Charles Gaba's blog

Finally, a solid update out of Vermont; thanks to Morgan True of VT Digger for pointing me towards the most recent Vermont Health Connect report as of just a week or so ago:

There's a lot going on in the table above. For one thing, this demonstrates, again, how stupid it was to hyperventilate about "How many have PAID???" back in February or March, when a good 40% or more of the people who would eventually enroll wouldn't even have their policies kick in for weeks or even months yet. Note that of those whose policies started between January 1 - May 1st, over 95% have paid their first premiums by now:

There's been a recent batch of insurance rate change requests reported across various states which has gotten a lot of press. However, as I noted a couple of weeks ago, there can be a big difference between what the insurance companies ask for and what the state insurance commissioner approves. This is one of the most important (and least-written about) aspects of the ACA: Insurance companies can no longer just jack up their prices however much they feel like; those rates have to be approved by the insurance commissioner for the state they're operating in if they want to sell their wares on the exchange.

Yesterday I posted an article in which I attempted to coin the term "Halbig Conspiracy!!®" (complete with not one, but two exclamation points). However, others including Kevin Drum of Mother Jones and Brian Beutler of the New Republic prefer the term "Halbig Truthers®", which I have to admit rolls off the tongue better, so I'll go with that instead.

In any event, last night Drum made a (tongue-in-cheek?) offer to give $10 to anyone who:

...can point out a conservative who so much as suspected that subsidies were limited to state exchanges prior to March 2010. Surely that's incentive enough? Let's start digging up evidence, people.

This led to a brief Twitter exchange in which Vox's Adrianna McIntyre offered to match Drum's $10, and I upped the ante (um...sort of) by offering up my collection of mint-condition official Todd McFarlane "Spawn" promotional action figures to sweeten the pot (I was a movie theater manager in a prior life and these were left over after the live action movie bombed in 1997).

Thanks to Paul Mullen for this find: A rare update out of North Dakota. Lots of useful data, but kind of frustrating because of the apples/oranges comparisons:

As of July 6, 9,953 North Dakota residents were covered by private insurance plans obtained through the federal marketplace, up from 8,374 reported at the committee’s last meeting May 14, according to Insurance Department figures.

That’s still lower than the 10,597 enrollment figure cited by the Obama administration in April, in part because the state counts only those who have actually paid their first month’s premium. Either way, enrollment fell short of the administration’s projection that 11,000 North Dakotans would enroll in private plans through the marketplace during its first six months.

Greg Sargent over at the Washington Post has done an excellent job of looking at the reality behind what I'm terming the "Halbig Conspiracy!!®" (note: if you choose to re-post this, I ask you to include both exclamation marks), by looking at the actual history of the federal exchange in the earlier drafts of the ACA bill:

...But documents from the Senate committees that worked on versions of the bill in 2009 — combined with a close look at the history of the phrase itself, and interviews with staffers directly involved in the drafting of the statutes — strongly undercut the argument that the law did not intend or provide subsidies to those on the federal exchange.

...1) The first Senate version of the health law to be passed in 2009 — by the Health, Education, Labor and Pensions Committee — explicitly stated that subsides would go to people on the federally-established exchange. A committee memo describing the bill circulated at the time spelled this out with total clarity.

No, I don't plan on posting Minnesota updates every day, but I'm still amazed that they seem to be having no problems doing so with their (supposedly) "faulty" exchange website, while the HHS Dept (as well as the New York exchange) has made an official policy decision not to post any updates for (presumably) the full 7 month off-season period.

In any event, MN's total enrollments went up another 1,200 from Sunday to Monday, with 67 more QHPs and 1,147 more Medicaid enrollees:

latest enrollment numbers

July 28, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 162,449
MinnesotaCare 58,838
Qualified Health Plan (QHP) 52,859
TOTAL 274,146

 

For a state which didn't even implement their Medicaid expansion program until April, Michigan continues to impress...

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 341,634
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
 

*Statistics as of July 29, 2014 
*Updated every Monday at 3 p.m.

Oregon continues to post impressive enrollment numbers considering their never-working website. Total QHPs are up another 922, Net QHPs are up 185 and Medicaid enrollments are up 12,517 over the past week:

July 28, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 336,146
Total private medical insurance enrollments through Cover Oregon: 96,037          

Oregon Health Plan enrollments through Cover Oregon: 240,109
 

Dental enrollments 
Total private dental insurance enrollments through CoverOregon 1: 18,794

Net enrollments 
Net private medical: 82,368
Net private dental: 15,218

An odd update from the DC exchange...not the update itself, which shows a modest-but-steady increase in QHP enrollment, but the fact that it only runs through July 9th even though it wasn't posted until yesterday (7/28). The prior update ran through July 1st, so that's a net gain of 197 people in 8 days, or about 24 per day. This is actually up slightly from the May/June average of 22/day.

