Charles Gaba's blog

My estimate for "woodworkers" in non-expansion Georgia has been around 63,000 people; this article pretty solidly places that number at about 1/3 higher: 91,000 to date:

As of Thursday, DCH has received more than 40,000 “account transfers” from the exchange, “with about 2,000 arriving every hour,’’ an agency spokeswoman, Kallarin Richards, told GHN.

These potential sign-ups in Georgia have been stalled for months due to technological snags.

Community Health said Friday that it’s waiting until all of the transfers have been received from the exchange before processing them. “This will ensure DCH is working from the most recent data and can identify any duplicative applications that may exist,” Richards said in an email.

Federal health officials recently reported that more than 91,000 Georgians were identified through the health insurance exchange as eligible for Medicaid or PeachCare.

Looks like last week's claim of 9,800 QHPs was a bit of an error...according to the official exchange update, the combined total of QHPs + SHOP enrollments is around 9,800:

Total since October 1, 2013

31,378 Applications completed in the Individual Marketplace
9,217 Individuals and families enrolled in the Individual Marketplace
588 Employers applied to SHOP Marketplace
628 Employees and dependents enrolled via SHOP Marketplace

BCBSNC reports 232,000 QHPs sold on the ACA exchange...but that's out of about 273,000 total enrollees; they've removed the other 15% who haven't paid their premium yet:

The Blue Cross enrollments reflect insured customers who signed up from October through May 1 and are still paying premiums. About 15 percent of customers who signed up never paid a premium and are not included in the 232,000 figure, Burke said. 

So, fine: 85% for Blue Cross of NC. As it happens, NC sold a total of 357,584 policies total, which means BCBSNC sold over 76% of the total.

Now, it's conceivable (but not likely) that 100% of the remaining 84,500 enrollees snapped up by other companies did pay their premiums, but even so, that would only bring the paid percentage up to about 88.5%. So, I think it's safe to say that for North Carolina, 85% is a reasonable "How many have PAID???" figure for the full state until more solid numbers are released.

OK, I know I recently posted my "final" update to The Graph for the first Open Enrollment period...but I included an asterisk next to "final" for two reasons: First, because there will obviously still be more enrollments added throughout the summer and fall (Medicaid, SHOP, etc); second, because I've been debating one other major addition for awhile.

As regular readers know, when the famous RAND Corp. survey came out a month or so ago, there was a lot of hubbub about their claims of up to 7.8 million OFF-exchange QHPs between October and mid-March. I made a note of this figure, but eventually downshifted in favor of the 5 million off-exchange QHP figure estimated by the CBO.

I spent quite a bit of time ripping on prominent healthcare/economic writers for their slavish worship of the February study by McKinsey & Co., which claimed, among other things, that only 27% of QHP enrollees were newly insured as of mid-February.

I should reiterate, however, that I was never directly criticizing the study itself...only the completely unfounded conclusions that so many anti-ACA pundits tried to draw from it. The main issue is that the McKinsey study included both on- and off-exchange enrollments (and stated so a good half-dozen times throughout), without any indication of what the ratio between the two was. As a result, that 27% figure could conceivably mean 54% of the on-exchange and 0% of the off-exchange enrollees, or vice-versa, making it completely useless for getting an answer to the question of how many EXCHANGE-BASED QHPs were previously insured.

ORIGINAL POST: MAY 2014. UPDATE BELOW: OCTOBER 2017.

As regular readers of this site know, I make no bones about my personal politics. I'm very much a progressive Democrat, and my ideology comes out from time to time in my commentary. However, I do my best not to allow that to influence the data or how I present it.

When the enrollment numbers sucked, I agreed that they sucked and recommended that the HHS Dept. be forthcoming with the data anyway. When the Hawaii exchange was still subject to the infamous Heartbleed bug a week or so after it was publicized, I called them on it publicly. When states like Massachusetts subjected a couple hundred thousand of their citizens to a shaky, uncertain "limbo" status due to their exchange being screwed up, I didn't try to cover that over. When a solid case was made that the "3.1 million" young adult figure that the Obama administration has been touting for months may actually be only half of that, I presented the argument, the source, the reasoning and make sure to include the lower figure on The Graph. When the RAND Corp. survey claimed that there have been an additional 8.2 million Employer-Supplied Insurance policies since last fall, I declined to add them to the total due to the bold claim and lack of any collaborating evidence (I still list this figure as a footnote, but am not including it on the Graph).

The numbers are the numbers.

I say all of this because the following is sure to cause quite a bit of controversy...but a) it's related to the ACA, b) it's a serious issue and c) it's horrifying.

Nevada is the only exchange still officially open for "normal" private QHP enrollments (although of course SHOP, Medicaid, etc. are all year-round). WIth this update, Nevada's paid QHP rate jumps from 71% up to 76% (still not great, but an impressive spike in one week...more the existing enrollees catching up with their payments than new ones being added):

The board overseeing Nevada Health Link was told Thursday that nearly 35,000 people had enrolled in a qualified health plan as of May 3, halfway through a two-month special enrollment period that ends May 30.

