Charles Gaba's blog

WOW!! This article from last week is chock full of data-nuggety goodness, including the first solid updates out of Washington State in some time:

The share of Washingtonians going without health insurance has fallen by nearly 40 percent, thanks to factors put in play by the federal Affordable Care Act.

That’s the word from the state Office of the Insurance Commissioner, which estimates that the overall 970,000 of uninsured residents had fallen by 38 percent to about 600,000. That drops the uninsured rate to 8.65 percent of the state, down from about 14 percent, OIC spokeswoman Stephanie Marquis said Wednesday.

...OIC has said the individual market has grown to more than 327,000 – which was about 81,000 more insured people than were in the individual market on Oct. 1, the date that the Washington Health Benefit Exchange opened for enrollments for 2014 coverage. The individual market included 156,155 people buying private insurance policies through the exchange and 171,286 who bought policies outside the exchange.

VERY interesting news out of Oregon. On the one hand, the gross QHP enrollment figure, which had been cut in half from 300/day down to 156/day is back up to over 200/day, right in line with the rebounds from Hawaii and Minnesota!

On the other hand, unlike last week when the net enrollment figure dropped from 280/day down to a measely 10 in an entire week, the number today is actually lower than it was a week ago!

July 14 NET enrollments: 82,637; July 21 NET enrollments: 82,183...a drop of 454 people.

July 21, 2014

Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 322,707
Total private medical insurance enrollments through Cover Oregon 1: 95,115 
Oregon Health Plan enrollments through Cover Oregon: 227,592

Net private medical: 82,183

Contributor deaconblues provides a very nice catch today: A story about Wisconsin's enrollment figures which gives all the tools necessary to calculate the state's total and paid QHP enrollments as well as the off-exchange total to boot...all without actually providing any of those numbers, which is kind of a neat trick!

Let's break it down:

Wisconsin’s Office of the Commissioner of Insurance has released information concerning the number of people that have acquired health insurance coverage as of June 1 of this year. The state’s Governor, Scott Walker, intends to cut the number of uninsured people throughout Wisconsin in half within the foreseeable future. According to state officials, the number of uninsured people in the state as of March of this year stood at 556,000.

Some 166,000 Wisconsin residents have purchased health insurance over the past several months, according to the Office of the Insurance Commissioner. Of these, some 134,000 people purchased coverage from the state’s health insurance exchange. a follow-up to the last Hawaii update, I've taken a look at Minnesota (the 2nd of the 3 states which caused me to issue a dramatic off-season forecast drop). The results are...inconclusive:

latest enrollment numbers

July 16, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 156,032
MinnesotaCare 55,941
Qualified Health Plan (QHP) 52,325
TOTAL 264,298

That's 61 more QHP enrollees in 3 days (7/13 - 7/16), or about 20 per day. On the one hand, that's still way down from the 52/day that the state had been averaging from late April through the end of June. On the other hand, it's way up from the 2 (yes, 2) per day that MN was averaging over the first 2 weeks of July.

Huh. A week ago I posted a Hawaii update which noted that exchange QHPs for Hawaii had actually dropped by 156 people from 6/28 through 7/05. This was quickly followed by similarly huge enrollment drop-off figures out of both Oregon and Minnesota.

However, check it out today...

Connector Updates for July 12, 2014

Total since October 1, 2013

32,991 Applications completed in the Individual Marketplace
9,675 Individuals and families enrolled in the Individual Marketplace
675 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*
* as of July 15, 2014

As I noted way back in October (seriously, I made a note of it at the bottom of the spreadsheet the very first week), the ACA situation in Guam, American Samoa, Puerto Rico, the U.S. Virgin Islands and the Northern Mariana Islands is, to put it mildly, kind of screwed up. Due to some massive oversights, they were stuck with some of the ACA's provisions (no denials for pre-existing conditions, having to accept everyone, etc.), but didn't get the other key provisions (no exchanges, no subsidies). As a result, it's been a bit of a mess.

Thankfully, the problem has been "solved", although not quite the way the Obama administration intended:

Guam and the four other American territories got some good news this week: they will no longer be held hostage by a byzantine set of Obamacare rules and regulations.

As deaconblues notes, a mixed bag. Scott Walker kicked 63,000 people off of Medicaid, of which 38,000 weren't able to receive coverage of any sort. On the plus side, over 97,000 additional people were added to Medicaid coverage.

So, if I'm reading this correctly, it sounds like Wisconsin's Medicaid program added around 160,000 people but lost 63,000 to get the net of +97K.

Coverage ended in April for 62,776 people who earn too much to remain on Medicaid; they had until June 1 to buy the federally subsidized insurance offered through the federal online marketplace where applicants can shop for plans.

The new DHS numbers show that 30 percent, or nearly 19,000 people, purchased a plan through the exchange by the June deadline. Nearly 5,900 more, or 9 percent, either became Medicaid-eligible and received coverage through the state's BadgerCare Plus program or were enrolled in both Medicaid and the exchange.

