Charles Gaba's blog

Through April 6, 41,402 Arkansans have purchased plans on the Arkansas Health Insurance Marketplace, the new marketplace created by Obamacare, according to information released yesterday by the Arkansas Insurance Department (see county  by county map above). As in the rest of the country, Arkansas saw a surge in enrollment recently, with more than 7,800 people signing up in the last two weeks. But while national enrollment in the marketplaces across the country hit initial projections, Arkansas will fall well short. 

...This does not include enrollment in the private option, the state's policy for Medicaid expansion which purchases plans on the Marketplace for folks that make less than 138 percent of the federal poverty level 

Oregon continues to slog it's way through enrollments in spite of their technical problems...

April 10, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 217,413
Total private medical insurance enrollments through Cover Oregon 1: 63,325 

Oregon Health Plan enrollments through Cover Oregon: 154,088

Net private medical:  59,923

This just in...Kentucky's tally is now up to nearly 80K exchange QHPs and 323K Medicaid enrollees:

BREAKING: 402,407 Kentuckians are enrolled in @kynectky. 322,827 in Medicaid, 79,580 have purchased private insurance. #ACA #kyga14

— Joe Sonka (@joesonka) April 10, 2014

Still ~75% of @kynect enrollees previously did not have insurance. That's over 300,000 Kentuckians who now have health coverage due to #ACA

— Joe Sonka (@joesonka) April 10, 2014

The numbers are small, but the percentages are impressive: Delaware's 3/31 tally is in:

DOVER – Delaware ended its first enrollment period for the nation's new Obamacare health plans with 11,335 people enrolled – about 3,000 more than federal goals for the state.

Another 3,411 people gained coverage through the state's expanded Medicaid coverage, which extended eligibility to 138 percent of the federal poverty level.

According to L.A. Times reporter Chad Terhune, CoveredCA has confirmed enrolling another 70,000 people in private QHPs in the first 9 days of the extension period. They had 1,221,727 as of 3/31, so that brings their total to 1.29 million as of last night:

#CoveredCA added 70,000 (on top of 1.2M) who picked a plan in the 9 days of the "grace period" since March 31 to April 15. @charles_gaba

— Health Access CA (@healthaccess) April 10, 2014

#CoveredCA exchange: 70K more enrolled since 3-31 deadline after extending sign-ups to 4-15, adding to 1.2M already in #ACA

— Chad Terhune (@chadterhune) April 10, 2014

Yeah, I know, I keep bouncing around on this; first I thought 8M was feasible, then I backtracked. However, let's do some simple math.

  • Obviously it wasn't exactly 7.1M on the nose at midnight on 3/31. Let's assume an overage of, say, 20K at a minimum.
  • It's also safe to assume that it was slightly over 7.5M as of midnight last night; let's say 20K there as well.
  • That means that in the first 9 days, QHP enrollments averaged 500K / 9 = 55.5K per day
  • I'd say a final weekend mini-surge is also likely for those who wait until the absolute last possible moment, which should cancel out what I'm assuming is a natural dropoff throughout the week. So...figure something like 30K/day today and tomorrow, then back up to 60K/day for the last 4 days. That's 300K added to the existing 7.52K, or 7.82M.

So, as my final projection for 4/15, I'm going with: Somewhere between 7.7M - 7.9M, with an outside chance of squeaking by the 8M mark after all (wishful thinking?)

Me, last night: Hey, Guess What? I think we just hit 7.5M QHPs.

HHS Secretary Kathleen Sebelius, moments ago: 

Health and Human Services Secretary Kathleen Sebelius says 7.5 million Americans have now signed up for health coverage under President Barack Obama's health care law.

That's a 400,000 increase from the 7.1 million that Obama announced last week at the end of the law's open enrollment period. The figure exceeded expectations, a surprise election-year success for the law after a disastrous roll-out.

Sebelius disclosed the new figure during a hearing Thursday before the Senate Finance Committee.

Assuming that my "back of the envelope" estimates on extension-period exchange QHP enrollment are accurate, the ACA has just crossed several important milestones, including:

  • 7.5 Million exchange-based private QHP enrollments (total)
  • 7.0 Million exchange-based private QHP enrollments (paid or will pay within a month of their policies actually kicking in)
  • 20 Million documented enrollments total (ie, including all types--individual QHPs, on exchange, off-exchange, Medicaid, woodworkers, sub26ers, etc...but not including the 13.9 million undocumented, non-specific additional off-exchange QHPs and ESIs suggested by the RAND Corp. study)

Note that I've modified The Graph a bit more tonight, separating out the ESIs (Employer-Supplied Insurance) into a 4th category (this includes the tiny number of SHOP enrollments, but mostly the controverisal 8.2M ESI estimate noted by the RAND study).

