Time: D H M S

OK, so I may have gotten people's hopes up a bit too much with the 8M by 4/15 thing. Still, 7.6M or higher would still be awesome, and the two reports which were sent my way this AM should more than make up for my lowered projection.

First up is this from the Motley Fool, regarding hospital readmission rates, especially among Medicare recipients:

After hovering around 19% for years, hospital readmission rates began dropping beginning in 2012 and continued to do so into 2013. (The above chart reflects data through August of last year.) The national rate appears to still be falling considerably this year based on the latest data from the Centers for Medicare and Medicaid Services, or CMS. 

Readmissions cost U.S. taxpayers a pretty penny. The federal government estimated that hospital readmissions for just Medicare patients has historically added up to $26 billion annually -- $17 billion of which could be avoided. 

(Sigh) See, this is why, when I said "I'm not gonna do the prediction thing this time" I should have stuck with that.

Dan Pfeiffer's statement about "200K this week" on Meet the Press yesterday (which was down about 1/3 from what I was figuring) got me thinking about the contrast between his statement and Peter Lee's (head of CoverCA) statement about CA having around 250K potential QHP enrollees in the queue.

It just occurred to me this morning that while my assumption about the number of applications is probably correct, my assumption about the number of individuals covered by those applications could be way too high...because that assumes that each application includes my standard 1.8x multiplier for spouses & kids in the household.

I don't have Sirius XM myself, but if anyone does, I'm scheduled to be a guest on "Left Jab" this evening, sometime between 7pm - 9pm. It's apparently on Channel 127.

I assume it'll be available as a podcast afterwards...

UPDATE: Nothing like having your kid banging on the door and shouting at you while you're on a live radio broadcast (sigh)...

Anyway, for anyone interested, the podcast of the show should be available around 9:30pm Eastern or so.

This is more of an updated/simplified version of my post from a couple of days ago. As I said, I'm not going to set up an elaborate spreadsheet and try to micromanage the projection data for the next 10 days the way I did during the regular enrollment period. Instead, I'm just going with a lazier, more general estimate: Based partly on the California data given by Peter Lee (500K partly done applications in under the 3/31 wire, half of which are likely Medicaid-bound), I'm figuring that total exchange QHP enrollments gonna end up somewhere around 900K total, for a nice round 8M by the end of April 15th. Perhaps a little higher (1M even?).*

As always, I'll be more than happy to be proven wrong, as long as I've undershot the mark :)

This breaks down to around 60K per day x 15 days, which is what I'll be tacking onto the Spreadsheet & Graph until the actual total comes out.

Oh for heaven's sake. Having grudgingly given up on the general "But how many have PAID????" argument (answer: around 85%, plus another 8% or so who will pay by the time they actually receive the bill or shortly after it's, you know, actually due), and having conceded some ground on the "But how many were UNINSURED???" argument (answer: At least 33% of the first 6 million, more likely a good 40% or more when the additional 1.1M+ are added in, and possibly even as high as 49% by some right-winger's own admission...see below), at least one Forbes writer openly opposed to the ACA is now moving onto the next tactic: Combining the remnants of these two arguments, Voltron-like, into a new talking point:

"OK, most people have paid, and a high percentage of the total may be newly insured after all...but how many of those who are newly insured have paid???"

That's right, this is where they're trying to move the goal posts.

Hmmmmm...not sure what to make of this update out of KUNM in New Mexico. NM only had 18,691 exchange QHPs as of 3/15, so 51.4K would be absolutely insane (a 2.75x increase). It looks like they've mixed the SHOP enrollees into the mix, which means it's not quite that crazy--take those out and the QHPs are down to 37,400, or a "mere" doubling of the existing total. So...I guess that makes sense.

HOWEVER, this causes bigger questions, because the only data I've had for New Mexico's SHOP exchange was a mere 524 as of March 18th. How the hell did they manage to enroll 28 times as many people in the next 13 days???

Simple and to the point (it's Twitter, after all). Also, 95% paid. Looking more and more like my 93% rule of thumb may actually be overly conservative (pun intended):

Updated @MNsure enrollment numbers: 47,046 QHPs, 35,603 in MinnesotaCare and 92,402 in MA. Total of 175,051.

— MNsure (@MNsure) April 4, 2014

I don't usually write this all out, but given the interest in the site these days, I figured I would give a play-by-play of the process of breaking down the CMS reports by state, using the February CMS report just released an hour or so ago.

First, skip to Pages 12-16, where you can see the grand total for February (which, unlike the HHS reports, covers February 1-28 itself, none of this "Saturday closest to the end of the month" business):

  • Expansion States Subtotal: 1,303,676
  • Non-Expansion States Subtotal: 945,444
  • Total: 2,249,120

Hmmm...that looks like a lot less than 3 million to me. The main reason for the missing 750K is because some of the new enrollments ran through the ACA exchanges (HC.gov/etc) while others went through traditional means (walking in the door of a state Medicaid agency office, etc). Furthermore, some of the states overlap--they're reported on both reports, which means I have to be careful not to double-count:

Unfortunately I don't have a link to the actual report yet; Politico just did one of their "Breaking News" things for now. Apparnetly it's slightly below 3M Medicaid/CHIP enrollments in February, for a total of 11.7M since October 1st. HOWEVER, not all of these are new (some are renewals), and others may be part of the "baseline churn" so it's not a simple matter of tacking on 3M to the total.

