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Eureka! That rarest of things, a mid-month enrollment update from a federally-run exchange state! Idaho reports hitting 38,000 private enrollments, up from 32,899 as of February 1st (I'm sure this is private enrollments only, because they were already at over 16K Medicaid enrollments as of 2/01. It's a short article and the whole thing is a gem, so here it is verbatim:

Idaho’s state-based health insurance exchange has now enrolled 38,000 people in health insurance, state Department of Health & Welfare Director Dick Armstrong told lawmakers today. And another 56,000 are “in the queue,” in the process of enrolling. “Our original target was 42,000,” he said, for signups by the end of the open enrollment period at the end of March. “Very rapidly, Idaho’s enrollment … has come up.”

When the exchange opened and faced problems due to computer system hang-ups in Washington, D.C., initial enrollment numbers were very low. “Everybody was just wringing their hands,” Armstrong said. “This is a breath of fresh air, to see that the enrollments are picking up this rapidly.”

One more very small update today. This isn't an official data release, but this press release from yesterday mentions the total enrollment in Minnesota as being "nearly 95,000". This presumably includes enrollments through 2/17.

Assuming the same 32% / 68% ratio between existing private QHPs and Medicaid enrollments in Minnesota, this should break out to roughly 30,200 Private / 64,700 Medicaid, an increase of around 700 and 1,700 respectively.

Today, MNsure announced new TV and radio ads that tell the stories of Minnesotans who have used MNsure to find better, more affordable health care coverage. The ads highlight the affordability of MNsure plans and underscore the fact that MNsure offers the lowest premium rates in the country – with additional financial help available through tax credits. The ads are aimed at encouraging more Minnesotans to enroll in affordable, quality health coverage before the March 31 deadline. Nearly 95,000 Minnesotans have already selected health insurance through MNsure.

Yes, it's true...sort of. With the addition of the latest numbers from Colorado, Hawaii and especially California, if you include all ACA Exchange-based enrollments reported to date--both paid and unpaid--the total currently sits at a tad over 3.56 million people. The original CBO projection for exchange-based private QHP enrollment was 7 million, so we've finally hit the halfway mark. Of course, the enrollment period itself is actually over 77% of the way through, so this is more of a purely symbolic milestone than anything else, but it's still worth noting.

There's a few additional caveats as well, of course; if you remove all enrollments known to be unpaid (about 265K) from the 5 states which have broken that out, and then subtract another 10% from the remaining 46 states, you'll only have about 3.05 million enrollments which are paid (or unpaid due to billing problems on the insurance company's end, which can hardly be blamed on the customer or the exchange system). However, this works out nicely as well, since 3.05 million is still over 50% of the revised CBO projection of 6 million total!

A flood of new enrollment data today! Colorado just posted their latest update, which runs through 2/17. Private QHPs are up from 69,627 as of 1/31 to 79,779 as of 2/17 (an increase of 10,152), while Medicaid enrollments are up to 128,219 from 117,607 as of Jan. 31st (an additional 10,612).

This is also more good news for the "February Drop-off" issue, since this knocks the likely drop-off in average daily enrollment from 11% down to 10% even:

This moves the likely February enrollment up from 820K to 830K, based on 13 states representing 98.7 million people, or 31.4% of the country.

Since the grand total was almost precisely 3.3 million as of 2/01, adding 830K in February would bring the total up to 4.13 million.

There's so much info in today's California press release I've had to move the Medicaid info to a third entry. There's a ton going on in the following passages:

Additionally, 877,000 applicants were determined to be likely eligible for Medi-Cal coverage. DHCS also transitioned 652,000 individuals into the Medi-Cal program from the state’s Low Income Health Program. Automated enrollment allowed county human services agencies to enroll 106,000 individuals into Medi-Cal coverage, and another 65,000 were enrolled through the Express Lane program.

approximately 1.5 million additional Californians have enrolled or been found likely eligible for Medi-Cal since October. 

** Does not include applicants for current Medi-Cal coverage through county human services agencies. 

OK, let's break this out: The 877K figure is up fro 850K in the January HHS report, which itself was already up from 584K as of January 15, which means a ton of new people enrolled in the 2nd half of January alone.

Some additional positive news out of California today; so much going on I decided to break it out into a second post:

Lee also noted that of those enrolled through Jan. 31, 626,210 are eligible for subsidies, and insurance companies are reporting that 80 percent of all enrollees have paid their first month’s premium. 

The wording of this makes it hard to tell whether "all enrollees" means all of them or only those through Jan. 31, but this CoveredCA Tweet clarifies:

#CoveredCA health insurance companies are reporting that 80% of all enrollees have paid their first month's premium.

— Covered California (@CoveredCA) February 19, 2014

OK, so this really does mean all enrollees. Fair enough. The downside is that I have to move 165,272 people over to the "Unpaid" category. The upside is that the "How many have PAID???" question just became about 12% cleaner.

Well THAT just figures! In the words of Emily Litella..."Never mind..."

Hot off the presses: California has released their first-half of February enrollment data: 100,228 people have enrolled in Private QHPs in "the first 2 weeks" of February (actually February 2 - 15, I assume, since the 728K number includes Feb. 1st). This breaks down to 7,159/day:

Nearly half of those covered [through 2/01] — 728,410 Californians — selected a Covered California health insurance plan. This strong enrollment trend is extending into February, where in the first two weeks more than 100,000 individuals enrolled in Covered California, increasing the cumulative total enrollment in Covered California to 828,638.

