2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

GAH!! That's three "solid numbers but vague definitions attached to them" articles in a row this evening:

Braley also used the debate as an opportunity to show that he has worked with Republicans such as Iowa Gov. Terry Branstad. The two worked together to expand Medicaid, giving more than 80,000 people health coverage who didn’t have it before. 

OK, that makes it sound like 80K newly added to Medicaid via ACA expansion. However, in an earlier Iowa update, it made it sound like IA has some sort of Arkansas-like "private option" thing going on which had 20,000 enrolled at that time. So...is the 80K referred to above in addition to those 20K, or are they included in it?

(sigh) Again, not sure how to handle this. Anyone familiar with the Iowa Medicaid situation, please feel free to chime in below. Either way, it sounds like I can safely bump Iowa's "strict expansion" tally up from 20K to at least 80K, anyway...

Hmmm....like Hawaii, this enrollment update is a) tiny (small state) and b) confusing, since it means that either not a single additional person has enrolled in Delaware since April 30th (which I highly doubt), or it means that the number of people dropping out has precisely matched the number added since then (which I also highly doubt), or it means that the reporter got their numbers and dates mixed up by mashing up the 4/30 QHP total with the 8/31 Medicaid total:

As of Aug. 31, a total of 22,340 Delawareans have enrolled in coverage since Oct. 1, 2013, which Rita Landgraf, secretary of Delaware Health and Social Services, said came as a pleasant surprise to the commission.

...Of the enrollees in the health-care marketplace over the past 11 months, 7,943 individuals enrolled as part of the Medicaid expansion, an 8 percent increase from the month of July.

As deaconblues notes, if you subtract the 7,943 Medicaid additions from the 22,340 total above, you get...14,397...the exact same number that was reported as of May 1st.

For all of the flaws with their implementation of an ACA exchange, Hawaii had at least one thing going for them during the off-season: They kept providing enrollment updates (as small as the numbers were) on a regular basis...through the end of July, that is. Since July 26th I haven't heard a peep out of HI before today:

The exchange, created by the Affordable Care Act, also known as Obama­care, has struggled with participation over the past year, attracting just two medical insurers -- Hawaii Medical Service Association and Kaiser Permanente Hawaii -- and signing up just 10,750 individuals, the lowest in the nation.

Hmmm...on the one hand, 10,750 is actually a reasonably decent increase since July (1,087 people added over about 2 months, or 18/day). On the other hand, it's entirely possible that this number includes the 1,057 SHOP plan enrollees...in which case it isn't an update at all, or (scarier) it would mean Hawaii has only added 30 people to QHPs since 7/26.

OK, all of this is moot if the new software platform proves to be as much of a mess as last year's was, but assuming the new setup works properly, this sounds like a fairly smart way of cleaning up the mess:

Open enrollment begins November 15, but individuals’ deadlines to enroll may vary.

A total of 285,000 people who currently have temporary coverage will need to re-enroll, but a proposal is in the state’s hands to do that enrollment in three waves, with three different deadlines– Jan. 15th for wave one, Jan. 31st for wave two, and Feb. 15th for wave three.

For those of you currently enrolled in a non-subsidized Affordable Care Act Plan, your deadline to re-enroll is by the end of this year, December 31st. Missing that deadline will cause you to have a gap in your coverage.

Thanks to top contributor deaconblues for jumping back into the game and providing me with a whole batch of updates this evening. First up, the DC exchange, which posted their first update in 2 months:

From October 1, 2013 to September 9, 201457,883 people have enrolled through DC Health Link in private health plans or Medicaid:

 14,402 people enrolled in private health plans through the DC Health Link individual and family marketplace.
 14,289 people enrolled through the DC Health Link small business marketplace.
 29,192 people were determined eligible for Medicaid coverage through DC Health Link.

That's an increase of 1,872 QHPs, 510 new SHOP enrollees and 4,472 more Medicaid additions to date.

Hmmm...looks like I may have to dust off my "$360.00 GoDaddy Solution" after all...

A federal judge in Oklahoma ruled Tuesday that Obamacare subsidies provided on the federal HealthCare.gov exchange are invalid, agreeing with a ruling by a three-judge D.C. Circuit Court of Appeals panel against the subsidies.

The ruling, along with the fallout from the D.C. Circuit decision, could be a potentially significant defeat for the Obama administration.

On the one hand, this development probably makes it more likely that the SCOTUS will end up taking on the Halbig case (from the DC Circuit Court) after all (and/or the King case from the 4th Circuit...all three appear to focus on pretty much the same "federal exchange vs. state exchange" issue).

Presented without comment:

Key Republicans running for election Nov. 4 say the federal Affordable Care Act is putting Kentuckians out of work, but employment data and interviews with Kentucky-based economists suggest otherwise.

...Factually, the claim doesn't appear to be accurate. Kentucky had 26,271 more people working last month than it did in March 2010 when President Barack Obama signed the Affordable Care Act into law, according to the U.S. Bureau of Labor Statistics. The state's unemployment rate in that same period fell from 10.5 percent to 7.1 percent.

Manoj Shanker, an economist at the Kentucky Office of Employment and Training, said the health care law "is expected to be a net gain for the economy."

"It is definitely expected to create jobs, and not just for doctors and nurses," Shanker said.

