2018 MIDTERM ELECTION

Time: D H M S

Some slightly updated numbers out of Oregon today, revealed during a conference call with the director of the beleaguered Cover Oregon exchange. Private enrollments are up from 20K to 23K, and exchange-based Medicaid enrollments up from 39,711 to about 42,000.

In addition, some info on the method of the 115,000 "direct transfers" to Medicaid off of the exchange: Apparently they used food stamp income information to do so, which is pretty clever if you think about it.

More than 65k enrolled so far through exchange, he says, 23k in private plans

— Nick Budnick (@NickBudnick) January 15, 2014

Oregon has enrolled more than 115k in Medicaid via workaround to avoid exchange, using food stamp income info

— Nick Budnick (@NickBudnick) January 15, 2014

Something interesting going on in Nevada. On 12/26, the official Nevada Health Link posted this to their Twitter feed:

Update: As of the 12/23/13 deadline to enroll, 12740 consumers confirmed QHP selections, 6219 have paid. Payment deadline is 12/30/13.

— Nevada Health Link (@NVHealthLink) December 26, 2013

Fair enough; 6,224 paid, 6,521 unpaid through 12/23.

As we recall, HealthCare.gov and most state insurance exchanges moved their enrollment deadline for January 2014 coverage, first from 12/15 to 12/23, then to 12/28 or as close to the New Year as possible.

That, however, will not be the case for February coverage. That deadline is firm – and it is today.

Thus the number of enrollment days in January will be roughly half that of December. Or to put it in an amusing way: January is almost half a month shorter than December. We must bear this in mind when examining any statistics of how many people have ACA-compliant insurance on February 1st, not drawing overly hasty conclusions about the declining enrollment rate.

Yesterday, HHS extended its coverage of people in the Federal High-Risk Pool. The new deadline is March 15th, coinciding with the deadline for the ACA’s open enrollment. This adjustment will help ensure a smoother transition for patients with pre-existing conditions.

Already, more than 55,000 of the 85,000 people that were in the PCIP programs per October 1st have enrolled in other healthcare plans. This is a reduction of at least 65 %. According to HHS, less than 30,000 people now remain in the federal high-risk pool.

Since it was launched in late 2010, the PCIP program, has provided coverage for a total of 135,000 people with serious pre-existing conditions who would otherwise have unable to obtain insurance.

Kaiser Health News has an in-depth article on this topic by Mary Agnes Carey.

Yesterday, Charles Gaba examined the big numbers in the most recent HHS report, an unanswered question in the Medicaid numbers and sorted states according to how they’re doing relative to their (admittedly debatable) enrollment targets. Here I would like to briefly mention some rather interesting outliers and other data points, and share a few observations.

There is an 8 % difference between the genders: 54 % of those who have selected a Marketplace plan are women, while men account for only 46 %. Men are in the majority in only two states: Connecticut (54 %) and Hawaii (51 %), whereas the District of Columbia was evenly split per 12/28.

It’s also worth noting that in the District of Columbia, so-called “young invincibles” (enrollees between 18–34 years of age) account for 44 %, while in Massachusetts HHS pegs the portion to be 31 %. Nationally, people 34 years of age or younger account for 30 % of the enrollment, and 18–34 year olds account for just over 24 %.

I've already noted that the State-Level CMS Projection Numbers are, for 40 out of the 50 states (plus DC), not particularly well-arrived at. However, for good or for bad, those are the numbers that the states are "supposed" to be striving for, so let's take a look at how they're doing.

With the official 12/28 HHS numbers in hand plus more recent updates for 13 states, here's where things stand purely on a "% of CMS projection attained" basis.

This is important to understand in cases like Kentucky, which has actually been operating quite successfully but which shows up as performing "poorly" due purely to the absurdly high "projection number" that it was assigned in the first place.

The official HHS ACA Exchange Medicaid enrollment figure for Illinois released earlier today was 82,286. However, contributor sulthernao noted that the actual number of people enrolled in Medicaid under the ACA in Illinois is at least 53,714 higher. As he/she put it:

Illinois is a partnership state for Medicaid enrollment, has used SNAP autoenrollment, and early expansion experiment in Cook County. For this reason, the numbers reported by the Federal Government (ASPE) are a severe underestimate of the enrollment. People who apply directly through the state's website may not be counted.

I realize that this probably has no connection to the "mystery" 1.24 million Medicaid/CHIP enrollments that I just wrote about an hour or so ago, but it's been a very long day and I'm extremely tired, so until I hear a better explanation for those 1.24M, I'm lopping the 53K difference out of that "unspecified" total at the bottom of the spreadsheet.

OK, the Medicaid situation is, to put it mildly...confusing. For most of the states I simply swapped out whatever numbers were there from the November report for the Dec. 28 total. However, there are easily a dozen states which either have one-time bulk automatic transfers from an existing state-run program (such as the 630,000 transferred from California's LIHP program, which was itself created in preparation for the ACA's Medicaid Expansion program); earlier mass enrollments in Medicaid which were quietly put through via other ACA elements long before the actual Exchanges launched (see DC and Minnesota); "special" cases such as Arkansas' unique "private Medicaid option" program; or simply updated numbers which have been released since 12/28.

