Charles Gaba's blog

Hmmm...Minnesota's exchange QHPs continue to grow, but the rate has plummetted over the past couple of weeks, dropping from 52 per day through the end of June to just 31 in the past 2 weeks. While I've been expecting the rate to slow down somewhat, this seems like an awfully large drop for such a short period of time.

Combine this with Hawaii, which reported an actual loss of QHPs and I'm starting to wonder if I've misunderstood how the state exchanges are reporting their numbers. It's possible that they're including people who drop their coverage after a few months as well as those who add coverage, which would result in the official tally holding relatively steady over time. I'll have to look into this...

latest enrollment numbers

July 13, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 154,106
MinnesotaCare 54,877
Qualified Health Plan (QHP) 52,264
TOTAL 261,247

Yesterday I posted an update from Michigan which touted the state meeting their 1st year Medicaid expansion enrollment target of 322K; today the official tally was updated again, with another 3,000 people being added:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 326,167
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 14, 2014 
*Updated every Monday at 3 p.m.

When we last checked in on Hawaii's ACA exchange on 6/21, the QHP tally stood at 9,586 people, and another 965 SHOP enrollees.

There have been 2 updates from the exchange since then; QHPs went up another 12 over the next week (6/28)...but in the most recent update, the number has dropped down to 9,442...a loss of 156 people:

Connector Updates for July 5, 2014

Total since October 1, 2013

32,959 Applications completed in the Individual Marketplace
9,442 Individuals and families enrolled in the Individual Marketplace

Hold everything: Something important was just announced:

We are teeming with excitement to announce that Nerdist is premiering “Weird Al” Yankovic’s first music video for his #8videos8days project. Feast your eyes on the video for “Tacky,” a wonderfully warped and wacky version of Pharrell’s hyper-bubbly mega-hit, “Happy.”

(Here's the lyrics, since some of them are kind of hard to make out.)

That is all.

A couple of weeks ago, I posted an entry regarding the proposed rate change requests by the 17 insurance companies participating on Michigan's ACA exchange for 2015. The news at the time was a mixed bag, with some companies requesting rate increases of up to 18%, while others were requesting a reduction of their rates by 22%. Overall, according to the Detroit Free Press article, the average rate increase request is a mere 0.8%. Hooray!

Michigan Governor Rick Snyder doesn't have many things to be proud of, but this is one of them: He did help push the ACA's Medicaid expansion through the extremist GOP-controlled state legislature. In response, the Healthy Michigan program has now enrolled over 323,000 newly-qualified people in Medicaid & CHIP:

LANSING, Mich. – Gov. Rick Snyder today announced that after less than four months, enrollment for the Healthy Michigan Plan already has surpassed its first-year goal of 322,000.

As of today, July 10, Michigan has 323,022 Michigan residents enrolled in the program. The Healthy Michigan Plan extends health care benefits to a half-million low-income residents. Enrollment for the plan began April 1.

The press release mostly crows about reaching the "first year goal" of 322K people in only 14 weeks, but to me the more impressive achievement is hitting 64% of the total eligible population (500K) in that time.

With the unexpected addition of QHP updates from 2 Federal Exchange-based states over the weekend (West Virginia and New Mexico), I've updated the Off-Season QHP Projection spreadsheet again, and now have it sitting at a range of between 9,500 - 12,500 additional exchange-based QHPs per day, or 285K - 375K per month:

I've also made a slight modification as to how I'm distinguishing the upper & lower-bound numbers. Instead of simply dropping Oregon out of the mix, I'm instead using every state with post-4/19 data for the upper bound, and then taking 75% of that for the lower bound. This has the same overall effect but seems more sensible than singling out one particular state for being an outlier.

In any event, this revision suggests that the total 2014 exchange QHP total should end up between 10.0 - 10.6 million. Subtract 10% from that for non-payment and you have somewhere between 9.0 - 9.5 million paid QHPs.

Some good news (relatively speaking) on the Massachusetts front: As you'll recall, the state which inspired the ACA (ironically due to the program being spearheaded by then-Governor Mitt Romney), and which has been operating under their state-level version of the law smoothly for some years now, had an incredibly embarrassing misfire with their ACA-specific exchange website. After hobbling through the first enrollment period (and leaving over 200,000 residents in healthcare limbo as a result), it was determined that the existing site was such a mess that they had two choices: Either replace the existing software with an entirely new system, or drop the whole thing and move over to the Federal exchange as Oregon is doing.

Instead, Massachusetts decided to hedge their bets and pursue both: They've been working with a new vendor to rebuild their own exchange from scratch, while simultaneously arranging for a quick move to HC.gov just in case Plan A doesn't work out.

