Charles Gaba's blog

I post guest entries once in a blue moon, and this one could be huge, if his conclusions are accurate (and still well worth discussion even if they aren't). Recently, both Sarah Kliff over at Vox and Margot Sanger-Katz & Kevin Quealy at the NY Times Upshot have delved into some fascinating and unexpected news regarding Medicare & Medicaid spending in the U.S. over the past few years.

Well, an ACASignups supporter named Jim Stuart (all I really know about him is that he's a retired executive and educator who attended Princeton and lives in Illinois) has gone even deeper into the weeds on this and, well, I'll let those who know more about such things than I do decide how much of a Big Deal this is.

With Jim's request/permission, I'm reposting his piece verbatim, but I'd also advise checking out his own blog.

This is an interesting overview/update about the state of the ACA's small business "SHOP" exchanges, which, by my calculations, have only enrolled around 72,000 people nationally to date (a rounding error compared to the 9,000,000 or so who've enrolled in individual QHPs so far):

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

The good news is that things should start ramping up on the SHOP side this fall:

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.

In spite of their amazingly successful manual workaround process (which has enrolled 465,000 people in either private or Medicaid coverage), Oregon's website debacle continues to fester. Even so, until recently they've ironically been one of the most reliable state exchanges when it comes to publicly posting updated enrollment data. New detailed data has been posted pretty much once a week since the crazy days of March/April on a regular basis.

That all came to a screeching halt just over 3 weeks ago; the last update out of CoverOregon was August 6th. Again, this is still much better than most other states which only publish updates monthly or not at all, but for Oregon it's been worrisome for me, since they're one of only a handful of states giving that info out at all during the off-season.

The big news ACA yesterday was that Kevin Counihan, the guy who ran AccessHealthCT (one of the best-run state exchanges) has left that post to become the new "CEO" of Healthcare.Gov, just in time to prepare things for the 2nd open enrollment period.

By all accounts, this is excellent news all around. Counihan has been widely praised for his work in Connecticut--as well as in Massachusetts prior to that (he was one of the guys in charge of the original "RomneyCare" initiative).

So. We now have a new HHS Secretary (Sylvia Burwell, who's been in charge since early summer), a new Healthcare.Gov CEO (the first, actually), and a new Communications Director for CMS (Centers for Medicare & Medicaid Services), Lori Lodes.

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 373,171
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of August 25, 2014 
*Updated every Monday at 3 p.m.

Oh, and by the way, while Michigan Governor Rick Snyder may deserve some credit for pushing his party to accept Medicaid expansion, this was only possible due to THE AFFORDABLE CARE ACT, AKA "OBAMACARE".

Amazing how many people can't seem to get that through their skulls, even as they heap praise on the Governor for basically "not being a jerk" in this instance. Apparently "not being a jerk" on one issue is worthy of high praise when it comes to Republican elected officials these days.

A few days ago, David Ramsey of the Arkansas Times reported about a leaked document with the proposed & approved private QHP premium rate changes for 2015. At the time, he calculated the weighted average of the approved rates to be a drop of around 3.5% overall.

Today he reports that the official rate approvals have now come out, and while there was a slight error in the original numbers, the final weighted average is still excellent news: An overall weighted drop of 2%:

Insurance companies have proposed a net reduction in premiums of 2 percent next year for the Arkansas Health Insurance Marketplace, the health insurance exchange created by the Affordable Care Act. The Marketplace includes all of the plans used for the private option, the state's unique plan which uses Medicaid funds to purchase private health insurance for low-income Arkansans.

That "private Medicaid option" factor is important as well, because...

I posted something about this a few days ago, but it didn't get nearly as much buzz/attention as I would have figured, probably due to my soft-selling the headline. Anyway, Enroll America has released a report which estimates that there's up to 6.7 million people who could qualify to enroll in a new, ACA-compatible health insurance plan via (or their state exchange, depending on where they live).

The current article focuses specifically on Texas, where up to 365,000 people should be eligible to enroll right now, even though it's the "off-season", due to major life changes such as recently getting married, divorced, having a child, losing their job and so on.

Round two of Obamacare enrollment starts Nov. 15. But a group promoting signups wants Texas’ 5 million uninsured adults between the ages of 18 and 64 to know that as many as 365,000 of them are eligible today to go online and enroll in the federally run health insurance marketplace.

The Washington State Insurance Commissioner just released a chart listing all of the companies operating on the exchange this fall (including 3 new ones, bringing the total to 12), how many plans they're each offering, the requested rate change and the approved ones for most of them.

Unfortunately, they don't include an actual enrollee breakdown, so I can't tell whether this is a weighted or unweighted average. Judging from the numbers provided, it looks like an unweighted average would be just 0.1%, so I'm guessing that the 1.9% mentioned in the press release is weighted, but I'd be more confident of this if they included how many people were enrolled by each company.

(h/t to Josh Z. for pointing out the uncertainty here)

In any event, the original average requested increase was 8.6% (4.8% unweighted), so this is still great news either way.

In addition, the total number of plans has doubled from 46 to 90:

90 health plans approved for next year’s Exchange with a record low 1.9 percent rate change – Exchange Board set to certify plans on Aug. 28

This is one of the lamest examples of negative spin that I've seen in awhile. The WSJ MarketWatch breathlessly reports that...

