Charles Gaba's blog

2018 MIDTERM ELECTION

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Last month there was news out of Massachusetts of some sort of extension being granted to "bring the state’s health care system in line" with ACA regulations. At the time I didn't pay much attention to it, thinking that it only related to administrative procedures or somesuch.

However, it turns out that there's actually 154,000 people who are currently enrolled in a sort of healthcare batter's box, being placed on hold until MA's screwed-up exchange is able to absorb them into the system via proper ACA-compliant QHPs (or Medicaid/CHIP...not sure about that yet):

Unable to immediately enroll applicants in new, private plans under the Affordable Care Act, state officials extended existing state coverage for about 124,000 individuals, and granted temporary state coverage to about 30,000 new applicants. Those individuals were supposed to move onto new plans by March. 31; the federal waiver gives officials another three months to do that.

So why am I bringing this up today, 3 weeks after that story broke? Because a contributor called my attention to this story out of Oregon:

Maryland's private QHPs went up 2,434 in the last week of February. More noteworthy, Maryland's exchange seems to be getting a lot of pressure to explain their "paid/unpaid" data; this is the most extensive explanation I've seen from any state about the subject (except for one Vermont report last month). They're up to 38,070 total, of which 20,439 are paid up.

Medicaid numbers are the same, since they're still through 2/25.

Through March 1, 38,070 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

On the one hand, it's nice to see Minnesota post 3 enrollment updates in a single week. On the other hand, for some reason they didn't include the exact number or the QHP/Medicaid breakdown this time. Not sure why...it's already known that their private QHPs have been making up around 30% of the total until now, and the exact tally through 3/1 will be out next week sometime anyway; no point in trying to mask low numbers. Strange.

Anyway, I'm still assuming a 30/70 split, which would be another 300 QHPs and 700 Medicaid/CHIP on the pile, for a total of 34,000 / 79,001.

ST. PAUL, Minn. —  Today, MNsure announced more than 113,000 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s new health insurance marketplace.

Hawaii's private QHP exchange may still be a mess, but there's great news out of the Medicaid side: Over 48,000 new enrollees since October 1st. The article specifies that these are a combination of "strict expansion" and "woodworkers", though it doesn't break the total out between those two, which would have been nice to have, but so be it. Based on existing data, I'll assume roughly 25% woodworkers to 75% strict expansion for now, or 12K / 36K.

Hawaii has seen a spike in Medicaid enrollment since eligibility was expanded under the federal Affordable Care Act, with more than 48,000 new enrollees since October.

“The expansion (to 138 percent of the federal poverty level) meant Hawaii was expecting about 48,000 additional beneficiaries because of the mandate that you have to have insurance,” said Kayla Rosenfeld, spokeswoman for the Hawaii Department of Human Services, who noted that enrollment has exceeded that benchmark to date. Increasing enrollment is also due to greater awareness rallying Medicaid-eligible individuals “out of the woodwork.”

The good news is that North Dakota's Medicaid tally has gone up from 1,700 as of early January to over 4,000 at the beginning of February. The bad news is that due to an oversight on my part, this is actually a drop from what I had entered in that field (a confusingly-worded article in January led me to confuse enrollees with the potential pool, which was considerably higher). Anyway, ND Medicaid stood at 4,071 as of a month ago.

As of Feb. 1, 4,057 people in North Dakota had selected an insurance plan through the marketplace. That’s up from 2,624 who chose a plan in the final three months of 2013. Another 4,071 here have been determined to be eligible for Medicaid or the Children’s Health Insurance Program.

Another non-exact update; in a press release issued today, MNsure gives the combined total of QHPs & Medicaid enrollees as "more than 112,000", up around 3,000 from a few days back. As I did then, assuming the same 30/70 split that MN has had up until now, this means an increase of around 900 QHPs and 2,100 Medicaid enrollees. 

As always, these figures will be adjusted as necessary when the formal data is released by MNsure.

To date, more than 112,000 Minnesotans have selected health insurance plans on the MNsure online marketplace. Under the Affordable Care Act, consumers must enroll in health insurance coverage by April 1, 2014, or face a penalty. 

Back in January, the McKinsey Center for U.S. Health Care Reform gave a lot of anti-ACA forces ammunition when they released a study which claimed that only 11% of the total exchange-based enrollees through the end of December had been previously uninsured.

This sounded awfully low to me, especially since New York was reporting that fully half of their enrollees were previously uninsured, but no one else seemed to be tracking this data point at the time, so it was all we had to go on.

Iowa's Medicaid total just got a nice shot in the arm. It seems that 55,034 Iowans who were previously enrolled in IowaCare have been bulk-transferred over ot Medicaid proper, on top of over 13,000 additional new enrollees. All of these people are specifically listed as being due to ACA Medicaid expansion, they are not woodworkers.

While the total above is 67,893, another article from the next day lists the exchange-based enrollments as "more than 13,000", so I've bumped it up by another 142.

More than 50,000 former IowaCare members automatically were enrolled in the new system, giving them access to more services and a choice in who provides their health care, including – in many cases – local options, McCoy said.

Including those who have signed up since, the Iowa Health and Wellness Plan through mid-February boasted a total enrollment of 67,893 – 55,034 in the wellness plan and 12,859 via the marketplace choice, according to McCoy.

This is an interesting example of the fundamental philosophical difference between those who support the ACA and those who oppose it (well, those who oppose it from the Right, anyway; some people oppose it from the Left because they'd prefer Single Payer, Public Option, etc.).

It seems that Illinois has seen Medicaid enrollments shoot up quite a bit more than expected since ACA Expansion officially went into effect on January 1st. This appears to be primarily due to the "woodworker effect", which the article, as a bonus, breaks out specifically: 200K Strict Expansion + 115,000 Woodworkers:

Illinois has added 315,000 people to Medicaid since Jan. 1. Here’s a breakdown:

Two nice finds about Connecticut from contributor deaconblues today. The first article (about CT shopping their successful exchange website package around to other states) gives the QHP enrollment through 3/01 as roughly 58,000; this is up from 53,673 eleven days earlier, an increase of 4,327.

The second article gives the total enrollments as of 2/24 as around 128,000, which suggests around 80,000 Medicaid enrollments, but a little simple math to account for the 5-day difference in the two figures gives the actual Medicaid portion of that as being around 2,100 higher, or 82,100 total. This is an increase of 9,120 people in 6 days.

As of March 1, some 58,000 state residents had signed up for private health insurance through Access Health CT, nearly twice the goal of 33,000 established by federal officials for the entire open enrollment period, which runs through the end of the month, according to Kevin J. Counihan, chief executive of the Connecticut exchange.

At a press conference today, the Secretary of the DHSS announced that Delaware's private QHP enrollments went up 38% in February while Medicaid expansion went up 55%, to 6,994 and 2,168 respectively. Not much in sheer numbers but a nice bump for a small state. This brings Delaware up to 58% of their reasonable 1st year QHP goal of 12,000.

Sec Landgraf says 6,994 Delawareans have enrolled in the marketplace through Feb. 28, up 38% from last month's report. #choosehealthDE

— DHSS (@Delaware_DHSS) March 6, 2014

Also, Sec Landgraf says 2,168 adults were determined eligible & enrolled in Medicaid expansion through Feb.28, up 55% from previous month.

— DHSS (@Delaware_DHSS) March 6, 2014

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.

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