2018 MIDTERM ELECTION

Time: D H M S

OK, I'll have to pull the numbers apart a bit because this story with New York's latest enrollment tally has some overlapping dates and numbers:

More than 800,000 New Yorkers have completed applications to enroll in New York's health-care exchange since Oct. 31, and 501,205 have officially enrolled, a 22 percent increase since Feb. 10, the state Health Department said today....

The state said that 70 percent of those who have enrolled were uninsured at the time of application. But the state didn't immediately say how many of those lost insurance because of the federal Affordable Care Act.

Of the total 501,205 people enrolled, the state said 276,681 chose private insurance plans, while 224,524 qualified for coverage under Medicaid, the government-sponsored health insurance program for low-income Americans.

"Woodworkers", in ACA Medicaid parlance, refers to people who were already eligible for Medicaid coverage prior to the ACA expansion (in states which have done so),  but who didn't actually enroll in Medicaid until after October 1st for a variety of reasons, ranging from not being aware that they qualified, to finding the enrollment process too difficult, to not even knowing what Medicaid was before the ACA exchanges launched.

In other words, these are people who already qualified, but were "brought out of the woodwork" to sign up since the exchanges launched in October.

I've been struggling with the question of whether to include "woodworkers" in the Medicaid/CHIP tally or not since I first learned of the distinction between them and the far stricter definition of who should "count" (ie, limiting it to "people who only legally qualify for Medicaid/CHIP due to expansion provisions within the ACA".

There's really two questions here--a philosophical one (should they be included) and a data-driven one (if you do include them, how many people fall into this category?).

Yesterday I posted an analysis of the current enrollment trends and gave a range of possible final QHP tallies through the end of March, ranging from 5 to 7 million depending on a variety of factors. However, I didn't really go into what those factors actually are, so here's a simple list of the forces supporting and opposing higher or lower enrollment going into the final 6-week stretch:

POSITIVE FACTORS:

Well, this isn't exactly a positive article, but more enrollments are more enrollments...this brings Hawaii up about 700 people since the previous update.

The Connector had enrolled more than 5,000 people as of Friday, according to interim Executive Director Tom Matsuda. However, more than 18,000 applications have been processed as of Feb. 15.

With the October website disaster at HC.gov and serious problems still plaguing some of the state exchanges, is it still even remotely conceivable that private QHP enrollment could reach the CBO's original 7 Million projection? Well, the CBO doesn't think this is likely; they issued a revised projection last month which dropped that projection down to 6 million.

IMPORTANT: I should stress that this ONLY refers to exchange-based, individual/group policy enrollments. It doesn't include SHOP small business enrollments (about 58,000 to date) or direct/off-exchange enrollments (almost half a million confirmed, likely several million more as well). It also doesn't include Medicaid/CHIP enrollments either, though you probably figured that already.

However, let's look at the possible scenarios, about 6 weeks away from the enrollment deadline.

This is a great article; not only does it update West Virginia's Medicaid Expansion tally (up 16,561 from the current 70,574 number), but it gives other useful info, such as the total number of WV residents eligible for the expansion program (130K). Most importantly, it specifically states that these 87K are in Medicaid due to the ACA expansion provision, an important clarification.

According to West Virginia Department of Health and Human Services, over 87,000 residents have been enrolled for health care coverage through the Medicaid Expansion...

Jeremiah Samples, assistant secretary for the DHHS, said that number is about 70 percent of everyone eligible for the expansion....

The total estimated number of West Virginians eligible for coverage under the expansion is 130,000, according to Samples.

By Feb. 13, a total of 87,135 people have enrolled, which Samples said is about 25,000 more than the projected number for 2014.

Well I'll be damned! Oregon has finally managed to enroll a small number of people through their website! (Until today, all 35,247 private QHP enrollments in OR have been processed manually...literally, paper forms filled out by hand and then manually entered into the system). With only 6 weeks to go, this may seem a bit underwhelming, but it's still something...

A Cover Oregon official says insurance agents and community groups have been able to enroll about 700 people in health coverage entirely online.

Chief Information Officer Aaron Karjala revealed the number to a state legislative committee on Friday.

Cover Oregon launched its website for a limited group of experts earlier this week, more than four months after it was originally scheduled to be operational.

There's still no date for when the system will launch to the general public. Karjala says developers are regularly testing and fixing elements of the system.

Individuals working without an agent or certified expert can continue to apply, but Cover Oregon staff will have to process a portion of their application by hand.

Massachusett's ACA exchange website is still undergoing massive technical problems, but there's been significant progress made in processing a mountain of paper applications. The immediate impact isn't that significant (11,000 total enrollments = only 2,861 more than the Feb. 1st tally), but the article suggests that another 50,000 applications should be getting pushed through the system any day now... 

Officials running the state’s troubled health insurance marketplace reported progress on Friday toward addressing its most immediate problem -- a massive backlog in processing applications...

As a result, people were urged to file paper applications instead, both to replace expiring policies and to enroll for the first time. The nearest-term problem has been simply processing 72,000 applications, many of which come from uninsured residents....

Overall, a spokesman for the marketplace said that there have been about 11,000 people who have newly enrolled successfully for coverage since October, almost all in unsubsidized coverage.

Maryland continues to creep along, adding 2,139 to their QHP tally (about 7%) and another 8,581 to their Medicaid enrollments (a bit under 6%).

