Charles Gaba's blog

Presented without comment:

Key Republicans running for election Nov. 4 say the federal Affordable Care Act is putting Kentuckians out of work, but employment data and interviews with Kentucky-based economists suggest otherwise.

...Factually, the claim doesn't appear to be accurate. Kentucky had 26,271 more people working last month than it did in March 2010 when President Barack Obama signed the Affordable Care Act into law, according to the U.S. Bureau of Labor Statistics. The state's unemployment rate in that same period fell from 10.5 percent to 7.1 percent.

Manoj Shanker, an economist at the Kentucky Office of Employment and Training, said the health care law "is expected to be a net gain for the economy."

"It is definitely expected to create jobs, and not just for doctors and nurses," Shanker said.

...About 3,600 additional health care jobs were created over the last year in Kentucky as places such as Perry County...saw the percentages of their population without health insurance drop from as high as 20 percent to no more than 8 percent.

Still no Medicaid update since 8/13, but Oregon's total QHP figure is up another 687 since 9/22, while NET QHPs are down 696, giving an overall attrition rate since the peak in mid-July of around 2.3% per month. Note that the net current enrollment figure is still 14% higher than the last official HHS report tally of 68,308:

September 29, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 354,958
Total private medical insurance enrollments through Cover Oregon: 102,596

Oregon Health Plan enrollments through Cover Oregon: 252,362*

*OHP enrollment data is current as of August 13, 2014. An updated number will be posted soon.

Net private medical: 77,920

I've already posted about this issue several times before, but I, like the Wall St. Journal, figured I should post a reminder since today's the deadline:

WASHINGTON—Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act.

The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for.

The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers.

This morning I introduced an all-new, cleaned-up version of The Graph which only includes commercial policy enrollments via the ACA (exchange QHPs, plus references to off-exchange QHPs, ACA-enabled ESIs and sub26er enrollees), projected out through Nov. 15th (when the whole process starts all over again).

Now I've added the other half of the revamped graph: ACA-enabled Medicaid/CHIP enrollments.  Like the QHP graph, there are 3 color-coded sections, but in this case they represent "Strict ACA Expansion" (people who are only eligible for Medicaid/CHIP due to the income provisions within the law in half the states); "Bulk Transfers" (ie, transferred from existing state-run programs such as LIHP in California, Commonwealth Care in Massachusetts, etc. due to ACA provisions) and "Woodworkers" (people who were already eligible for Medicaid prior to the expansion provisions, but who never enrolled before due to either being unaware of their eligibility, not understanding the process, etc). "Woodworkers" are folks who have been "drawn out of the woodwork" since last October thanks to a robust outreach program by the government and affiliated nonprofits, as well as a streamlined enrollment process and other measures.

QHPs are up another 183, Medicaid 5,242 and MinnesotaCare (which is a little bit like high-end Medicaid, from what I can tell) is up another 1,160 over the past 7 days:

latest enrollment numbers 

September 28, 2014

Health Coverage Type Cumulative Enrollments
Medical Assistance 212,331
MinnesotaCare 74,609
Qualified Health Plan (QHP) 55,001
TOTAL 341,941

OK, I'll be frank, this has little to do with the Affordable Care Act itself. Michigan's state legislature has already (grudgingly) passed the ACA's Medicaid expansion program (we call it "Healthy Michigan" here, and it's been very successful).

In other words, the only directly ACA-related items likely to come up over the next couple of years are presumably a) continuing support for Medicaid expansion (not sure if it has to be renewed annually or what) and b) the outside possibility of voting on establishing our own ACA health insurance exchange in the event that the Halbig/King cases end up being upheld by the SCOTUS.

Having said that, if you support me and the work I'm doing here, I'd like to ask a personal favor of you: Please help out the woman running for representative in Michigan's 40th state house district, Mary Belden.

Louise Norris of HealthInsurance.org has posted a couple of fantastic articles the past week or so. First up is an explanation of why most current healthcare policies weren't cancelled...which is to say, the insurance companies cancelled most of them for different reasons than what ACA critics are claiming:

But AV is just one of numerous factors involved in compliance with the ACA. There were many other reasons that existing plans were not compatible with the law. Of particular importance, less than 2 percent of the individual health plans in existence in early 2013 provided coverage for all ten of the ACA’s mandatory essential health benefits.

...So when policies are being cancelled and replaced with ACA-compliant coverage, AV isn’t likely to be the primary culprit. Virtually no individual policies that were in effect prior to 2014 are compliant with the ACA, for a host of reasons other than AV.

ACA-compliant plans will be cancelled? Wrong.

Hmmm...now this is interesting. Yesterday it was brought to my attention via Twitter that the Covered California website (or at least the actual off-season enrollment portion of it) had been offline for "2+ weeks". Sure enough, when I took a look for myself, after clicking past the home page, the enrollment section had a message saying that it was offline for maintenance but that I should "check back on September 15th". Of course, seeing how it was Sept. 28th when I read this, that suggests that the maintenance started sometime before the 15th and continued well past the estimated completion date.

