END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

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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.

NewA couple of weeks ago I predicted the total January Private QHP enrollment number with accuracy that surprised even myself (I called it at precisely 3.3 million; it came in at 3,299,492).

I also gave airy, back-of-the-napkin predictions for February and March, figuring that February would come in at around 1.14 million in Febuary and between 1.5 - 2.0 million in March, for a final total of roughly 6.0 - 6.5 million enrollments. Note that this does not take into account the "paid vs. unpaid" factor, since some people won't be paid in full until mid- to late-April or beyond.

This just in...Kentucky's latest update has KY Private QHP enrollment up to 49,662 from 48,611 on February 1st (a modest 2% increase) and Medicaid enrollment up to 181,705 from 155,172 (a 17% increase).

231,367 Kentuckians are enrolled in new health coverage through @kynectky. If #ACA is repealed, 231,367 Kentuckians are SOL. #kysen

— Joe Sonka (@joesonka) February 14, 2014

181,705 Kentuckians have enrolled in Medicaid, 49,662 in private insurance through @kynectky.

— Joe Sonka (@joesonka) February 14, 2014

Maryland's Private QHP enrollment is up to 31,112 (up from 29,059 on 2/01), and their Medicaid/CHIP enrollment has increased to 52,091 people plus another 95,889 transfees from the Primary Adult Care program; this is up from 44,592 Medicaid + 95,824 PAC transfers a week earlier.

Through February 8, 31,112 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,889 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of February 11, 2014, an additional 52,091 individuals were newly enrolled in Medicaid effective January 1.  

OK, not exactly an eruption of new enrollees, but add 265 more people to the list...

Total since October 1, 2013

3,879 Enrollments in the Individual Marketplace

Happy Valentine's Day!

Now that the dust is settling on the January HHS Report and I've had a chance to fully tackle the "But how many have PAID???" issue, I decided this would be a good point to do some cleaning up of The Graph.

First of all, as I announced last night, I've added a "90% Either Paid or Unpaid for Legitimate Reasons" marker to address the "Paid/Unpaid" issue.

Secondly, now that I've switched both the Medicaid and Private QHP numbers over to a "range" format, I've decided to drop the Grand Total numbers from 2 decimal points to one (that is, the range is now 8.8 - 14.4 million instead of 8.78 - 14.46). All of the numbers involved are large enough now that it doesn't make sense to be so anal about it anymore (don't worry, the actual spreadsheets will remain as precise as I can make them).

Well how do you like that? Here I go and spend all morning crunching numbers, reviewing different state reports and so forth...and a few hours later the New York Times goes and makes my point for me:

WASHINGTON — One in five people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts say.

Paying the first month’s premium is the final step in completing an enrollment. Under federal rules, people must pay the initial premium to have coverage take effect. In view of the chaotic debut of the federal marketplace and many state exchanges, the White House urged insurers to give people more time, and many agreed to do so. But, insurers said, some people missed even the extended deadlines.

OK, now that the January numbers are out, let's take a look and see how the individual states are doing. The wonderful Kaiser Family Foundation has a much more sophisticated version of this, but my spreadsheet has two features theirs doesn't: Ugly color-coded cells...and more recent enrollment data for 13 states.

While including post-February 1st data fro some states but not for others does give a bit of an unfair advantage to those states, it's still worth taking a look at to see how the states are faring.

First, let's use the official CMS Projection percentages. These absurdness of these numbers has already been discussed repeatedly, so I won't rehash that here, but we should at least check it out before looking at a more rational measurement.

SEE UPDATE BELOW!!

OK, the anti-ACA talking point of "How many enrollees have actually PAID???" has been one of the most commonly-made attacks on the exchanges since the first decent numbers started rolling in at the end of November. It seemed awfully silly back then, since at the time, the actual coverage start date was still weeks away. Most people I know don't pay their utility or credit card bills until just before they're due, so it seems disingenuous to assume that a health insurance policy (which could be up to $1,000+ per month for some families) would be any different.

Here's what I said about the issue on January 2nd, right after the first wave of policies kicked into effect:

Larry Levitt of Kaiser makes an interesting observation in a couple of Tweets yesterday:

States with big increases in ACA enrollment since December:

  • Mississippi ↑ 116% 
  • Florida ↑ 88% 
  • Louisiana ↑ 87% 
  • Texas ↑ 75% 
  • Georgia ↑ 73%

This list is all fed marketplace states. Growth generally lower in state exchanges because enrollment was higher to begin with.

Let me point out a few things that are worth noting here:

Less than 8 hours after the HHS Dept. released their big January enrollment report, Nevada has already issued another update to their numbers: 

Update as of 2/8: 23,686 consumers have confirmed Qualified Health Plan selections, 16,030 have paid.

The 16,030 number is a 7% bump over a week earlier (14,999), and the unpaid number (7,656) is slightly higher than the prior week (7,598).

With all the focus on fixing the problems with the individual/group healthcare exchanges, there's been far less attention paid to the more-troubled SHOP (Small Business) exchanges. The administration had already announced that the HC.gov version (covering 34 states*) wouldn't be launched at all until this fall, and 2 of the state-run exchanges (Oregon and Maryland) recently announced that they'd be offline until well after the end of the March enrollment period as well.

Today, Covered California announced that while their SHOP exchange has been operational (with a small number of enrollments to date), they're shutting it down until this fall as well. This leaves 14.5 state-run SHOP exchanges in operation (and yes, that's 14.5, not 15...Washington State's SHOP is only running in 2 counties at the moment).

Still, the press release does give a slight bump in CA's SHOP enrollment before they stop taking new signups: 4,490 individuals covered, plus another 1,200 being processed, for a total of 5,690. That's where it'll stay through the end of the March enrollment period unless they reverse themselves between now and then.

OK, given how messy and confusing the Medicaid/CHIP situation is, I had to think through the best way to incorporate the January HHS Report into the mix. The problem is that not only are the monthly HHS reports only part of the equation (the January CMS report probably won't be released for another 10 days or so, based on prior months), but it's not a simple "add HHS now, then add CMS later". The two actually intermingle, and some of the caveats and overlapping data changes from month to month, which means that some of the data I include today will have to be modified or removed after the CMS report is released, and some of the data which I've removed will have to be added back in...or part of it will, anyway.

Having said all that, I think I have a pretty good grip on how to do this now:

OK, I've scrambled and have updated the Private QHP spreadsheet with the January HHS Report figures.

While the official number as of 02/01 is just shy of 3.3 million, my spreadsheet includes partial updates since February 1st for several states. As a result, the actual current total is at least 3.43 million in all:

  • 3,149,008 from the 46 states which haven't been separated out between Paid and Unpaid enrollees
  • 169,382 known to be paid enrollments from NV, RI, VT, WA & WI

This adds up to 3,318,390, which is the number that I'm counting towards the "Percent of CBO Projection" total...which I'm now calling 46.9% as of today.

  • Then, there's another 119,164 known to be unpaid enrollments from NV, RI, VT, WA & WI

Add these all up and you get a total of 3,437,554.

Add in the 124,220 known Off-Exchange Private QHP enrollments and the 54,814 known SHOP enrollments, and you have a grand total of 3,616,588.

Add in the 3,101,000 known "sub-26ers" and this goes up to about 6.71 million people on the Private QHP side.

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