UPDATE: CNBC Reports that 2 additional states (well, one state, Minnesota, as well as DC, anyway) have released their paid/unpaid data; the chart has been updated below, which changes...nothing really; Minnesota is at 90% while DC is at 75%, and Vermont's paid rate has apparently fallen from 85 to 59%...between the three they seem to have cancelled each other out.
I've written about the "But How Many Have PAID???" issue many times before, but going into the final stretch, I wanted to explain my reasoning as clearly as possible.
The following chart only includes states which have broken out Paid vs. Unpaid Enrollments. If you only use these 9 states as a guideline, it looks like the paid rate is around 80%:
Connecticut continues to Do It Right®. Not only have they broken their own combined goal by 60%, they're also now 37% past their fair share of the CBO's original 7 million QHP figure. The exchange's CEO is quoted in the article as saying that CT doesn't expect to see much of a "March surge", but that isn't too concerning to me--they're already doing fantastic, so any enrollment rate increase wouldn't be as dramatic by comparison anyway.
Oh, yeah--and 92% of all of their enrollees to date are paid up, even more impressive considering that this should include people whose policies don't even start until April.
In Connecticut, 160,580 people have enrolled in coverage through Access Health CT, surpassing the exchange's self-imposed goal of 100,000 people. Counihan said roughly 62,000 of those who enrolled signed up for one of three private health plans represented on the exchange. Most of the remainder signed up for some form of Medicaid.
Considering that their exchange website is still a complete mess, Oregon is actually doing a pretty good job of processing enrollments (not sure how many of these are newly added or reducing the backlog of older ones, not that it matters). Private QHPs are up almost 2,800 over last week, and Medicaid enrollees are up over 8,700.
In fact, so far, Oregon's March QHP enrollment rate (526/day) is actually nearly triple what it was in February (179/day). If every state were to pull this off, the total would actually surpass 7 million after all, though that doesn't seem likely at the moment.
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon
Total: 145,941 Private insurance: 45,119
Oregon Health Plan: 100,822
Earlier today, contributor Esther Ferington brought an old New York Times article from last October to my attention. The article is actually about off-exchange enrollments as an option to using the exchanges, but the opening line of the story includes an interesting snippet:
WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites.
(Sigh) Don't get me wrong, I'm glad Minnesota is staying on the ball with their updates but really, this is like 8 in the past 9 days or something...anyway, this one includes specific numbers for both categories, no messing with private/public ratios: 33,722 QHPs, 86,932 Medicaid.
Today, MNsure announced more than 120,000 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s health insurance marketplace. With an original goal of enrolling 135,000 Minnesotans, MNsure is on pace to meet or exceed that goal when open enrollment ends on March 31.
“We are averaging about 1,000 new enrollees every day,” said interim CEO Scott Leitz. “We anticipate we will continue, or improve this pace, keeping us on track to meet our original goal of enrolling 135,000 Minnesotans during this open enrollment period.”
The goal of enrolling 135,000 Minnesotans during the 2014 open enrollment period was discussed at the MNsure Board of Directors meeting on October 16, 2013.
Their last update had them at 57,090 QHPs and 223,378 Medicaid/CHIP, 280,468 total, so this is an increase of at least 19,532.
KY has recently shifted towards roughly a 17.5% QHPs / 82.5% Medicaid split. I'll assume a 15/85 with the newest batch for now, which brings the totals to 2,932 QHP / 16,600 Medicaid, for totals of over 60,000 and 240,000 respectively.
In addition, California's NEW Medicaid enrollee numbers continue to skyrocket, up from 877K (exchange) / 652K (bulk transfers/other) at the end of January to a whopping 1.136 Million + 968,500 = 2,104,500 total (!)
The wording of the 1.136M Medicaid number specifies that this is a combination of NEW enrollees as well as "ongoing caseload activity", which sounds to me like people who enrolled a few months earlier but are still having paperwork issues. Either way, it sounds clear to me that these are not "renewals (aka rederminations)".
A beautiful find by new contributor Uncle Toby: Highmark Inc., a major insurer which serves Pennsylvania, West Virginia and Delaware, just did exactly what I've been wanting every insurer to do: They officially announced not just their off-exchange enrollments, but specified the exact date that these run through and the fact that they're all 100% ACA compliant.