@CoveredCA website has been down for 2+ weeks. What are people supposed to do? At least update your home page. #ACASignups #CoveredCA

— Julie Kornack (@jkornack) September 28, 2014

As we approach the 2nd Open Enrollment period, and as The Graph has become far too unwieldy to keep laid out in its current format, I've decided to break out the commercial plans (Exchange-based QHPs, plus references to the off-exchange QHPs, ESIs via SHOP exchanges/etc. and "sub26ers") onto their own graph. As you can see, this allows me to add another important new feature: My projection of the currently enrolled/paid up figure at any given time. We're also close enough to Year Two now (and my projections to date have proven accurate enough so far) that I'm comfortable projecting the QHP graph forward through November 15th (at which point Year Two starts up).

The 11/15 projections (as well as the "currently enrolled" line) assume a 9,000 new enrollments per day, a 90% payment rate, and a 2% average monthly attrition rate. This lines up almost precisely with the recent CMS announcement that 7.3 million people were currently enrolled & paying as of August 15th.

OK, I feel a bit silly posting this several days after HHS Sec. Burwell stated it officially, and it may seem especially anticlimactic given that I had already posted similar numbers from not one, not two, not three, not four, but five different respected national health insurance coverage surveys a couple of months ago (RAND Corp, Gallup, Urban Institute, Commonwealth Fund and the New England Journal of Medicine, to be precise), but it still seems like a good idea to lock this down for the record:

Taking questions yesterday from reporters for the first time at a White House news conference, HHS Secretary Sylvia Mathews Burwell said insurance programs created by the Patient Protection and Affordable Care Act have reduced the nation’s uninsured population by 26 percent. She called the reduction “the most important number” to measure the law’s success.

OK, the number-crunching gets a little complicated here, and isn't helped by some sloppy wording on the part of the reporter (though it's a highly useful article overall).

First, let's start with the headline: "Thirty-percent attrition bites into exchange revenues"

Health exchange managers expect to lose about 30 percent of enrollees due to attrition by year’s end.

That means they’ll carry over about 114,000 existing customers as they head into the 2015 open enrollment season.

Connect for Health Colorado managers expect enrollments to slide back from a total of 146,000 so far.

...Of the 146,000 people who signed up by the end of August, exchange managers said 10 percent dropped out right away, never paying their first month’s premium. Then about 20 percent more leave in subsequent months.

Holy cats.

A couple of weeks ago, a GAO report concluded that a dozen or so insurance companies, along with the Washington State ACA exchange, weren't fully complying with the "no federal funding of abortion" provision within the Affordable Care Act:

The new GAO study shows that, instead, taxpayers are subsidizing abortions. Customers in five states have no abortion-free plans available to them, and in many states, customers can't tell which plans cover abortion and which don't.

...Fifteen issuers and the Washington Health Benefit Exchange ... did not itemize the premium amount associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they send a separate bill for that premium amount.

One of last week's big ACA stories was the news that the largest insurance company on Minnesota's exchange, PreferredOne, was dropping out of MNsure.

ACA critics pounced all over this news as Yet More Proof That Obamacare Is Failing®, even though pretty much every "proof" they've presented to date has turned out to be nonsense or, at best, vastly exaggerated (never mind, either, the fact that overall, 77 new insurers are joining the ACA exchanges while only 15 are dropping out, for a net gain of 62 companies nationally).

The official toll as of 9/22 is slightly lower, at 395K...

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 395,547
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 22, 2014

...but there's an even more recent figure given today, as GOP Governor Rick Snyder tries to take credit for the program (note that the article doesn't mention "Obamacare" or "the Affordable Care Act" anywhere in it):

LANSING, Mich. (AP) — Just over 400,000 low-income adults in Michigan have signed up for Healthy Michigan, the state’s Medicaid expansion program.

In addition, the original estimate of the maximum eligible number of MI residents was apparently a bit high (500K); evidently the actual number is slightly lower...meaning that the percentage reached is even better by comparison:

...The state expects enrollment to eventually reach 477,000.

A couple of weeks ago, I reported that Maryland, which was one of the states which had embarrassingly bad technical problems with their ACA exchange--and which ended up scrapping their platform completely and moving to an all-new system based on Connecticut's excellent platform--was making some very wise decisions for 2015 based on lessons hard-learned from 2014:

BALTIMORE (Tuesday, Sept. 16, 2014) — The second year of Maryland’s health insurance marketplace for individuals and families begins on Nov. 9 when consumers will have access to a newly redesigned website that enables “anonymous browsing,” the ability to compare plans — without registering personal information — before enrolling. This feature is being launched earlier than originally planned to enhance the shopping experience for Marylanders.

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