Another 11,000 have selected plans but not yet paid for them.

Managers believe they had QHP enrollment information and premium payments for 34,820 residents as of May 3.

In spite of their several-hundred-million-dollar meltdown of a website, Oregon has managed to pull off an impressive feat: Between private QHPs, standard Medicaid/CHIP and their "fast track" program (not included below), they've enrolled nearly 400,000 people in healthcare plans of one sort or another via the ACA.

May 8, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 271,180
Total private medical insurance enrollments through Cover Oregon 1: 77,583                

Oregon Health Plan enrollments through Cover Oregon: 193,597
Total private dental insurance enrollments through CoverOregon 1: 15,926               

Net enrollments 
Net private medical: 72,890
Net private dental: 14,602

OK, Massachusetts' exchange is still seriously screwed up, and their reporting methodology is equally confusing, but it appears to be, as contributor deaconblues notes:

  • QHP: 32,706 unsubsidized + 773 subsidized = 33,479 (up from 31,695 as of 4/19)
  • Medicaid: 195,955 (expansion plus churn)
  • Limbo Status: 93,778 + 10,382 + 201,113 = 305,273
  • SHOP: 4,982? (1,869 members in Business Express and 3,113 members in QHP)

Really not sure how to handle the SHOP numbers, and that "Limbo Status" number keeps growing (it was 270K last I checked). Come June 30, I have no idea what those 300,000 people are going to do...

As with my recent Alabama post, in which BCBS of Alabama stated that they're seeing an 82% payment rate out of an 87% market share, this is not proof absolute for Maine, but it's the best guideline we have for the state at the moment: In yesterday's Congressional testimony, executives for Wellpoint, the 2nd largest insurer in the country, stated that 90% of their exchange QHP enrollments have been paid so far. I took a look at the states Wellpoint operates in; there's a good dozen or so, and their market share varies in each one, but there's one, Maine, where they had a whopping 74% market share last year.

So, the absurd GOP House Energy & Commerce Committee Report which claimed that only 67% of exchange QHP enrollees are paid up has been thoroughly demolished by not just myself, but pretty much every other legitimate news media outlet there is (which leaves out FOX News, I'm afraid). In addition to only running through 4/15 (when 38% of the total QHP payments weren't even due yet), it only counted 160 of the 300+ insurance providers on the ACA exchanges, among many other ludicrous methodological flaws.

However, something did just occur to me. Take another look at their state-by-state breakout (which, again, only includes states on the Federal exchange...and even then, leaves out Idaho and New Mexico for reasons unknown), and there's several states which I find rather interesting:

OK, this doesn't give a complete picture of Alabama's exchange QHP payment rate for two reasons: First, because the 82% figure is a blend of 85K via the exchange and another 20K off-exchange enrollees; second, because while BCBS does have the lion's share (87%) of exchange QHP enrollees in the state, there's still another 12,870 QHPs (out of the 97,870 total in Alabama) which belong to other insurance companies, which may have a higher or lower payment rate to date.

Having said that, assuming that the ratios are representative on both counts, it looks like about 82% of Alabama's enrollees have paid so far:

Some 82 percent of those enrolling in Blue Cross and Blue Shield of Alabama through the exchanges have paid their first month's premium, mirroring figures released today by other large insurers in preparation for congressional testimony.

"We have enrolled over 105,000 members both on and off the federally facilitated exchange in Alabama," said Koko Mackin, BCBS of Alabama said in an email to Al.com. "Over 85,000 members enrolled through the federal exchange, while another 20,000 signed up directly with Blue Cross -- 82% of our exchange enrollees have paid their first month’s premium."

Presented without comment:

U.S. Department of Health & Human Services
202-690-6343
News Division
media@hhs.gov
www.hhs.gov/news

FOR IMMEDIATE RELEASE

Wednesday, May 07, 2014

New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

Hospital Readmissions Fall by 8 percent among Medicare beneficiaries

Today, the Department of Health and Human Services announced that new preliminary data show an overall nine percent decrease in hospital acquired conditions nationally during 2011 and 2012.  National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

OK, not exactly the most stunning headline in the world (although this does appear to be shocking news to a certain anti-ACA political party), but still kind of cool to have some solid numbers on just how many lives could be saved with universal coverage:

Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.

Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.

Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.

Not exactly surprising, but rather embarrassing for the state which spawned the ACA in the first place.

If the "off-the-shelf" replacement works, great. If not, and they follow Oregon into having HC.gov take over, that would mean a net change of...zero states, with MA and OR moving into the fold while New Mexico and Idaho break out on their own exchanges.

Massachusetts has scrapped its hopes for a totally customized state-based health exchange under the Affordable Care Act, and will instead purchase an “off-the-shelf” solution that can be installed by the fall with the possibility of joining the federal exchange if all else fails.

The state announced Monday that it would contract with Virginia-based hCentive for health insurance exchange software that has been used to power online marketplaces Kentucky, Colorado, New York and other states.

Health and IT officials will simultaneously work to ready the state and its insurers to join the federal health exchange in case the hCentive software solution cannot be implemented in time for the next insurance open enrollment period that begins in November.

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