The good news is that so far, anyway, the new platform seems to be working out in early testing, though it's way too early to be sure of anything:

Wow! This editorial is fairly short but chock full of great up-to-date enrollment data: Exchange QHP enrollment has risen exactly 6,000 people since April 19 (an increase of over 30%); the Medicaid expansion tally is up by 4,556 to 132,556 people (almost 93% of the total eligible), and the overall uninsured rate has plunged from 17% to just 6.6%...all in less than 10 months. Amazing.

President Barack Obama’s Affordable Care Act is a superb success in West Virginia, according to new reports.

A total of 132,556 lower-income West Virginians have gained coverage through the Medicaid expansion approved by Gov. Earl Ray Tomblin. An additional 25,856 were able to enroll in subsidized private insurance plans. And about 18,000 young adults were allowed to remain covered by their parents’ policies until age 26.

That’s more than 176,000 Mountain State people who gained the ability to visit a doctor, get prescriptions filled or receive hospital care. Hurrah. It’s a big advance for compassion and humane values. Everyone should have access to medical treatment, and nobody should be left out.

OK, I've just updated The Graph again, with two major changes: First, I've updated it to include the new May 2014 CMS Medicaid/CHIP report data, which nudges the total up by several hundred thousand.

In addition, however, I've also done something which has been on my mind for awhile now: For the first time, I've removed the UNPAID Exchange QHP section from the graph completely. In addition, I've knocked the "Paid" percent down one more notch to 89%--not because I've changed my mind about the eventual paid percentage hitting 90%, but because at any given time the most recent enrollees (from the past couple of months) will fall below that threshold, meaning the overall paid percentage will be slightly lower.

OK, I just received the report itself, so it'll take awhile to slog through the numbers, but here's the chief takeaways:

Medicaid enrollment continues to increase all across the country, especially in those states that have expanded their Medicaid programs under the Affordable Care Act.

As of the end of May, 6.7 million more individuals were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) as compared to the baseline period from July through September 2013, an increase of 11.4 percent. That includes more than 920,000 additional people enrolled in May as compared to April in the 48 states and the District of Columbia that reported data.

As we’ve seen for months, growth was more pronounced in 26 states (including the District of Columbia) that had adopted and implemented the Medicaid expansion by the end of May.  Enrollment in those states rose by 17 percent, while states that have not expanded reported only a 3 percent increase.

Oregon continues to rack up impressive QHP numbers, although their daily average is definitely slowing down as we move farther from their "extended-extension period". Even so, their net enrollments are still up another 1,258 since 6/24, while Medicaid enrollment has gone up just 1,221. My suspicion for the Medicaid enrollment drop-off (also noted by contributor deaconblues) is that they've simply run out of Medicaid-eligible people in the state...which makes sense seeing how they've added 355K people to the program since January (227K via the exchange + another 128K via their "fast track" program), when the Kaiser Family Foundation estimated that there were only 260,000 uninsured people even eligible for Medicaid to begin with!

Guest Post by Brian White:

Contrary to the conservative meme that everything in the Patient Protection and Affordable Care Act (ACA) is an unprecedented overreach of federal power, the ACA contraceptives mandate was patterned on longstanding state “insurance-equity” laws. Such laws promote the health of women, children and families by assuring access to prescription contraceptives. Though not superseded by the decision handed down by the Supreme Court in the Hobby Lobby case, these state laws never actually pertained to Hobby Lobby or any other large employer with pockets deep enough to avoid state-regulated insurance products altogether by self insuring.

A few days ago, several people sent me a link to this story from the Philadelphia Inquirer which discussed the impact of the ACA on Medicaid enrollment in the 26 states which expanded the program vs. the 24 which haven't done so (including Pennsylvania), and the positive impact it would have on PA's uninsured rate if they were to do so.

However, the following passage seemed rather strange to me, and I didn't want to post anything about it until I cleared up the mystery:

Pennsylvania and the 23 other states that haven't expanded Medicaid have signed up fewer than three million people for the program. That's in sharp contrast to the almost 10 million people enrolled by the 26 states and District of Columbia that expanded Medicaid when the marketplace opened November.

Hot on the heels of this morning's Commonwealth Study survey, which pegs the reduction of the number of uninsured adults at 5% (around 9.5 million, plus perhaps 2.5 million children under 18, for a total reduction of around 12 million) comes another study by the Urban Institute, which gives a slightly smaller reduction (4% of all adults nationally, or around 8 million...or around 10.5 million or so if you add children in).

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