END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

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Colorado does this odd thing where they simply upload an image file with the latest metrics, which can be irritating but also handy. To that end, here's their latest tally which runs through January 31st:

From this we have the latest Private QHP enrollments up slightly to 69,627 (from a prior estimate of 68,999 a few days ago) and Medicaid enrollments up to 117,607 from 101,730 two weeks earlier. It's important to note that Colorado's Medicaid tally supposedly includes only brand-new enrollees, not renewals. This represents a 15.6% increase from 1/15.

An interesting, but hardly surprising development today: The CBO, which had previously projected that appx. 7 million people would enroll in Private QHPs via the Health Exchanges created by the Affordable Care Act (as well as 9 million additional people enrolling in Medicaid or CHIP thanks to the expansion provisions within the ACA) by the end of 2014 have now reduced both of these projections by 1 million apiece, to 6 million and 8 million in the first year. Thanks to Dan Diamond for bringing this report to my attention.

You have to scroll all the way down to page 108 of the report to find it, but here's the relevant screen shot, and the relevant paragraph from pages 112 - 114 of the report:

4,975 more people enrolled since January 30. No Private/Public breakdown, but based on the existing ratio, I'm guessing around 23% Private QHP / 77% Medicaid/CHIP, or 1,145 / 3,830. This brings KY up to 45,305 and 155,172 respectively.

Add another 55K direct new Medicaid enrollments and you're at 210K on the Public side.

200,477 Kentuckians have signed up for affordable healthcare using @kynectky! #kynect #ACA #GetCovered http://t.co/6B8TGA8NMH

— Steve Beshear (@GovSteveBeshear) February 3, 2014

In my prior estimated breakdown, I had NY private QHP's as 237, 411 and Medicaid/CHIP at 106,785. Turns out I was only missing 3,800 on the private side, but they've added an additional 30,000+ more on the Medicaid/CHIP side.

Of the 380,747 who have signed up, 241,242 people have enrolled in private health plans and 139,505 have enrolled in Medicaid.

I should note that just as the Private QHP number doesn't include direct off-exchange enrollments, neither does the Medicaid/CHIP tally; when you add those, the new Medicaid enrollment total comes to over 330,000 for New York.

The first number is only slightly higher than last week, but at the time I didn't know if that referred to employees only or their families as well. This article is more specific, so using Covered California's very conservative 1.8x factor for dependents, the actual number of people covered by the SHOP exchange comes to about 711.

As of Jan. 28, 1,612 New Mexico employers had signed up to buy insurance on the SHOP for their employees. A total of 395 employees and their dependents have selected plans on the SHOP.

In addition, as the submitter noted, the numbers aren't huge but the 1,612 employers signing up is extremely promising.

Maryland continues to move along...

Through January 25, 26,832 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

95,318 Marylanders signed up through the Primary Adult Care (PAC) program were automatically converted to Medicaid coverage effective on January 1, 2014, and now have full Medicaid coverage. As of January 28, an additional 42,302 individuals were newly enrolled in Medicaid effective January 1.

Leigh McGivern, PR & Social Media Manager for CoOportunity Health of Iowa and Nebraska, has done me a huge favor by agreeing to release the Co-Op's on-exchange and off-exchange (direct) enrollment figures through January 24!

Unfortunately, the on-exchange numbers are both less than the 12/28 totals for either states (there are 2 insurance companies operating on Iowa's exchange and 3 on Nebraska's), so I don't know how much those have gone up since December, but the off-exchange numbers are quite impressive and very telling! I'm not breaking out the age data, but here's the key numbers:

Iowa Off-Exchange QHP Enrollments: 5,325 Individual; 4,694 Small Group; 147 Large Group = 10,166

Nebraska Off-Exchange QHP Enrollments: 7,867 Individual; 8,079 Small Group; 1,833 Large Group = 17,779

Between the two, that's nearly 28,000 more people added to the Private QHP tally.

OK, this is a new one...two updates for the same state only 14 hours apart:

Hot off the press at #RWJFRR - Kentucky official says 195,502 have used Kynect to get coverage (up by 12,000 this week). 44,160 are in QHPs.

That's 760 more QHPs / 12,742 more Medicaid/CHIP enrollees than I had last night. This also brings Kentucky up to over 20% of their absurdly-high "projection" of 220,000 QHPs (or, conversely, 46.4% of the more reasonable "Proportional % of 7 Million" figure).

UPDATE: I should have noted that the actual total number of new Medicaid enrollments for Kentucky is now over 206,000 if you include direct (off-exchange) enrollments.

OK, no exact numbers here, but the totals on 1/24 were 42K Private and 136K Medicaid/CHIP, so similar ratios would be about 1,400 extra QHPs and 4,600 Medicaid/CHIP additions.

Kentucky Gov. Steve Beshear said Monday that 182,000 Kentuckians have signed up through Kynect since October 1.

Some minor updates out of Oregon today: Private QHP enrollments are up to 31,664 from 30,157 a week ago; exchange-based Medicaid enrollments have gone up to 57,858 from 53,018, and Medicaid "Fast Track" direct enrollments are up to 122,869 from 121,190. As noted last week, only the difference in Fast Track enrollments since 12/28 are being listed on the spreadsheet, since the other 120K or so are already included in the CMS report numbers.

Cover Oregon: Private insurance: 31,664 / Oregon Health Plan: 57,858 
Oregon Health Authority “Fast Track”: Oregon Health Plan: 122,869

No exact numbers, but roughly 5,600 more private QHPs than the 1/15 official update of 63,407. No new Medicaid/CHIP here, however:

Almost 69,000 people have gotten private health insurance through the exchange that meets new federal mandates, Fontneau said. That's a big uptick from the end of 2013, when just over 50,000 had gotten coverage.

