Charles Gaba's blog

COLORADO: Exchange COO joins exodus, new system late

Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.

And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins.

VIRGINIA: Funds to help Va. health care coverage signups

Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance.

Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15.

VERMONT: Federal Law Raises Questions About Who Can Bid For IT Projects That Support The Exchange

A provision of the Affordable Care Act precluding health insurers or companies in the “same controlled group of corporations” as a health insurer from holding exchange contracts raises questions about Optum working on Vermont Health Connect.

Concerns regarding Optum were raised at the federal level by Sens. Orrin Hatch, R-Utah, and Chuck Grassley, R-Iowa, the ranking members of the Finance and Judiciary committees respectively.

IDAHO: Your Health Idaho to launch sign-up system

Basically just an overview of the new Idaho ACA exchange; ID is the only state moving from HC.gov to their own website for the 2nd year, giving them a unique perspective. Most interesting to me is that they're spinning the "autonomy/states-rights" angle, which was the whole reason for pushing states to set up their own exchanges in the first place:

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

Some fun with numbers.

As I predicted in early September, Part Two of the "OMG!! GAZILLIONS OF POLICIES CANCELLED!!" freakout has commenced with 3 weeks to go before the election. Case in point: Colorado, where the state Insurance Commissioner sent a letter to "state Senate Republicans" yesterday (I'm going to assume that this was in response to their request, as opposed to the Commissioner voluntarily choosing to only inform the Republicans specifically) stating that a total of 22,000 policies are scheduled for cancellation due to non-compliance with ACA provisions:

Over 22,000 Coloradoans have had their health insurance canceled by Obamacare in the past month — and 200,000 are slated to be shut down in 2015, the state insurance department announced Friday.

The Colorado Division of Insurance wrote to state Senate Republicans Friday, notifying them that five more insurance carriers have ended plans for 18,783 more Coloradoans in just the last month. By far, the most canceled plans will come from Humana Insurance Company and Humana Health Plan.

When I last checked in on New Jersey back in June, their Obamacare Medicaid expansion tally was at around 229,000 people. This number has jumped to 343,000, out of around 466,000 NJ residents eligible for the program, or roughly 74%:

The 343,000-person expansion in Medicaid enrollment this year is nearly three quarters of the 466,000-person expansion-eligible population estimate by the Kaiser Family Foundation. But the 161,775 residents who enrolled through the marketplace are equal to just over one quarter of the estimated 628,000 eligible.

The other noteworthy thing here is that according to my own breakdown of the KFF estimates, New Jersey only has around 562,000 uninsured eligible for tax credits via the ACA, not 628K. However, this is mostly moot since those with insurance can also purchase QHPs via the exchange as well if they wish, so it's not really that big of a deal.

As for the 161,775 QHP figure, that dates back to last spring, so no update there.

A couple of days ago, in response to my debunking of Mitch McConnell's litany of lies about the Affordable Care Act, I posted a letter from a Kentucky resident who gave his view of the situation.

In response to thatanother Kentucky resident responded with a different perspective. Again, aside from cleaning up some typos and breaking it into more paragraphs for easier readability, I'm presenting it verbatim:

Mr. Gaba, I am also from Kentucky. I appeciate your fact checking of McConnell on the ACA and in most instances I would say that you are correct and he is not.

That said, I work in health care and we have also seen a boon in our bottom line due to decreased uncompensated care and bad debts. We are also in a poor county and almost 80% of the people were Medicaid recipients including some of my family members, so the ACA, at least in the short term has benefited us.

I'm swamped with my day job at the moment, so I won't be able to do an analysis/breakdown until later, but the August CMS Medicaid/CHIP report has been released, and the major takeaway is that even more people have been enrolled in Medicaid or CHIP programs thanks to the Affordable Care Act than even I had estimated (which is either a good or bad thing depending on your partisan leanings):

The Health Insurance Marketplace, Medicaid, and Children’s Health Insurance Program (CHIP) are critical in ensuring coverage for many individuals. As of August 15, 2014, 7.3 million Americans were enrolled in Marketplace coverage and had paid their premiums. This number represents a snapshot of a point in time, not the cumulative enrollment data from October 2013 through August 2014. 

The other day I noted that Republican Congressman Tom Cotton of Arkansas, currently in a heated battle with U.S. Senator Mark Pryor to take Pryor's seat, is proposing not only stripping healthcare from the 200,000 people in his state who have gained healthcare this year thanks to the Affordable Care Act's Medicaid expanion provision (the "private option" in AR) as well as 40,000 people who are paying for policies via the ACA exchange, but is going even further by pushing for half of the pre-Obamacare Medicaid/CHIP budget to be slashed.

This would effectively result in up to 20% of the state's entire population losing their healthcare coverage...every one of whom is either poor or barely middle-class at best.

