Charles Gaba's blog

The growth of Michigan's ACA Medicaid expansion program is finally slowing down, but they've still tacked on another 3,000 or so people in the past week, bringing enrollment up to 64% of the total eligible to enroll:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 317,931
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 7, 2014 
*Updated every Monday at 3 p.m.

This Just In: From the Paul Gallo Show, the Mississippi Insurance Dept. and Cover Mississippi: One of the 2 insurance companies operating on the ACA exchange in Mississippi plans on cutting their rates by a whopping 25%!

The caveat is that we still don't know what the other company's rate plans are, nor do I know what that 25% rate cut was in the first place, but this is still excellent news:

@paulgalloshow @MSInsuranceDept really good news for Mississippi. ACA Marketplace carrier to cut it rates by 25%! #acaworks @charles_gaba

— Cover Mississippi (@CoverMS) July 7, 2014

With the latest updates out of Colorado and the District of Columbia--both of which (to my surprise) showed an increase in the average daily rate of off-season exchange QHP enrollment in June over late April and all of May--I'm feeling a lot more confident about my overall off-exchange projection chart, which is currently showing a lower bound of around 9,000 per day and an upper bound of around 12,000 per day since April 19th.

In the interest of caution, however, I'm still keeping my "official" projection a bit lower still, at around 8,000 per day (though this is up from the 7,000/day I had been using until now). This translates to around 616,000 new QHP enrollments as of yesterday (77 days out), bringing the estimated total to a bit over 8.6 million overall.

When I last checked in on the District of Columbia exchange, they were reporting 11,582 exchange QHPs as of June 11...868 higher than the last official HHS tally as of 4/19. That means that they had been averaging around 16 new QHPs per day at that time.

Well, today they issued another update: As of July 1st, the total is up to 12,333. This is another 751 higher, bringing the overall off-season average up to 22 per day. That's right: Just like in Colorado, DC's QHP off-season enrollment rate is actually increasing as we move farther away from 4/19...at least so far.

So, what does this mean for the national trend? Well, the numbers are too small to impact the overall range, of course, but so far both Colorado and DC's latest updates have only inched the trend upwards; it now sits at a lower bound of around 9,000/day and an upper bound of 12,000 per day.

As always, I continue to be cautious in my actual tally prediction, though I've moved this up from 7K/day to 8K/day; if the lower bound reaches 10K, I'll bump my "official" projection up to 9K and so on.

BRAVO to Washington State!

OLYMPIA, Wash. – Washington Healthplanfinder today announced a limited special enrollment period for Washington state residents whose same-sex domestic partnerships were recently converted to marriages on June 30. The 60-day enrollment window provides these couples with a unique opportunity to enroll in a Qualified Health Plan before the next open enrollment period that starts on Nov. 15, 2014 for coverage beginning in 2015.

A related article has the number of people impacted (3,600 couples, or about 7,200 people total):

Washington’s health benefit exchange is opening up a 60-day special enrollment period for couples in same-sex domestic partnerships that were recently converted to marriages.

On June 30, most state-registered domestic partnerships were converted to marriage automatically in Washington. This affected an estimated 3,600 gay and lesbian couples in the state.

This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:

MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.

Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.

Enrollment has remained above 1 million in March, April and May.

As of the previous update (5/31), Colorado was averaging around 177 QHP enrollees per day in the post-open enrollment period (7,413 / 42 days). With this latest update (dated June 24), they've actually increased this average slightly (4,185 / 23 = 182/day), for an overall off-season average of 178 per day:

The number of new enrollees in private health insurance through the state exchange, Connect for Health Colorado, continues to inch upward by about a couple hundred a day — and now stands at 137,000, officials said Tuesday.

Although open enrollment officially ended March 31 with 118,000 signups, it unofficially ended at 124,000 in mid-April as people who started before the deadline finally finished the process.

This stability makes me more confident of my 9K - 12K/day off-season estimate, since the late April/early May enrollments might otherwsie have just been chalked up to unprocessed leftovers from the enrollment extension period. However, the rate increasing (if only slightly) suggests that for Colorado, at least, the off-season rate seems to be pretty stable.

I wrote a week or so ago about the Halbig v. Burwell (formerly Halbig v. Sebelius) case currently pending in the D.C. Circuit Court of Appeals. The short version is that there's a challenge to the IRS doling out tax credits to the 5 million people or so who enrolled in and qualified via Healthcare.gov (the Federal exchange) across 36 states, based on the wording of one particular section of the Affordable Care Act which supposedly refers to subsidies only being allowed for the exchanges run by the state.

At issue is Section 1401, which states:

The premium assistance amount determined under this subsection with respect to any coverage month is the amount equal to the lesser of—

(A) the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer's spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act, or...

Since the SCOTUS's Burwell v. Hobby Lobby decision, a lot of people have been pointing out the Pandora's Box that this could potentially open for company owners to start violating civil rights laws willy-nilly, all based on whatever their particular flavor of religion happens to be.

