just wandering around; I don't have any particular agenda.

Hope to see you there!

The growth of Michigan's ACA Medicaid expansion program is finally slowing down, but they've still tacked on another 3,000 or so people in the past week, bringing enrollment up to 64% of the total eligible to enroll:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 317,931
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 7, 2014 
*Updated every Monday at 3 p.m.

This Just In: From the Paul Gallo Show, the Mississippi Insurance Dept. and Cover Mississippi: One of the 2 insurance companies operating on the ACA exchange in Mississippi plans on cutting their rates by a whopping 25%!

The caveat is that we still don't know what the other company's rate plans are, nor do I know what that 25% rate cut was in the first place, but this is still excellent news:

@paulgalloshow @MSInsuranceDept really good news for Mississippi. ACA Marketplace carrier to cut it rates by 25%! #acaworks @charles_gaba

— Cover Mississippi (@CoverMS) July 7, 2014

With the latest updates out of Colorado and the District of Columbia--both of which (to my surprise) showed an increase in the average daily rate of off-season exchange QHP enrollment in June over late April and all of May--I'm feeling a lot more confident about my overall off-exchange projection chart, which is currently showing a lower bound of around 9,000 per day and an upper bound of around 12,000 per day since April 19th.

In the interest of caution, however, I'm still keeping my "official" projection a bit lower still, at around 8,000 per day (though this is up from the 7,000/day I had been using until now). This translates to around 616,000 new QHP enrollments as of yesterday (77 days out), bringing the estimated total to a bit over 8.6 million overall.

When I last checked in on the District of Columbia exchange, they were reporting 11,582 exchange QHPs as of June 11...868 higher than the last official HHS tally as of 4/19. That means that they had been averaging around 16 new QHPs per day at that time.

Well, today they issued another update: As of July 1st, the total is up to 12,333. This is another 751 higher, bringing the overall off-season average up to 22 per day. That's right: Just like in Colorado, DC's QHP off-season enrollment rate is actually increasing as we move farther away from 4/19...at least so far.

So, what does this mean for the national trend? Well, the numbers are too small to impact the overall range, of course, but so far both Colorado and DC's latest updates have only inched the trend upwards; it now sits at a lower bound of around 9,000/day and an upper bound of 12,000 per day.

As always, I continue to be cautious in my actual tally prediction, though I've moved this up from 7K/day to 8K/day; if the lower bound reaches 10K, I'll bump my "official" projection up to 9K and so on.

BRAVO to Washington State!

OLYMPIA, Wash. – Washington Healthplanfinder today announced a limited special enrollment period for Washington state residents whose same-sex domestic partnerships were recently converted to marriages on June 30. The 60-day enrollment window provides these couples with a unique opportunity to enroll in a Qualified Health Plan before the next open enrollment period that starts on Nov. 15, 2014 for coverage beginning in 2015.

A related article has the number of people impacted (3,600 couples, or about 7,200 people total):

Washington’s health benefit exchange is opening up a 60-day special enrollment period for couples in same-sex domestic partnerships that were recently converted to marriages.

On June 30, most state-registered domestic partnerships were converted to marriage automatically in Washington. This affected an estimated 3,600 gay and lesbian couples in the state.

This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:

MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.

Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.

Enrollment has remained above 1 million in March, April and May.

As of the previous update (5/31), Colorado was averaging around 177 QHP enrollees per day in the post-open enrollment period (7,413 / 42 days). With this latest update (dated June 24), they've actually increased this average slightly (4,185 / 23 = 182/day), for an overall off-season average of 178 per day:

The number of new enrollees in private health insurance through the state exchange, Connect for Health Colorado, continues to inch upward by about a couple hundred a day — and now stands at 137,000, officials said Tuesday.

Although open enrollment officially ended March 31 with 118,000 signups, it unofficially ended at 124,000 in mid-April as people who started before the deadline finally finished the process.

This stability makes me more confident of my 9K - 12K/day off-season estimate, since the late April/early May enrollments might otherwsie have just been chalked up to unprocessed leftovers from the enrollment extension period. However, the rate increasing (if only slightly) suggests that for Colorado, at least, the off-season rate seems to be pretty stable.

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