Last night I posted that Washington State, which officially is not offering any sort of extension period, actually is allowing late enrollments on a special, case-by-case basis.

Then, earlier today, I learned that Hawaii (which I never really read an official policy on one way or the other, but which I thought was not extending enrollments) actually is doing so for up to potentially 1,100 people or so (192 to date).

Now it appears that Connecticut, which had been very explicit about their "no extension" policy...apparently is allowing up to 10,000 people to (potentially) sneak in under the wire after all:

Connecticut’s health insurance exchange ended its first open enrollment period with 197,878 people signed up for health care coverage, including 5,917 who enrolled Monday.

Yesterday I posted an update for Michigan's just-started Medicaid expansion. Officially the number was about 32K, but there was a reference to "tens of thousands more" transferred over from an existing state-run healthcare program (similar to the 650K LIHP transfers in CA, the 107K transferred from Commonwealth Care in MA and so on).

Today, it turns out that "tens of thousands" actually meant a whopping 53,700 people:

Since April 1, Michigan has received 54,479 applications and enrolled 32,071 Michiganders into the Healthy Michigan Plan. The difference represents those with applications that are pending confirmation, others who were eligible but enrolled in different Medicaid programs or have applications in progress or have been denied. Prior to April 1, MDCH transitioned the previous Medicaid Adult Benefits Waiver population into the program with coverage beginning on April 1. These enrollment activities combined mean that Michigan has already enrolled 85,761 residents into the new program.

85,761 - 32,071 = 53,690 "bulk transfers".

CO had the official exchange QHP tally as 118,628 as of 3/31, so this means they've added another 2,343 to that total over the past week. The Medicaid number hasn't been updated:

Connect for Health Colorado reports that nearly 280,000 state residents gained coverage during the six-month enrollment period, including 120,971 who signed up for private insurance plans as of Monday and 158,521 who enrolled in the expanded Medicaid program as of April 1. In an interview last fall, Patty Fontneau, CEO of the non-profit organization running the exchange, had estimated that 125,000 to 140,000 Coloradans would sign up for insurance through the exchange during its first year.

So, a lot of people, including myself, have talked quite a bit about the people who had their pre-2014 insurance policies cancelled due to them not being compliant with one or more of the requirements of the Patient Protection & Affordable Care Act (one of the few times I've used the full name, I might add). And yes, those people absolutely do exist; I know, because (as I've noted many times before), I was one of them. My wife and I received one of those "scary" cancellation notices last fall (nothing scary about it...just a simple note saying, "Your current policy isn't compliant with the law, so it'll end as of 12/31/13...we invite you to replace it with a new policy which is compliant with the law."

Whoops...apparently I was wrong about Hawaii not joining in with most other states on the "finish by 4/15 if you started by 3/31" bandwagon. Thanks to deaconblues for the catch:

Total since October 1, 2013

28,374 Applications completed in the Individual Marketplace
 7,788 QHP Enrollments in the Individual Marketplace
557 Employers applied to SHOP Marketplace
269 QHP Enrollments from the SHOP Marketplace

4 different people brought Minnesota's latest update to my attention...their exchange QHPs are up another 651 from 47,046 since 3/31, while their Medicaid tally is up another 5,655 from 128,005:

ST.PAUL, Minn. – Today, MNsure announced 181,357 Minnesotans have enrolled in quality, affordable coverage through MNsure, the state’s health insurance marketplace. The growing numbers come from continued processing of “in line” applications, as well as Medical Assistance and MinnesotaCare enrollments.

...To date, MNsure has enrolled 47,697 Minnesotans in a Qualified Health Plan, 37,050 in MinnesotaCare and 96,610 in Medical Assistance.

Until today, I had The Graph broken into 7 distinct categories:

  1. Exchange-Based Individual QHPs (Paid or To Be Paid Soon)
  2. Exchange-Based Individual QHPs (Unpaid or May Not Pay)
  3. OFF-Exchange Individual QHPs
  4. Exchange-Based SHOP (Sm. Biz) QHPs
  5. Medicaid/CHIP (Strict Expansion)
  6. Medicaid/CHIP (Woodworkers)
  7. Sub26ers (Low Est. / High Est.)

Yesterday, however, the release of the RAND Corp. Survey made me realize that I was handling the 3rd category (OFF-Exchange Individual QHPs) the wrong way.

You see, in the rare cases where I had access to the off-exchange enrollments for a particular company, I mushed their individual and group policies together. The numbers weren't huge--only about 34,000 people--but the potential numbers, as the RAND survey indicated, could potentially be massive.

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