Through February 15, 33,251 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 18, 2014, an additional 60,672 individuals were newly enrolled in Medicaid effective January 1. 

Minnesota issued an official update today (as opposed to the estimate that I came up with a few days ago based on a "nearly 95K" line in an unrelated press release); I was only off by 888 people on the private enrollment side, but by more than 5,500 on the Medicaid/CHIP side of the equation:

ST. PAUL, Minn. — Today MNsure announced that more than 100,000 Minnesotans have enrolled in quality, affordable health insurance through the state’s new insurance marketplace. MNsure is working to enroll thousands more Minnesotans in coverage before open enrollment concludes on March 31, 2014. Today’s new milestone highlights the progress MNsure has made to significantly improve its performance, and the services it provides to Minnesota consumers....

31,088 Minnesotans selected private health plans;
21,574 Minnesotans enrolled in MinnesotaCare; and
48,682 Minnesotans enrolled in Medical Assistance (MA).

101,344 total enrollments

This update/correction also makes a slight improvement in the overall Feb/Jan enrollment model (from 75.6% of January's total to 75.8%).

Well this was unexpected...apparently at a fundraiser, President Obama gave a very rough update on the current ACA exchange tally:

President Obama said Thursday that "close to 4 million Americans" had signed up for insurance on the ObamaCare exchanges, a hint that enrollments may be accelerating as the deadline to purchase coverage nears....

"Right now, we've already got close to 4 million Americans who signed up for exchanges," Obama told a gathering of Democratic donors and governors at a luxury hotel just blocks from the White House.

Let's see how that jibes with my current February-vs-January rate projection.

At the moment, based on the still-limited data available, I'm showing an expected February total enrollment of around 866,000 people through March 1st:

President Obama's statement was yesterday (the 20th), which presumably means that the "close to 4M" number was based on data through the end of the day before (Feb. 19th).

Quite a day for Direct/Off-Exchange Enrollment news. First the Washington revelation, now this profile in USA Today of eHealth Insurance, a private web-based health insurance exchange that's seen tremendous success selling ACA-compliant plans to people who don't qualify for tax credits through the government-run exchanges.

Not exact numbers, but these are reasonable given the previous breakdown (49,662 Private / 181,705 Medicaid): KY Governor Steve Beshear announced that the combined total of enrollments in Kentucky has hit 244,000, broken out roughly 25% to 75%, which would be 61K private, 183K Medicaid. However, to be safe I'm erring on the side of caution and making it 59K Private / 185K Medicaid until a formal press release comes out.

[as of Thursday], 244,000 Kentuckians have signed up for coverage through Kentucky's exchange, Beshear said.

About three-fourths of them enrolled in the state's expanded Medicaid program and the rest in private insurance plans. The state's performance has earned praise from PresidentBarack Obama.

"Those aren't just numbers," Beshear said. "They represent ... real improvement in people's health."

This is significant for another reason. Previously, Kentucky's limited February data made it look like private QHP enrollments had plummeted, down to 20% of their January rate.

No fuzzy terminology here. Unlike some other Medicaid enrollment data which leaves you guessing as to whether it's "expansion", "base churn", "redeterminations" or "woodworkers", this AP article is pretty clear and to the point:

COLUMBUS (AP) — More than 23,000 low-income Ohioans enrolled in Medicaid last month under an expansion of the taxpayer-funded program supported by Republican Gov. John Kasich.

That's about 6 percent of the roughly 366,000 residents who the state projected would be newly eligible for coverage by the end of June 2015.

The state's monthly report on Medicaid caseloads does not include those who have applied to the health program for the poor and disabled. But the numbers released Monday provide the first glimpse as to how many people have successfully enrolled under the expansion. The report shows 23,156 residents have obtained coverage so far.

Sometimes it really is that simple.

For months I've been trying to hunt down the ever-mysterious "Off-Exchange" private QHP enrollment data...people who have purchased new, ACA-compliant healthcare policies since October 1st, but have done so directly via the various insurance companies. These are, for the most part (at least in the states which haven't granted a 1-year extension of non-compliant policies) the same (or very similar) policies as those sold via the exchanges; the enrollment process simply bypasses the exchange websites, that's all. There are several reasons why people do this; the most obvious is if their taxable income is too high to qualify for an ACA subsidy. Why go through the hassle (on some exchange sites, not others) of jumping through the extra hoops of the Exchange process if you're certain that you aren't going to qualify for a tax credit anyway? In other cases, the insurance company itself may have made some sort of special offer for enrolling directly (or, in some unfortunate cases, they may have pretended that it was a better deal or not even mentioned the exchange as an option).

In any event, this data is difficult to hunt down because unlike the Exchange enrollments, the insurance companies are under no legal obligation to make it public (at least I don't think they are...possibly in their quarterly SEC filings or something?) Until today, I only had hard numbers from 2 companies: WellPoint, whose CEO revealed last month that about 19% of their enrollees since October 1st have been signed up directly. I don't have a more recent update on this, and he didn't break those numbers out by the half-dozen or so states that WellPoint operates in, but that's still 95,000 people. In addition, one other company, a Co-Op that operates in Iowa and Nebraska, cheerfully provided a full breakdown of their enrollments. Add these together and you have about 124,000 people...until today.

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