Charles Gaba's blog

Not much for me to add to this, really, other than to say that THIS is the correct answer to the "But...but how many were ALREADY INSURED???" complaints:

Uninsured rate down nearly four percentage points since late 2013

WASHINGTON, D.C. -- The uninsured rate for U.S. adults in April was 13.4%, down from 15.0% in March. This is the lowest monthly uninsured rate recorded since Gallup and Healthways began tracking it in January 2008, besting the previous low of 13.9% in September of that year.

The uninsured rate peaked at 18.0% in the third quarter of 2013, but has consistently declined since then. This downward trend in the uninsured rate coincided with the health insurance marketplace exchanges opening in October 2013, and accelerated as the March 31 deadline to purchase health insurance coverage approached -- and passed -- for most uninsured Americans. The Obama administration decided in late March to extend the deadline to April 15 for those who had already begun the enrollment process.

A couple of days ago, Avalere Health (with whom I've alternately butted heads and agreed with on various Medicaid enrollment data issues) released a study which, at first glance, seems to paint a fairly positive picture of how well the ACA exchange QHP enrollment ended up doing: Enrollment expectations were exceeded in 22 states, even if you assume only an 85% final premium payment rate!

However, there's a couple of data points which Avalere chose to use which made me furrow my brow. The first is that they based their findings on the CBO's lowered projection number of 6 million exchange-based QHPs instead of the original 7 million figure. I suppose there's nothing wrong with doing this, but considering that the actual grand total ended up being well over 8 million, it seemed a bit odd to me that they'd choose to compare the state-level figures against the lower, 6 million figure when there really isn't a need to do so.

More curious to me, though, was this line from their press release:

In addition to the March/April HHS report being released on Thursday, the CMS Dept. decided to take care of everything in one shot and also released the March ( April data included) CMS report as well.

As a result, I just finished plugging in the data from both reports onto the Medicaid/CHIP spreadsheet (followed, of course, by having to go through and delete out big chunks of the data from one or the other to avoid double-counting or any Medicaid renewals).

Normally each of these reports (which are usually released a couple of weeks apart) bumps the new Medicaid/CHIP numbers up by a half-million or so apiece after separating out the renewals & baseline churn. This time around, the impact looks much more dramatic because 1) both reports were added on the same day, 2) the HHS report includes 2/3 of April as well as March and 3) there appears to have been a bit of a spike in Medicaid enrollments as the 3/31 open enrollment deadline approached just as there was for QHPs (this may sound strange since there's no deadline for Medicaid, but a lot of people might not have realized that, and the frenzied outreach effort probably swept up a lot of potential Medicaid enrollees in the final weeks of March as well).

Online private insurance broker eHealth Insurance has provided a detailed Price Index Report covering the full open enrollment period from October 1, 2013 - March 31, 2014. For the most part it focuses on the pricing demographics, but also gives an updated number of policies as well (all of which are fully ACA-compliant QHPs purchased off-exchange):

Data collected and presented is based on over 213,000 individual and family health insurance applications submitted through between October 1, 2013 and March 31, 2014.

The prior number I had from back in January was around 148,000, so this is a significant increase...but it also specifies "individual and family" applications, so I'm assuming the standard 1.8x-per-household factor, which brings the total number of lives covered up to around 383,000 people.

However, until/unless I'm able to separate out any Blue Cross (or other BCBSA) enrollments from the total, I can't really plug this number into the spreadsheet, so I'll leave it as a blog entry for now.

One of the more interesting parts of the March/April HHS report is that they finally released the data for the "Are you currently insured?" question on the enrollment process.

Given all the fuss about "But how many were ALREADY INSURED???" from various outlets, this would seem to be a bit of a Holy Grail answer: At last, we know the answer, and it's pretty impressive: Only 13% responded that they had health insurance coverage at the time of their application, meaning a whopping 87% were newly insured! Wowzers!!

HOWEVER...there's a LOT of caveats here, just as there were with the infamous McKinsey study which claimed only 27% were previously uninsured back in February.

As the HHS report itself puts it:

"But, many have PAID???" in Rhode Island?

Christine Ferguson, executive director of HealthSource RI, said 91% of the 27,968 individuals who signed up for private plans during the open enrollment period from Oct. 1 to March 31 paid their first premiums by the April 23 deadline. Analysts have pointed to that percentage as a key test of whether the enrollment figures were as strong as they looked.