Even with all of this, there's still roughly 1.24 million "unspecified" Medicaid/CHIP enrollments which are necessary to make up the other "3.9 million" figure which the HHS Dept. has been touting since around December 20th. I am simply unable to determine exactly what these "unspecified" enrollments are, since the "normal" Exchange-based Medicaid/CHIP numbers only add up to about 1.58 million.

In short, as best as I can figure, it breaks down as:

Whew! OK, after plugging in the numbers from the December HHS report (which actually only runs through 12/28, which is important to keep in mind), I now have the spreadsheet as up to date as it can be. There are 12 states which have released more up-to-date enrollment figures since 12/28. When you add these more recent numbers to the 2.153 million in the HHS report (which, again, only covers through 12/28), you get the following total: 2,347,097

Now, some of this may be questionable, which is why it's clearly italicized on the spreadsheet. Specifically, there's 72,178 enrollees in Washington State who hadn't made their first payment as of January 2nd, and another 1,999 who haven't paid yet in Rhode Island. Finally, there's the confusing case of 22,000 people in Massachusetts who have apparently been approved but are just waiting on some paperwork processing to be completed; in the meantime, they've been put on some sort of temporary state-financed healthcare plan until this is resolved.

OK, I'm gonna be scrambling to review the data and fill in/update everything, but here's what I can say right now:

  • If you look at Week 13 on the spreadsheet, you'll see that ACASignups.net had 2,137,630 private enrollments as of 12/31.
  • According to the official December HHS report, the total number of exchange-based private enrollments was 2,153,421 as of 12/28.
  • ACASignups.net was, therefore, appx. 99.2% accurate (ok, knock 0.2% off for the missing 3 days of data...call it 99% even).
  • I have no idea why the HHS report doesn't include the last 3 days of the year; perhaps a lack of personnel during the holidays? Will post something about this if/when I find out what the deal was there.

OK, I've plugged the numbers into the spreadsheet, but since most people's browsers won't be wide enough to view it, here's the state-by-state breakdown; remember, these numbers are only through 12/28:

Rhode Island becomes the 2nd (or possibly 3rd, depending on how New York's final tally turns out) state to break through the CMS's private enrollment projection, hitting 12,300 when employees enrolled via the Small Business exchange are included (and yes, these count. They're still people who didn't have insurance prior to the ACA, who do now thanks to a part of the ACA).

This moves RI up from an 80% paid rate as of New Year's Eve to an 83% paid rate as of January 8th. The rest will have to wait until February for coverage at this point.

Nearly 2,000 people of the 11,770 who signed up for health insurance through HealthSource RI did not pay their premiums by the Jan. 8 deadline...

The numbers show that 23 percent of enrollees are age 18 to 34, and 56 percent are 45 or older. Also, 54 percent are female. These numbers are based on the figure of the 11,770 who selected a plan by Jan 4....

Some 75 small businesses have enrolled, with coverage for a total of 530 people. 

A friend who wishes to remain anonymous provides a bit more info on the MinnesotaCare program discussed earlier.

The program seems similar to California's Low Income Health Program. The LIHP wasn't part of Medicaid, but it was set up with federal funds in preparation for Medicaid Expansion. However, Minnesota Care predates the ACA. It began in 1992. Part of its funding comes from federal Medicaid funds:

"MinnesotaCare is a publicly subsidized health care program for residents who do not have access to affordable health care coverage. It is funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid funds and enrollee premiums.

Most enrollees pay a monthly premium based on family size and income. Children under 21, some military families, and families with an enrolled American Indian do not pay a monthly premium.

Still waiting for clarification of the distinction between private enrollments and Medicaid/CHIP expansion on the new additions, but assuming they're a similar ratio to the prior enrollments, it should be roughly 38,500 private and 14,500 Medicaid/CHIP. If that ratio is close, this means that New York has essentially reached their March 31st private enrollment projection of 218,000 (give or take a few thousand).

Bonus: It was also revealed during NY State Senate testimony today that a whopping 40% [Ed: 30%, thanks to DwightKSchrute for the correction] of enrollees are under 35, and another 16% are between 34-44. This should go a long way towards quieting the ""young invincibles" aren't signing up!" ACA attack point.

A regular site visitor has sent me some in-depth information about the public healthcare program situation in Minnesota, which is evidently quite a bit more complicated than most other states. I've put together this information into what I hope is a cohesive whole, with my response below. Anyone who's more familiar with the Minnesota situation can feel free to correct or clarify any of this if you'd like.

Regarding your blog post entitled Minnesota Update: Nominal private increase; Medicaid up 10% In it, you quote the Minnesota StarTribune, which states, in part, that:

"Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans."

Several thousand more than 26,000 should be counted as exchange sign-ups rather than Medicaid signups. Minnesota has a sort of in-between basic health plan called MinnesotaCare. It covers people between 133% and 200% (I think?) of poverty. It is not Medicaid (which is called Medical Assistance in Minnesota) and therefore not part of the ACA Medicaid expansion, but it is a public plan. So, when the StarTribune refers to "public plans," they are lumping Medicaid and MinnesotaCare together. The state has cleared this up before in reporting on Minnesota's enrollment numbers in the New York Times. MinnPost reported on this correction back in November.

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