Both the SHOP and Medicaid numbers also went up slightly as well, but again, this only covers an 8 day period:

Monday, July 28, 2014

Enrollment

From October 1, 2013 to July 9, 2014, 51,059 people have enrolled through DC Health Link in private health plans or Medicaid:

 12,530 people enrolled in private health plans through the DC Health Link individual and family marketplace.
 13,779 people enrolled through the DC Health Link small business marketplace.
 24,720 people were determined eligible for Medicaid coverage through DC Health Link.

Once toothless, Cover Oregon board tackles an uncertain future

...After taking political heat for the exchange's technological failure, the appointees of Gov. John Kitzhaber are taking on a more significant role, transforming the agency for the future. At a time when critics of the agency say it should go away, it's the bureaucratic equivalent of an existential moment for an agency considered crucial to federal health reforms.

... The state's planned 2015 partnership with the federal exchange is called a "supported state-based" exchange. But it's supposed to be a temporary fix before setting up a full-fledged state-based exchange. It allows Oregon to keep insurer fees of about 2.5 percent of premiums for itself until the state resurrects its own website.

Vermont Health Connect shakes up practices, adds personnel

Yup, it definitely looks like my "QHP sky is falling" warning from a couple of weeks back was a false alarm...or, as Dan Diamond noted at the time...

The first time @charles_gaba made a forecasting error was when he predicted he made a mistake. http://t.co/4hiufhbVAG

— Dan Diamond (@ddiamond) July 16, 2014

Indeed.

In any event, while there is indeed a small slowdown which seems to have kicked in since the COBRA extensions dropped out at the end of June, it's now looking more and more as though the huge drop I saw the first week of July was mainly a combination of a data entry error in Hawaii and the long 4th of July weekend in general.

Unfortunately, the full article is locked behind the paywall, but Taegan Goddard's WonkWire reports that "some" of the 36 states being run through HC.gov are taking various measures just in case the Halbig decision is ultimately upheld:

Wall Street Journal: “A number of states are scrambling to show that they—not the federal government—are or will soon be operating their insurance exchanges under the 2010 health law, in light of two court decisions this week.”

“The efforts are aimed at ensuring that millions of consumers who get insurance through the exchanges would be able to retain their federal tax credits if courts ultimately rule against the Obama administration.”

“Amid the uncertainty, some of the 36 states in which the federal government has a role in the exchanges are moving to shore up their status. Some are saying publicly that their exchanges have always been state-operated. Others are trying to make the case that they should be considered to have state exchanges regardless of federal involvement. Still others, such as Arkansas, are pushing ahead to take over their exchanges, which would likely free them from the effects of any court decision.”

The last time I updated the Kentucky numbers, all I had to go on was a rough number of around 450,000 people enrolled via Kynect, without any breakdown between private QHPs and Medicaid enrollees. At the time, I took the official 4/19 numbers and then assumed a 90/10 Medicaid/QHP split for the additions since then. This gave me an estimated breakdown of around 87K QHPs & 363K Medicaid.

Today, while there's no updated numbers provided, Joe Sonka over at LEO Weekly brings a hard breakdown of how the 4/19 Medicaid numbers break out:

Yes, 49 people is pretty tiny even for a state with as low an uninsured population as Hawaii, but it's still further evidence that the drop in QHP enrollments in the first week or so of July was either a typo or a data entry glitch, as the total has since risen for 2 weeks straight. SHOP enrollments haven't changed since 7/15:

Connector Updates as of July 19, 2014

33,042 Applications completed in the Individual Marketplace
9,724 Individuals and families enrolled in the Individual Marketplace
689 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*

* as of July 15, 2014

While all the fuss & bother over the Halbig case continues to get bopped around by every pundit under the sun (including me? Do I count as a pundit now?), the ACA itself continues to actually, you know, work as another 8,400 people are added to Medicaid via the expansion program here in Michigan:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 334,599
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 21, 2014 
*Updated every Monday at 3 p.m.

(Note that this is actually as of a week ago...there should be another update later this afternoon...)

As there are an estimated 500K eligible for the expansion program, this means that Michigan has already reached 2/3 of the total in less than 4 months.

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