The most commonly used example (one I've used myself) is "What if a Muslim Company Used the 'Hobby Lobby' Decision to Impose Its Values on White Christians?"

How would conservatives and their agents respond if a company with Islamic beliefs (however defined) decided to impose its religious values on white, Christian, American employees?

Sharia hysteria would spread in such a way as to make the present day-to-day Islamophobia of the Right-wing echo chamber appear benign and muted by comparison.

What if a Black cultural nationalist organization such as the Nation of Islam or the Black Israelites claimed that they possessed a "religious freedom" to actively discriminate against white people in the workplace or elsewhere?

The great irony here is that this accurate and helpful data point is provided by a very anti-ACA story, but whatever:

A total of 243,230 Ohioans have already been added to the state’s Medicaid rolls under the Obamacare expansion implemented by Republican Governor John Kasich this January.

Based on the Ohio Department of Medicaid’s May caseload report released last week, enrollment under the expansion was 232,711 in April — not the 184,671 reported last month.

The March enrollment figure was also revised dramatically upward last week, to 208,213 from the 171,910 reported last month. In April, the Ohio Department of Medicaid estimated that March enrollment for those eligible under Obamacare was 106,238.

This morning, Glenn Kessler of the Washington Post discussed former HHS Secretary Kathleen Sebelius's recent quote, speaking at a rally, that "There are now 22 million people with affordable coverage thanks to the Affordable Care Act, and that’s a big deal and that number will grow.”

As regular visitors to this site know, my own "estimated total, all sources" number shown on The Graph currently ranges between 24 - 29 million people...but is in turn broken down into different types of enrollments, with different caveats, disclaimers and so forth depending on what criteria you're trying to measure.

In the case of Sebelius's quote, Kessler is attempting to parse 3 specific points: The number (22 million); the description ("affordable coverage") and the credit ("thanks to the ACA").

Add Georgia to the list of states where the "Obamacare is socialism!!" meme seems to be having trouble taking hold:

ATLANTA ‑ UnitedHealthcare, Coventry, Cigna and Time Insurance Company have each submitted plans with the state to offer insurance in the federally run health care exchange in Georgia next year.

They join the five holdovers from this year’s exchange that are also submitting rates for review: Alliant Health Plans, Blue Cross and Blue Shield of Georgia, Humana, Kaiser Permanente, and Peach State Health Plans.

Also, you may recall a nice graph by Dan Diamond from a couple of weeks back showing the states which are increasing their exchange competition for 2015; I've crudely updated it with new competition data from 4 additional states: Connecticut, Maryland, North Carolina and Georgia (plus one more added to Kentucky since he posted it):

Not that any of this will appease anti-vaxxers any more than solid, comprehensive, overwhelming scientific evidence will get Climate Change Deniers, Obama Birthers, 9/11 Truthers or the Flat Earth Society to let it go already, but I'm presenting it here anyway:

The researchers, from the RAND Corporation, searched databases of scientific literature for vaccine-related studies, turning up 20 ,478 in total. This included studies of childhood vaccines — such as DTaP (diphtheria, tetanus and acellular pertussis), hepatitis A, hepatitis B, influenza, meningococcal, MMR (measles, mumps and rubella), and varicella — as well as adult vaccines such as flu shots.

Then they boiled this number down to 166 controlled studies — the gold standard of scientific research — in order to directly compare the effects of being vaccinated with the effects of getting a placebo injection or no vaccination.

CRUCIALLY, THEY FOUND ABSOLUTELY NO LINK BETWEEN CHILDHOOD VACCINES AND AUTISM SPECTRUM DISORDERS

With the addition of some new enrollment data out of Kentucky and Minnesota, I've updated the Off Season QHP Enrollment chart. Note that the available data only includes states representing about 8% of the total enrollments nationally, and even some of those are only updated through early May, so the numbers will no doubt bounce around a lot as fresh numbers come in.

I plan on only updating both the Off Season chart as well as The Graph on the 1st and 15th of each month, unless there's major new data which comes in (like, say, from CoveredCA...hint, hint...).

Visit the link for a pretty cool rollover county-by-county map showing ACA exchange enrollments in New York State:

Last week, the state's health department released demographic information on who used New York's new health insurance exchange to enroll in a health insurance plan.

The data showed how many people across New York signed up for private health insurance plans, enrolled in Medicaid and took advantage of Children's Health Plus.

In total, nearly 1 million people got health insurance coverage through New York State of Health, or about 5 percent of the state's population. The exchanges were created by the Affordable Care Act.

Capital broke that down by county: We found Queens County had the highest percentage (6.78) of its population enroll while Madison County (2.86) had the lowest. But in Madison about half the people who enrolled signed up for a Medicaid plan while half signed up for private insurance. In Queens, twice as many people signed up for Medicaid compared to a private insurance plan.

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