California's January enrollment rate was (728,410 - 498,794) = 229,616 / 35 days = 6,560/day, which means that their February enrollment rate is actually increased from that of January, by over 9%!

So, how does this impact the "February Drop-Off" factor? MASSIVELY! Take a look:

Hawaii's private QHP enrollments continue to crawl along, increasing from 3,879 as of 2/08 to 4,297 as of 2/15.

Total since October 1, 2013

18,752 Applications completed in the Individual Marketplace
 4,297 Enrollments in the Individual Marketplace
 444 Employers applied to SHOP Marketplace

They also list the number of employers enrolled in their SHOP system, but there's no update on the actual number of people covered by those plans, so it stays at 307. No Medicaid/CHIP update either.

The good news is that Hawaii becomes the first state of the 11 for which I have partial February data to actually increase it's enrollment rate over January. The bad news is, Hawaii's numbers are so tiny that this is a drop in the bucket, only reducing the overall drop percentage by 0.2%.

I know I've become a bit obsessive about this "February Drop-off" thing, but I couldn't help myself. Since the Jan. HHS report was simply wrong on New York's private QHP figure, I found the closest correct figure to Feb. 1st that I could--an official NY State of Health press release from 2 days later, Feb. 3, which gives the correct private QHP enrollment number as 241,242 as of Feb. 3.

Updating the "Feb Drop-off Chart" with this info as well as yesterday's Nevada update, we now have some more solid Feb-vs-Jan data to work with. I've modified the graph to show how many days are being counted for each state, as well as the starting & ending dates for each month:

This morning I noted that New York has seen a dramatic increase in the percent of their ACA enrollees who were previously uninsured, rising from 66% of the total on 1/10 up to 69% as of yesterday. While a 3% increase doesn't sound like much, this is especially notable because, as I demonstrated, it means that between 92 - 100% of the newest enrollees were previously uninsured (probably around 95%), since that's what it would take to raise the overall enrollment up with such a comparatively small number of additional enrollments.

However, I forgot another, earlier NY update which fills in this picture even further. Back on January 13, there was another press release which noted that as of December 24, 2013, about 50% of the 230,624 New York enrollees were previously uninsured:

Another update from Nevada: Private QHPs up from 16,030 paid / 7,656 unpaid to 17,047 paid / 8,595 unpaid from 2/08 - 2/15.

This also gives some additional data to work with regarding the February Drop-off issue...and there's some good news here, whether you look at total QHPs or paid only:

Update as of 2/15: 25,642 Nevadans confirmed QHP Selections. 17,047 have paid.

— Nevada Health Link (@NVHealthLink) February 18, 2014

Over the weekend, I threw some cold water on the ACA enrollment momentum theme with a one-two punch: First, I pointed out that the February report will only include 4 weeks of data (2/02 - 3/01) vs. January's 5 weeks (12/29 - 2/01); then I looked into the actual data to see if this story from Yahoo Finance was correct in suggesting that enrollments have dropped off even on a daily-average basis since January.

Ah, just in time to help clear up my confusion about the New York situation from over the weekend: The latest tally has NY with a total of 266,177 private QHP enrollments, up 14,871 from 251,306 a week earlier. Medicaid enrollment via the exchange is up to 189,865 from 160,915, an increase of 28,950.

This is noteworthy for a couple of reasons. First of all, this gives some additional, solid data to plug into my weekend "NY Enrollment Number Mystery Project" that I've written a couple of posts about the past few days. Connected to this, however, is something which may be cause for a bit of concern--up until now, New York has been bucking the tide and averaging around a 60/40 split in favor of private QHP enrollments. Today's additions, however, reverse that with the numbers switching to 34/66 in favor of Medicaid enrollments:

Another 44,000 people enrolled in a health insurance plan through the state's exchange over the past week, pushing the total to 456,042, according to the state Department of Health.

Earlier today, I pointed out some potentially bad news for total ACA enrollmentthat February's enrollment tally is likely to be a good 20% lower than January's for the simple reason that the February HHS report is only going to include 4 weeks' worth of data, while January's included 5 weeks. Nothing neferious or evil going on here, just measuring 28 days instead of 35 (for the record, the final report for March will include 30 days' worth of data (March 2nd - 31st)).

While writing up the main part of the entry, however (which addressed a Yahoo Finance article which claims that February enrollments will be way down for a variety of unrelated reasons), I noticed something very curious about New York's enrollment numbers. I went into this in the earlier entry but decided that it's important enough to merit it's own full repost.

Here's the official enrollment numbers from the October, November, December and January HHS Reports...and the most-recent official press release from the NY State of Health Exchange:

Most ACA critics now grudgingly admit that people are getting insured after all, but they say there's a catch. "Where are we going to get all the doctors?" a social worker asked me recently. "We're overwhelmed as it is." A letter in the local paper said, "People aren't really covered unless someone accepts their 'insurance', and if nobody is accepting it, then why should people pay for it?"

I briefly answered the letter writer online, saying that the solution was in the provisions of the Affordable Care Act to increase the primary care workforce, not only with more primary care doctors but also more nurses, nurse-practitioners and physician assistants. I was then curious to find out more about what the ACA has been doing to upgrade primary care in the U.S. and found that it has already made major improvements.

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