Since this period is evenly split pre- and post- Sec. Sebelius' "3 Million Total" announcement, I'm subtracting a little more than half from the "Not Broken Out Yet" amount and considering the other half to be newly added since then.

The next quote from a Colorado exchange representative is also quite telling:

"As much as we may have overestimated what would happen in October and November, we underestimated what would happen in January," she said.

Arkansas' unusual "Private Medicaid Option" already had 74,000 enrollees at the end of December; it looks like they've added another 5,000 people since then. The other 74K are already included in the "CMS Direct" report columns on the spreadsheet, so I'm only increasing the tally by the new 5K.

More than 79,000 people have enrolled in Arkansas' private option program, and state officials say they expect it to hit 100,000 when the Legislature convenes next month for a session focused primarily on the state's budget. 

And voila, with the quarterly earnings conference call for WellPoint Insurance, we have our first clue as to just how many ACA-compliant policies have been sold directly via the insurance companies instead of being run through Healthcare.gov and/or the state-based exchanges: Around 95,000 nationally:

Of the half million new members Wellpoint said that have applied for coverage so far, more than 80 percent came through public exchanges and two-thirds of those were “subsidy eligible.”

Unfortunately, these are pretty rough numbers--"half million" could be as few as around 490,000 or as high as perhaps 520,000, and "more than 80%" could mean anywhere from 81 - 83%, but for the moment I'll assume 81% out of 500,000, which means 19% off-exchange.

Oh, and no, these should not include any of the "1-year extensions of non-compliant/junk accounts" which the Obama administration has been allowing; the article specifies these as new members of WellPoint, not renewals/extensions of existing policies.

According to a report issued last July by the Kaiser Commission on Medicaid and the Uninsured, if all states accepted Medicaid Expansion the number of uninsured would be reduced by an additional ten million people. The comprehensive report noted, however, that 4.9 million of those people were living in states that had refused the expansion and another 1.5 million were in states that had not yet decided.

Why have many governors refused the offer of the federal government to fund 100% of the expansion for three years, and 90% thereafter until 2022?  Among other reasons, the governors claim they cannot depend on the promise of federal funding, but they rarely state their main concern: the possibility that a large number of additional regular Medicaid clients will come "out of the woodwork." These are people who could have qualified previously under the regular Medicaid rules but never enrolled, perhaps because they did not know about the system, did not realize they might qualify, or did not know how to find out.  As reported by NPR in 2012: "what really has many state leaders worried is something called the 'woodwork effect.' When big parts of the health law go into force in 2014, they worry it will bring out of the woodwork the millions of people who are already eligible for Medicaid but aren't already enrolled."

It appears that many people have indeed been signing up for regular Medicaid because of the publicity about healthcare.gov and the state exchanges, as well as an easier, streamlined enrollment process required by the ACA. Evidence of the woodwork effect can be found in the latest CMS report. For states with Medicaid Expansion, there was an average increase of 14.4% in Medicaid applications Oct-Dec compared to the July-Sept average. For states not expanding Medicaid, there was an average decrease of 10.1% during the same period. This decrease may reflect a typical seasonal pattern, which makes the 14.4% increase in the Expansion states even more remarkable.

States refusing Medicaid Expansion fear the woodwork effect because the federal government pays a much smaller share of the costs of regular Medicaid: from 73 percent in a poor state like Mississippi, for example, to 50 percent for states such as Wyoming, California and Connecticut. When it comes to paying its share of Medicaid costs, the federal government will have to require that states distinguish clearly between regular Medicaid clients and the "non-elderly", non-disabled, childless, low-income adults between the ages of 19-64 who are newly enrolled because of Medicaid Expansion. 

Currently, these states (plus DC) are expanding Medicaid:

AZ, AR, CA, CO, DE, HI, IL, IA, KY, MD, MA, MI, MN, MA, NV, NJ, OH, UT, NM, NY, ND, OR, RI, VT, WA, WV

States not expanding Medicaid:

AL, AK, FL, GA, ID, LA, MS, MO, MT, NE, NC, SC, SD, TX, WI

States that may expand Medicaid or accept a modified version in 2014:

IN, KS, ME, NH, OK, PA, TN, VA, WY

Regarding the latter group, a recent article says "an unusual alliance of powerful hospital, business and religious interests has been leaning on Republican leaders to reverse course." It is probable that as the benefits of Medicaid Expansion to a state's budget become increasingly evident, such as less uncompensated care, more states will accept Medicaid Expansion despite their initial objections.

Good Morning! I have some mid-level changes to both spreadsheets this morning which visitors should be aware of:

--On the Private QHP Spreadsheet, I've replaced the very rough percent-based "Total Uninsured" numbers with the raw numbers from the same Kaiser Family Foundation table. Again, this is the same source, I'm just using the raw number view now instead of the percent view. In addition, using percentages were based on the July 2013 census estimates, while the KFF numbers are based on 2011-2012 population totals. Combine this with the percentages being previously rounded off, this resulted in some significant differences in the state numbers.

For example, at the high end, the California number changed from around 7.6 million to only 7.1 million, a half-million difference! Meanwhile, at the low end, Vermont has "dropped" from 57,000 uninsured prior to October 1st to just 47,900…which makes the original CMS projection for Vermont (also 57,000) all the more absurd.

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