Well, that number just went up a bit more:

The massive data dump from this afternoon out of Covered California was mostly excellent news, both for the ACA as well as myself personally:

  • I nailed the total QHP enrollment figures during the off-season almost precisely (99% accurate on the total number, 96% accurate on the daily average)
  • The gross attrition rate has been only 1.6% per month, and the net attrition rate since April is an astonishingly low 1.8% over 6 months, or just 0.3% per month, which is far better than anyone (including myself) had imagined. Basically, people being added are almost entirely cancelling out people dropping coverage.
  • The list of technical improvements, new features, beefed-up staffing and ramped-up outreach efforts for the 2nd open enrollment period included in the press conference was extremely impressive (see the lower half of this entry from earlier today).

HOWEVER, there was one key data point which was quite surprising and disappointing to me: The initial payment rate.

OK, I've started a new entry since the last one was getting pretty long.

I still have to sort through a bunch of data, but the main takeaway is this:

  • I projected the total California QHP enrollment figure to be around 1.68 million. The actual number is 1,414,668 (as of 4/15...see update at bottom of this page) plus 200,000 off-season enrollments from 6/1 - 9/30 plus an unknown number from the 46 days between 4/16 - 5/31.
  • I have no idea why they left those 46 days out of the press conference. Very odd.
  • There were 200,000 people who enrolled from June 1st - September 30th (122 days), or 1,639 people per day.
  • Assuming the missing 46 days saw a similar rate to the rest of the off-season period, that would be 1,639 x 46 = 75,394 additional enrollees.
  • Assuming this is correct, that's 1,614,668 + 75,394 = 1,690,062
  • That would make my projection 99.4% accurate.

Regular readers know that given the HHS Dept's going radio silent on the total ACA enrollment figures since the last official report was released back in May (which only ran through April 19th), I've been patching together bits and pieces of enrollment data from a handful of state exchanges, plus the occasional snippet of info from other states which has managed to find daylight from time to time.

Based on this, I've been projecting roughly 9,000 QHP enrollments being added per day during the off-season, translating into around 270,000 per month, of which about 90% eventually pay their first months premium. That translates to around 240K paid enrollees being added per month, which in turn is being roughly cancelled out by people dropping their policies after the first few months as they move on to other types of coverage (Medicare, ESI, Medicaid and so forth). Based on these estimates, there should now be a gross total of around 9.6 million enrollments, of which around 8.3 million have paid their first premium, and around 7.4 million who are currently enrolled as of October.

Looks like Access Health Connecticut is having a press conference even as I type this...

CT exchange update: 74,334 people in private insurance plans, 208,468 signed up for Medicaid

— Arielle Levin Becker (@ariellelb) October 16, 2014

As of April 19th, 79,192 people in Connecticut had enrolled in QHPs. Since their non-payment rate has been "in the single digits" (call it 8%), that means around 72.8K paid enrollees as of then.

If there are currently 74,334 enrolled, that means there are 2% more enrolled (and paying) today than there were 6 months ago, which is right in line with my projections as well as the national 7.3 million figure mentioned by HHS Secretary Burwell as of August.

Meanwhile, Medicaid enrollees via the exchange are now up to 208,468. This is only a small increase over a month ago (around 1,400 people), but there's a very good reason for that:

First, I just want to take a minute to note that over the past year, I've discovered that while there's lots of good reporting on the ACA nationally, there are certain states which have one particular person who's the "go to" journalist for all things Obamacare-related.

In Connecticut, it's Arielle Levin Becker. In Vermont, Morgan True. In Kentucky, it's Joe Sonka. In Colorado, it's Louise Norris. In Oregon, it's Nick Budnick. And in Arkansas, it's David Ramsey:

A nice, simple, no-nonsense enrollment update from the DC exchange:

From October 1, 2013 to October 7, 2014, 60,771 people have enrolled through DC Health Link in private health plans or Medicaid:

  •  15,110 people enrolled in private health plans through the DC Health Link individual and family marketplace.
  •  14,486 people enrolled through the DC Health Link small business marketplace.
  •  31,175 people were determined eligible for Medicaid coverage through DC Health Link.

That's an increase of 708 QHPs, 627 in SHOP policies and 1,983 in Medicaid.

A nifty summary of technical data points/specs behind the completely overhauled/revamped state ACA exchange website in Massachusetts after the first one failed spectacularly last year includes the following key points:

306,000 — the latest number of Massachusetts residents enrolled in temporary coverage. Will all these people need to get coverage through the state? No one knows, because there’s been no way to process their eligibility this year. But the total number of people trying to use the site during the three months of open enrollment could be around…

450,000 — which is 306,000 + the 100,000 or so people who are still in subsidized Commonwealth Care plans and another 33,000 or so residents who buy insurance through the Connector.

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