Watch this post for updates once I actually hunt down the PDF of the report itself...

Remember, this is for Februarynot March. The March CMS report probably won't be out until the first week of May, and possibly even later (I'm assuming it'll be even more of a PITA to compile, given the craziness at the end of March...)

Meanwhile, the HHS report for March, which is the one which will confirm/clarify the big 7.1M exchange QHP figure (along with the other half of the Medicaid data) should be out sometime next week...although again, it might be delayed due to the March rush.

UPDATE: OK, I have a copy of the report now!

Sean Parnell sent me a clarification of the 64.6M Medicaid number out of Rhode Island from the OHHS in Rhode Island (which did seem a bit high to me, but surge and all...)

New Medicaid enrollment figures through March 31, 2014

Medicaid enrollment:  64,590 (through HealthSource RI from October 1, 2013 through March 31, 2014)

Of that number, 42,320, or 65.5 percent, represent adults in Medicaid’s new eligibility group, adults 19-64 without dependent children who were not previously eligible for Medicaid but became eligible on January 1, 2014.    The new eligibility group is authorized under the Affordable Care Act’s Medicaid expansion and is financed with 100 percent federal dollars for its first three years, 2014-2017.

The other roughly one-third represents those enrolling who were eligible for Medicaid under previously existing rules.

Unfortunately they don't specify how many of the remaining 22.5K are renewals vs. "woodworkers". I'm going to go with about half (11K, or around 17% of the 65K total) unless I receive further clarification one way or the other. This reduces the current "woodworker" estimate of 16.6K by about 5,600.

OK, this one is actually semi-legitimate, depending on your perspective.

According to Glenn Kessler of the WaPo, when the CBO crunches the numbers next year to see how many 2014 ACA Exchange QHPs actually did qualify as being counted towards their 7M (then 6M) projection, they're actually going to have to slice up every single person enrolled into 12ths.

That is to say, if your policy started coverage in January and was paid for straight through until the end of the year, you'll be counted as one "CBO person", but if it didn't start coverage until, say, April 1st, you'd only be counted for 9 months, making you 3/4 of a "person" in CBO terms.

Needless to say, not only does this complicate matters considerably, it also means that when the CBO releases their full-year 2014 report next year (January? February?), it may look something like the following:

A lot of people have asked me if I plan on doing a 4/15 QHP projection. Honestly, I'm a little burnt out at the moment and need some chill time on the prognosticating thing. However, if this news is any guide, it could be huge:

Now topping more than 3 million, the number of Californians who have enrolled in a private health care plan or in Medi-Cal through the state's health insurance exchange will likely rise by about 500,000 people who started but did not finish their applications by Monday's midnight deadline, exchange officials said Thursday.

At a news conference, Peter Lee, executive director of the Covered California exchange, told reporters that of the half-million individuals who had started their applications in the last week of March, at least 20,000 had finished their applications by Tuesday.

Now, I'm assuming that "finished their applications" in this case actually means "enrolled", because 500K / 15 days = 33,333 per day if they plan on squeezing that many in under the new 4/15 wire.

Now that we're past the official Open Enrollment period, I've overhauled The Graph with some major changes & updates. These include:

  • By popular request and much pondering (see comments at bottom of link), I am no longer subtracting the 3.7M Cancelled Policies from the grand total. However, these are still clearly and prominently noted in the yellow box.
  • As promised, I have lowered the "Sub-26er" bottom-end estimate again, from a low of 2.2M to 1.6M. I'm done mucking around with this until further notice.
  • With the official announcement of a whopping 1.7M OFF-exchange QHP enrollments from the BCBS Association, I have increased the documented off-exchange total to 2.17M on the graph, causing a noticable spike at the end (obviously these weren't all enrolled in today, but I can't really back-date these so they're all added at once).
  • Note that I've also deleted all of the state-specific BCBS off-exchange QHPs since the 1.7M total noted above supercedes all of them.
  • Since the 9M total off-exchange figure credited to the Rand Survey was a very rough estimate (see update at bottom of link), I've added an "up to" caveat (and the 6.83M balance isn't on the graph itself anyway).
  • I've replaced the 7M arrow with 6M and 7M lines to reduce the clutter.
  • Finally, the most controversial change is probably the removal of the "documented unpaid" exchange QHPs (as well as the "estimated additional" QHPs; instead, I've simplified things greatly by separating the total Exchange QHP number into 2 areas: 93% estimated PAID (or will pay soon) and 7% UNPAID (or may not pay).
    I'll be happy to revise this 93 / 7 ratio one way or the other as more data comes in, but for now, based on all the partial "Paid/Unpaid" data I've seen to date, that seems to be fairly accurate.

About 5 different people have sent me a link to this new study by the Urban Institute, which concludes that the total number of uninsured adults in the U.S. has been reduced by around 5. million people since last fall.

They're pretty clear about the time period: it runs from just before the exchanges launched until...well, actually, until early March (more on this below):

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014.

The results? According to this study, it's a net reduction of 5.4M uninsured:

As deaconblues reminds me, the 29K is in addition to the 720 subsidized enrollees that they've managed to get through their messed-up system.

Massachusetts will not meet its goal of moving more than 200,000 people into insurance plans that comply with the federal law by the end of June. It has managed to enroll about 29,000 residents in unsubsidized coverage, 138,000 in temporary coverage, and another 114,000 in extended coverage since the October launch of its new website, with a significant number applying on paper, said a Connector spokesman Thursday.