“My takeaway of that 91% is that we have work to do to keep them, but that’s a high conversion rate, and it’s a testament to the work that the staff’s done to really work with people,” Ferguson told

“I think it’s a reflection of the work that’s been done in the marketplace, the care that we took in the kinds of plans we offered and the range, and I think it is a reflection of the system working reasonably well,” she said. “I think for us the real issue – and I think the thing that people have not paid enough attention to nationally – is retention.”

The District of Columbia is one of a handful of exchanges which went beyond the 4/15 extension period out to 4/30; here's DC's final tally:

From October 1, 2013 to April 30, 2014, 44,833 people have enrolled through DC Health Link in private health plans or Medicaid:

  • 11,106 people enrolled in private health plans through the DC Health Link individual and family marketplace;
  • 20,497 people were determined eligible for Medicaid coverage through DC Health Link; and
  • 13,230 people enrolled through the DC Health Link small business marketplace.

I actually already posted an entry using this exact same story out of the WV Gazette, but thanks to Esther Ferington for pointing out something else that I missed in the article:

Health insurance enrollment numbers through the federal exchange surged to 18,631 between March 31 and the April 15 federal extension, Highmark West Virginia President Fred Earley said.

Highmark, the only insurer participating in West Virginia's Affordable Care Act insurance marketplace, also reported that 6,171 people have enrolled directly through Highmark since Oct. 1. 

The numbers released represent the highest jump in enrollment the company has seen since the ACA rollout; it reported in April that, as of March 31, 14,839 people had enrolled through the exchange and 5,292 purchased plans directly through Highmark. 

I'm assuming this is due to correction of some clerical errors, double entries, unpaid or cancelled acounts and so on, but the 4/26 county-by-county tally from Connect for Health Colorado is actually about 1,500 lower than the 4/19 total from the HHS report:



Given that they were only at 8,742 just a few days earlier, Hawaii managed to pull off an impressive (relatively-speaking) mini-surge in the final few days:

The Hawaii Health Connector, the online marketplace responsible for implementing President Barack Obama’s Affordable Care Act in Hawaii, enrolled 9,800 residents as of Wednesday’s final deadline for its first year of providing coverage.

The Connector collected 31,310 individual applications as of Saturday but was unable to enroll two-thirds of those applicants despite a push in the final two months.

Simple and to the point: These are all expansion enrollees:

In Illinois, an additional 287,000 have enrolled in expanded Medicaid coverage.

(I previously had the total at 350K, but that included determinations, not actual enrollees).

Wow. I'm not certain what the "strict expansion" vs. "woodworker" breakout is here, but am assuming it's roughly a 3:1 ratio:

An even greater number in Ohio, 156,899, were deemed eligible for Medicaid or the Children's Health Insurance Plan, or CHIP, government plans for low-income families that have been expanded under the act. That, however, is only a partial number, based on information that individuals provided when they contacted the federal health care marketplace to see about insurance. According to state figures released by the U.S. Department of Health and Human Services, Ohio has seen a combined Medicaid-CHIP surge of 208,280 since the Affordable Care Act, or ACA.

The key point of this article is that it specifically designates the 98K as being expansion enrollees (no woodworkers/churn):

Another 98,000 New Jersey residents were determined to be eligible for the new, expanded version of Medicaid.

UPDATE: More accurate number from another source:

Another 98,240 Garden State residents enrolled in the expanded Medicaid program, NJ Family Care. 

This is really more of a confirmation of my own estimates than anything; I had Iowa down as around 81K "Strict Expansion" plus another 800 or so "Woodworkers". The actual total appears to be slightly less: 78,860. Not sure what the breakout between the two is, I'm going to assume roughly 75K "strict" and another 3,860 "woodworkers" for now:

The federal report also said that 78,860 Iowans more were enrolled in Medicaid or related programs at the end of March than were enrolled in those programs last fall. Medicaid is a joint federal and state health-care program for the poor. Under the Affordable Care Act, states could opt to expand their Medicaid programs' rules to allow more poor, working-age adults to join. Iowa chose to do so with a pair of programs, the Health and Wellness Plan and the Marketplace Choice Plan, which have similarities to Medicaid. There is no deadline for Medicaid enrollment. People who qualify for the public plans can sign up any time.

This is really part of the actual HHS report, but I haven't had a chance to plug in the Medicaid numbers for every state yet so I'm including it here for now:

The state reports that nearly 263,000 Marylanders have gained Medicaid coverage in 2014.