...About 3,600 additional health care jobs were created over the last year in Kentucky as places such as Perry County...saw the percentages of their population without health insurance drop from as high as 20 percent to no more than 8 percent.

Still no Medicaid update since 8/13, but Oregon's total QHP figure is up another 687 since 9/22, while NET QHPs are down 696, giving an overall attrition rate since the peak in mid-July of around 2.3% per month. Note that the net current enrollment figure is still 14% higher than the last official HHS report tally of 68,308:

September 29, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 354,958
Total private medical insurance enrollments through Cover Oregon: 102,596

Oregon Health Plan enrollments through Cover Oregon: 252,362*

*OHP enrollment data is current as of August 13, 2014. An updated number will be posted soon.

Net private medical: 77,920

I've already posted about this issue several times before, but I, like the Wall St. Journal, figured I should post a reminder since today's the deadline:

WASHINGTON—Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act.

The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for.

The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers.

This morning I introduced an all-new, cleaned-up version of The Graph which only includes commercial policy enrollments via the ACA (exchange QHPs, plus references to off-exchange QHPs, ACA-enabled ESIs and sub26er enrollees), projected out through Nov. 15th (when the whole process starts all over again).

Now I've added the other half of the revamped graph: ACA-enabled Medicaid/CHIP enrollments.  Like the QHP graph, there are 3 color-coded sections, but in this case they represent "Strict ACA Expansion" (people who are only eligible for Medicaid/CHIP due to the income provisions within the law in half the states); "Bulk Transfers" (ie, transferred from existing state-run programs such as LIHP in California, Commonwealth Care in Massachusetts, etc. due to ACA provisions) and "Woodworkers" (people who were already eligible for Medicaid prior to the expansion provisions, but who never enrolled before due to either being unaware of their eligibility, not understanding the process, etc). "Woodworkers" are folks who have been "drawn out of the woodwork" since last October thanks to a robust outreach program by the government and affiliated nonprofits, as well as a streamlined enrollment process and other measures.

QHPs are up another 183, Medicaid 5,242 and MinnesotaCare (which is a little bit like high-end Medicaid, from what I can tell) is up another 1,160 over the past 7 days:

latest enrollment numbers 

September 28, 2014

Health Coverage Type Cumulative Enrollments
Medical Assistance 212,331
MinnesotaCare 74,609
Qualified Health Plan (QHP) 55,001
TOTAL 341,941

OK, I'll be frank, this has little to do with the Affordable Care Act itself. Michigan's state legislature has already (grudgingly) passed the ACA's Medicaid expansion program (we call it "Healthy Michigan" here, and it's been very successful).

In other words, the only directly ACA-related items likely to come up over the next couple of years are presumably a) continuing support for Medicaid expansion (not sure if it has to be renewed annually or what) and b) the outside possibility of voting on establishing our own ACA health insurance exchange in the event that the Halbig/King cases end up being upheld by the SCOTUS.

Having said that, if you support me and the work I'm doing here, I'd like to ask a personal favor of you: Please help out the woman running for representative in Michigan's 40th state house district, Mary Belden.

Louise Norris of HealthInsurance.org has posted a couple of fantastic articles the past week or so. First up is an explanation of why most current healthcare policies weren't cancelled...which is to say, the insurance companies cancelled most of them for different reasons than what ACA critics are claiming:

But AV is just one of numerous factors involved in compliance with the ACA. There were many other reasons that existing plans were not compatible with the law. Of particular importance, less than 2 percent of the individual health plans in existence in early 2013 provided coverage for all ten of the ACA’s mandatory essential health benefits.

...So when policies are being cancelled and replaced with ACA-compliant coverage, AV isn’t likely to be the primary culprit. Virtually no individual policies that were in effect prior to 2014 are compliant with the ACA, for a host of reasons other than AV.

ACA-compliant plans will be cancelled? Wrong.

Hmmm...now this is interesting. Yesterday it was brought to my attention via Twitter that the Covered California website (or at least the actual off-season enrollment portion of it) had been offline for "2+ weeks". Sure enough, when I took a look for myself, after clicking past the home page, the enrollment section had a message saying that it was offline for maintenance but that I should "check back on September 15th". Of course, seeing how it was Sept. 28th when I read this, that suggests that the maintenance started sometime before the 15th and continued well past the estimated completion date.

@CoveredCA website has been down for 2+ weeks. What are people supposed to do? At least update your home page. #ACASignups #CoveredCA

— Julie Kornack (@jkornack) September 28, 2014

As we approach the 2nd Open Enrollment period, and as The Graph has become far too unwieldy to keep laid out in its current format, I've decided to break out the commercial plans (Exchange-based QHPs, plus references to the off-exchange QHPs, ESIs via SHOP exchanges/etc. and "sub26ers") onto their own graph. As you can see, this allows me to add another important new feature: My projection of the currently enrolled/paid up figure at any given time. We're also close enough to Year Two now (and my projections to date have proven accurate enough so far) that I'm comfortable projecting the QHP graph forward through November 15th (at which point Year Two starts up).

The 11/15 projections (as well as the "currently enrolled" line) assume a 9,000 new enrollments per day, a 90% payment rate, and a 2% average monthly attrition rate. This lines up almost precisely with the recent CMS announcement that 7.3 million people were currently enrolled & paying as of August 15th.