As a bonus, they've included specific state-by-state breakdowns as well as a comparison against their on-exchange enrollments. 32% of PA's, 27% of WV's and 29% of Delaware's QHP enrollees to date have been off-exchange. This proves exactly what I've been saying: There are absolutely several million (at a minimum) direct QHPs out there which simply haven't been documented publicly yet.
A couple of days ago, Avalere Health, with whom I've alternately butted heads with and agreed with on all things Medicaid-related, has issued their QHP projection: They're calling for around 5.4 million total. In order to hit that number, the March average would be around 38,600/day.
Avalere is basing their projection primarily on the Medicare Part D enrollment pattern back in 2006. They could very well be correct, but there's also some key differences between that situation and this one (the most obvious one: Medicare enrollments were presumably mainly limited to those over 65, whereas it's the "Young Invincibles" that are the primary target at the moment). However, I'm not going to pooh-pooh their projection either, as there are many similarities between the two as well: Both were/are large, national government healthcare enrollment programs, with a 6-month limited enrollment period, a financial penalty for not enrolling by the deadline and so on.
After a couple of weeks where the paid QHPs seemed to only be drawing from the existing unpaid enrollments (a sign of new additions drying up), WA seems to be back in gear with 2,740 more paid QHPs, 4,019 more unpaid QHPs and 16,247 new Medicaid/CHIP additions, all since February 27th.
Qualified Health Plans: 109,021
Medicaid Newly Eligible Adults: 222,607
Medicaid Previously Eligible but not Enrolled: 115,159
Qualified Health Plan Applicants – Need to Pay: 82,060
*Note: These numbers reflect enrollments and applications through March 6.
Looks like the 30/70 QHP/Medicaid split that I've been assuming for Minnesota has shifted somewhat; as a result, I actually have to lower the QHP number by a bit compared with the 3-4 mini updates from last week. MN QHPs now stand at 33,362; new Medicaid/CHIP enrollees are at 85,267 as of March 11.
In addition, SHOP (Sm. Biz) enrollees are up a bit from 1,042 to (660 employees x1.8 per household) = 1,188 total individuals covered.
DC itself has an unusual situation: Due to the quirky ACA rule that has Congressional Staffers (some 10,000 of them) enroll via the Small Business SHOP exchange instead of the individual exchange (or that of their home state), DC's SHOP exchange actually has twice as many enrollees as individual QHPs. Anyway, QHPs have gone up 267 in the first week or so of March, while SHOP enrollees have gone up 104. Meanwhile, new Medicaid enrollees are up 506.
As of March 9, 2014, 30,642 people have enrolled through DC Health Link in private health plans or Medicaid:
6,516 people enrolled in private health plans through the DC Health Link individual and family marketplace; 11,383 people gained Medicaid coverage through DC Health Link; and 12,743 people enrolled through the DC Health Link small business marketplace.
Eureka! I just received an explanation from the New York Dept. of Health of the mysterious 40,000 QHP enrollment discrepancy between the February HHS report and the New York State of Health press releases--apparently the additional 40K are newly-added enrollees in NY's Child Health Plusprogram, which is privately operated (and thus not included under Medicaid/CHIP) but is also technically not an official "Qualified Health Plan" by the technical definition.
According to the NY DOH, the higher NYSoH enrollee numbers include both the technical QHPs as well as enrollment in the state's CHild Health Plus program. This program covers kids up to 19 years old, with subsidies given for families up to 400% of the FPL. Therefore, children who fit this criteria get enrolled in Child Health Plus instead of actual QHPs.
They've specifically confirmed that "over 40,000 additional children have been enrolled in Child Health Plus through the Marketplace."
Contributor Steve Ciccarelli brought the following footnote ("Appendix D") from the February HHS report to my attention, which kind-of, sort-of explains the 40,000 QHP enrollment discrepancy between HHS (which gives the 3/01 total as 244,618) and the NY State of Health Exchange, which had the total as appx. 285K as of 3/01:
It is important to note that the SBM enrollment-related data that are reported in this issue brief represent state data that have been reported to CMS through March 7, 2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report.
I've already corrected for the "different time periods" in order to get the 285K number from the NY exchange for March 1st. The 40,000 difference between them and HHS appears to fall into the "different metric definitions".