Fresh off a Philadelphia Fed survey of manufacturers finding that the Affordable Care Act is acting as a drag on hiring and increasing part-time employment, a Dallas Fed survey finds the much same thing.

Like the Philly Fed survey, it was tacked on to an existing monthly survey of conditions. In this case, a net 23.5% of respondents say the number of workers employed is lower due to the effects of what’s commonly called Obamacare. Part-time work is up, the amount of work outsourced is up, wages and salary compensation per worker is down, other benefits are down, and prices charged are higher.

OK, I'm feeling a bit foolish now. Earlier today I lamented the fact that the number of state exchanges issuing regular updates continues to dwindle. A few moments ago I realized that I hadn't checked in on Colorado in awhile, and sure enough, they've posted an update through the end of July.

No Medicaid numbers are included, but the exchange QHP tally has risen by another 3,750, to break the 140K milestone at 140,355.

The enrollment rate in CO has dropped a bit since earlier this summer, but they're still running pretty strong. With the new updates from CO and MN, my off-season enrollment projection has dropped a bit as well and now ranges between 8,100 - 10,900/day, still centered squarely on the 9,000/day mark.

SHOP enrollments, meanwhile, have gone up a whopping 19, to 2,392.

Even in states whose ACA exchanges have operated pretty smoothly such as Connecticut and Kentucky, there's bound to be some technical problems. Washington State is no exception. As a result, the WA insurance commissioner has announced that anyone who tried to enroll earlier but has struggled with billing, payment or other technical issues (WA is one of only 2 states that run payments through the exchange and require the 1st months premium to be paid before even reporting the enrollment) can now give it another shot or make whatever changes are necessary without requiring a "qualifying life event" to do so:

The Washington Health Benefit Exchange (the Exchange), also known as the Washington Healthplanfinder, is making progress to correct the enrollment and payment difficulties that have affected some consumers. Those fixes are continuing, but may take additional time to resolve.

Yeah, yeah, I know the title is lame, but it's not easy to find alliterative synonyms for "ugly" and "unpleasant" starting with "O"...

Anyway, a few days after Oracle sued Oregon for $23 million in unpaid bills over the CoverOregon exchange debacle, the state has counter-sued the tech company...for a whopping $5.5 BILLION...including "Whoa...heavy, dude!" charges by the state Attorney General such as racketeering:

In the aftermath of what was likely the most spectacular failure among state-run Affordable Care Act health exchange site launches, the state of Oregon has filed a lawsuit against Oracle America Inc. over the total failure of the Cover Oregon exchange. “Oracle’s conduct amounts to a pattern of racketeering activity that has cost the State and Cover Oregon hundreds of millions of dollars,” Oregon Attorney General Ellen Rosenblum wrote in a civil complaint filed August 22. The lawsuit seeks over $5.5 billion in damages from Oracle, plus legal fees.

The complaint comes after Oracle filed its own lawsuit against the state’s health exchange for failure to pay for services rendered in early August. Oracle’s attorneys claimed that Oregon Governor John Kitzhaber had defamed the company in a “smear campaign” while failing to take responsibility for the failure of state management of the project and not paying Oracle for additional work done.

The Good News: Minnesota, as always, continues to provide consistent, up-to-date enrollment data, adding 56 QHPs over a 3 day period:

latest enrollment numbers

August 24, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 183,503
MinnesotaCare 67,054
Qualified Health Plan (QHP) 53,866
TOTAL 304,423 

The Bad News: Up until recently I was only receiving regular upates from 3 states (plus monthly updates from Maryland and random, occasional updates from various other states). For the past few weeks, however, even 2 of those 3 states (Hawaii and Oregon) have seemingly gone radio silent as well. Aside from the next monthly MD update (due sometime this week, I believe), that leaves Minnesota as the sole state keeping their data up to date.

Meanwhile, Minnesota's exchange Medicaid total has now broken the 250K mark and stands at 250,557.

The news broke just a few hours ago that Kevin Counihan, the head of AccessHealthCT (Connecticut's extremely successful ACA exchange, which works so well that they were able to actually sell the software platform to Maryland to replace MD's original broken system) is leaving the CT exchange for an unspecified position at the HHS Dept:

Access Health CT CEO Kevin Counihan, who spearheaded Connecticut's largely successful first round of Obamacare enrollment through the state's public insurance exchange, is departing, a source close to the matter confirmed.

Access Health has scheduled a noon press conference Tuesday to make the announcement. No replacement will be named today, according to the source, who said Counihan is leaving to take a federal position within the U.S. Department of Health and Human Services.

Well, Sarah Kliff over at has now broken the news about just what that new HHS position actually is...and it's very good news indeed:

Breaking: White House announces Kevin Counihan will be new CEO. Currently runs the Connecticut exchange.

I stumbled across an article in the Philadelphia Inquirer today which makes a rather odd claim in both the headline and the lede:

State sites outperform U.S. marketplace in Affordable Care Act signups

States running their own Affordable Care Act marketplaces enrolled more people in health insurance than those using the federal marketplace, according to an analysis by researchers at the University of Pennsylvania's Leonard Davis Institute.

Given the federal Website's dreadful October launch, that isn't exactly jaw-dropping news. But Penn's Health Insurance Exchange researchers were surprised to find that even after began working well in December, state-based marketplaces kept outperforming the federal site.

Huh. Interesting. They even specified that this was true "even after December".

Of course, there's a very good reason why they would be "surprised" at this's not even remotely close to being true.