Michigan continues to quietly enroll thousands and thousands of people in ACA-expanded Medicaid, having already reached 81% of the 320K first-year goal in just 7 weeks (or, alternately, 52% of the total eligible for expanded Medicaid state-wide):
Healthy Michigan Plan Enrollment Statistics
Beneficiaries with Healthy Michigan Plan Coverage: 259,007
OK, due to my unexpectedly-far-longer-lasting bout of shingles, I've gotten a bit backed up with my ACA news the past few weeks, but I did want to address the "cost per enrollee" story which popped up a week or so ago:
Sometimes there really are economies of scale. And the nation’s health insurance exchanges may be a case in point.
As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.
The article (and others like it) goes on to break out the individual state exchange costs. Some do better than others, of course, and Hawaii comes in dead last (in part simply because their uninsured population is so small to begin with). While it's certainly interesting to see which ones were the most efficient and which were the least, there's a big part of me which keeps asking "why is anyone surprised by this?"
In spite of all the hand-wringing that people have had about the insurance company premium rates for the 2nd year of the exchanges (this is the main reason for all the freaking out about how many "young invincibles" there would be, etc etc), the truth is...the new premium levels appear to be all over the place:
May 15--A first-glance snapshot of the lowest premium rates being proposed for individual health-insurance plans to be sold in the Washington Healthplanfinder exchange marketplace reveals spirited competition and more choices for consumers.
These rates are not yet approved, and it's likely the number of plans requested will decline, according to the Office of the Insurance Commissioner.
That office is now reviewing rate changes the companies requested.
Changes proposed by companies asking to sell plans on Healthplanfinder ranged from a nearly 7 percent decrease in one case to an increase of more than 11 percent in others.
If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:
Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.
...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.
They may have flushed a couple hundred million dollars down the drain on their website, but that just makes Oregon's manual QHP processing achievement all the more impressive. Over 6 weeks after the official enrollment period ended, and over 2 weeks after their extension period wrapped up, Oregon continues to push their QHP and Medicaid enrollment totals up:
Medical enrollments through Cover Oregon: 280,334 Total private medical insurance enrollments through Cover Oregon 1: 81,358
Oregon Health Plan enrollments through Cover Oregon: 198,976
A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:
As of April 29, 2014, 275,090 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
As of May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.
The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.
I may have had some issues with Avalere Health's methodology in the past, but they're pretty well respected in the industry, and they've certainly brought up legitimate issues with my own methodology as well (they're the ones who pointed out that the early version of my Medicaid/CHIP estimates was mixing "baseline churn" into the mix, which has since been corrected).
Anyway, they're out with an interesting new study which estimates that there of those newly-added to the Medicaid/CHIP roles, roughly 550,000 of them--specifically in the 24 NON-expansion states--rightly belong in the "woodworker" category: People who already qualified for Medicaid under the pre-ACA rules, but who didn't enroll until after October 1, 2013 for any number of reasons (not knowing they qualified, not knowing how to apply, being embarrassed about doing so, etc). Since the ACA exchanges also included a massive education/outreach effort (some of which even spilled over into the states which didn't expand the Medicaid program), and since the application process was streamlined in many states as part of the law, these folks who "came out of the woodwork" to enroll in Medicaid are rightly considered part of the success of the ACA specifically.
Some more fantastic numbers out of Ohio after the earlier ones from Michigan: 185K strict expansion, 124K woodworkers and another 146K in the works:
Through April though, 184,671 newly eligible applicants were approved for coverage, the state said Monday.
About 563,000 Ohioans became eligible for Medicaid when the state agreed to accept federal support provided under the Patient Protection and Affordable Care Act to pay for broadening the health insurance program. The change raised the household income eligibility limit to include families earning up to 138 percent of the federal poverty rate -- about $32,500 for a family of four. They became eligible for coverage in January.
Another 124,195 people, meanwhile, were also added to Medicaid when it was determined they qualified for the program under the old guidelines. State officials had said they expected the public attention on expanding Medicaid would also draw in people who were already eligible but who had not signed up.
...But about 146,000 applications from that time period are still being processed and could add to the totals.
Michigan may have been 3 months late to the Medicaid expansion game, but once we got started, things really took off. The original target was 320,000 adults in the state...and MI has already reached over 74% of that goal:
Healthy Michigan Plan Enrollment Statistics Total Healthy Michigan Plan Beneficiaries: 237,329
*Statistics as of May 12, 2014
*Updated every Monday at 3 p.m.
My own calculations (based on KFF.org data) give the total number of Michigan residents eligible for Medicaid expansion as about 500,000; even at that number, 237K still represents over 47%, which is fantastic.
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.