Montana's official 4/19 exchange QHP tally was 36,584, of which I estimate around 33,000 have actually paid their first month's premium. Since MT has not expanded Medicaid, and is a sparsely-populated state, I only have them pegged with around 5,000 Woodworker enrollees, for a total of around 38,000 people.

Considering that the Kaiser Family Foundation has estimated the "previously uninsured" rate at only around 57% nationally, it's actually quite impressive that the net reduction in Montana's uninsured is 30,000; that suggests that for this state at least, it's closer to perhaps 79%:

HELENA, Mont. (AP) — About 30,000 more Montana residents are enrolled in a health insurance plan than were before the Affordable Care Act enrollment period took place, state officials said Tuesday.

State Insurance Office Deputy CommissionerAdam Schafer told a legislative panel his office surveyed the state's largest insurance companies to learn whether the number of uninsured decreased after the federal health care overhaul.

The good news: While Maryland's enrollment numbers are still way below their expectations due primarily to a screwed-up exchange website, they're continuing to crank out smaller numbers of enrollees, and have now hit the 75K milestone:

Maryland enrolled about 75,000 people in private health plans, about half as many as the state initially aimed to sign up in private insurance plans. However, the state ended up enrolling about 300,000 people through Medicaid. The Connecticut health exchange technology was chosen largely because it was effective and preserves Medicaid enrollments.

The 300K Medicaid number is impressive, but I already have that number plugged in so no changes there.

On the down side, MD's move to an all-new exchange website platform (purchased from Connecticut), while a welcome move, will also require everyone who's receiving subsidies to re-enroll this November:

I posted about Colorado's June enrollments a couple of weeks ago, but that was a rounded number and apparently was mixing in SHOP enrollees with QHPs. The official report has been released, and the numbers are a bit worse than I thought (though still impressive for off-season enrollment): 136,605 QHPs and 2,373 SHOP enrollments.

Arizona may not be adding Medicaid expansion recipients at nearly the same rate as states like Michigan, West Virginia and Arkansas, but they're doing a pretty good job; AZ is now up to over 192K people, or about 41% of the estimated 469K uninsured individuals who are eligible for Medicaid:

During the month of June, 19,736 were added to AHCCCS in the Proposition 204 Restoration Category (0-100% FPL) and 4,771 were added to Adult Expansion category. To date, 192,268 Arizonans have been added since January. The total AHCCCS population now stands at 1,552,186.


Yeah, yeah, I's a bit stupid to set up a Facebook page now instead of, say, back in October, November, December...but whatever. I was encouraged by the response at Netroots Nation 2014 that there's still enough interest to keep the site not just running but running robustly, so here you go: The official ACA Signups Facebook Page.

Also, while I'm at it, I've established a separate Twitter account just for ACA Signups. I mainly did this to prevent any imposters from doing so, since so many people are already following @charles_gaba for ACA updates, but I'll probably start cross-posting at @ACASignups as well if enough people start following it.

NOTE: Yes, I'm back from the Netroots Nation convention here in Detroit, and yes, I have a mountain of ACA submissions (along with actual paying client work) to catch up on. However, with the DC Circuit Court ruling expected to come out tomorrow, it behooved me to post this ASAP:

A couple of weeks ago I posted a 2nd story about the last (to my knowledge) major anti-ACA case winding its way through the federal court system: Halbig v. Burwell.

In a nutshell, the plaintiffs are arguing that the precise wording of the ACA allows the IRS to issue tax subsidies to people who enroll in QHPs using the state exchanges (NY, CA, KY, CT, etc.), but not to people who enroll through the federal exchange (ie, Healthcare.Gov). If the case survives all the way through to the SCOTUS (or if it survives the full DC Circuit Court and the SCOTUS refuses to look at it), then it would presumably mean that almost 5 million people (or more) who enrolled via and qualified for subsidies (about 85% of them) would a) have those subsidies cut off and b) could theoretically have to pay back the subsidies that they already received, assuming the ruling was retroactive.

I know I said I wouldn't be posting during the Netroots Nation convention unless something significant happened. Well, thanks to the Kaiser Family Foundation, I've learned of a pretty important development. The state of Rhode Island just released their decision on the APPROVED insurance premium rates for Blue Cross Blue Shield in 2015. Check it out:

As you can see, BCBSRI asked for an average rate increase of 8.9%. The state insurance commissioner approved...4.5%.

Obviously this may not be typical of what will happen in other states or for other companies, but the point is made: the preliminary rate requests are just that: Preliminary. You can REQUEST anything; that doesn't mean you'll get it.

UPDATE: I've found the market share breakout for both companies (the third one is new to the exchange), and it looks like BCBSRI made up almost all of it (98%), so the weighted average looks to come in at around 4.3%.

As I mentioned the other day, I'll be attending the Netroots Nation conference here in Detroit for the next few days. On the one hand, this would seem to be the perfect event to post lots of blog updates. On the other hand, most of those updates require me to muck around with spreadsheets and whatnot, which I don't really feel like screwing with for the duration of the conference.

So, unless there's some really major ACA-related news which breaks between now and Sunday, I probably won't be posting anything until then. Please feel free to send updates, they just won't be posted until after the conference.

Thanks, and perhaps I'll see a few of you there!