Oregon continues to post impressive enrollment numbers considering their never-working website. Total QHPs are up another 922, Net QHPs are up 185 and Medicaid enrollments are up 12,517 over the past week:

July 28, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 336,146
Total private medical insurance enrollments through Cover Oregon: 96,037          

Oregon Health Plan enrollments through Cover Oregon: 240,109
 

Dental enrollments 
Total private dental insurance enrollments through CoverOregon 1: 18,794

Net enrollments 
Net private medical: 82,368
Net private dental: 15,218

An odd update from the DC exchange...not the update itself, which shows a modest-but-steady increase in QHP enrollment, but the fact that it only runs through July 9th even though it wasn't posted until yesterday (7/28). The prior update ran through July 1st, so that's a net gain of 197 people in 8 days, or about 24 per day. This is actually up slightly from the May/June average of 22/day.

Both the SHOP and Medicaid numbers also went up slightly as well, but again, this only covers an 8 day period:

Monday, July 28, 2014

Enrollment

From October 1, 2013 to July 9, 2014, 51,059 people have enrolled through DC Health Link in private health plans or Medicaid:

 12,530 people enrolled in private health plans through the DC Health Link individual and family marketplace.
 13,779 people enrolled through the DC Health Link small business marketplace.
 24,720 people were determined eligible for Medicaid coverage through DC Health Link.

Once toothless, Cover Oregon board tackles an uncertain future

...After taking political heat for the exchange's technological failure, the appointees of Gov. John Kitzhaber are taking on a more significant role, transforming the agency for the future. At a time when critics of the agency say it should go away, it's the bureaucratic equivalent of an existential moment for an agency considered crucial to federal health reforms.

... The state's planned 2015 partnership with the federal exchange is called a "supported state-based" exchange. But it's supposed to be a temporary fix before setting up a full-fledged state-based exchange. It allows Oregon to keep insurer fees of about 2.5 percent of premiums for itself until the state resurrects its own website.

Vermont Health Connect shakes up practices, adds personnel

Yup, it definitely looks like my "QHP sky is falling" warning from a couple of weeks back was a false alarm...or, as Dan Diamond noted at the time...

The first time @charles_gaba made a forecasting error was when he predicted he made a mistake. http://t.co/4hiufhbVAG

— Dan Diamond (@ddiamond) July 16, 2014

Indeed.

In any event, while there is indeed a small slowdown which seems to have kicked in since the COBRA extensions dropped out at the end of June, it's now looking more and more as though the huge drop I saw the first week of July was mainly a combination of a data entry error in Hawaii and the long 4th of July weekend in general.

Unfortunately, the full article is locked behind the paywall, but Taegan Goddard's WonkWire reports that "some" of the 36 states being run through HC.gov are taking various measures just in case the Halbig decision is ultimately upheld:

Wall Street Journal: “A number of states are scrambling to show that they—not the federal government—are or will soon be operating their insurance exchanges under the 2010 health law, in light of two court decisions this week.”

“The efforts are aimed at ensuring that millions of consumers who get insurance through the exchanges would be able to retain their federal tax credits if courts ultimately rule against the Obama administration.”

“Amid the uncertainty, some of the 36 states in which the federal government has a role in the exchanges are moving to shore up their status. Some are saying publicly that their exchanges have always been state-operated. Others are trying to make the case that they should be considered to have state exchanges regardless of federal involvement. Still others, such as Arkansas, are pushing ahead to take over their exchanges, which would likely free them from the effects of any court decision.”

The last time I updated the Kentucky numbers, all I had to go on was a rough number of around 450,000 people enrolled via Kynect, without any breakdown between private QHPs and Medicaid enrollees. At the time, I took the official 4/19 numbers and then assumed a 90/10 Medicaid/QHP split for the additions since then. This gave me an estimated breakdown of around 87K QHPs & 363K Medicaid.

Today, while there's no updated numbers provided, Joe Sonka over at LEO Weekly brings a hard breakdown of how the 4/19 Medicaid numbers break out:

Yes, 49 people is pretty tiny even for a state with as low an uninsured population as Hawaii, but it's still further evidence that the drop in QHP enrollments in the first week or so of July was either a typo or a data entry glitch, as the total has since risen for 2 weeks straight. SHOP enrollments haven't changed since 7/15:

Connector Updates as of July 19, 2014

33,042 Applications completed in the Individual Marketplace
9,724 Individuals and families enrolled in the Individual Marketplace
689 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*

* as of July 15, 2014

While all the fuss & bother over the Halbig case continues to get bopped around by every pundit under the sun (including me? Do I count as a pundit now?), the ACA itself continues to actually, you know, work as another 8,400 people are added to Medicaid via the expansion program here in Michigan:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 334,599
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of July 21, 2014 
*Updated every Monday at 3 p.m.

(Note that this is actually as of a week ago...there should be another update later this afternoon...)

As there are an estimated 500K eligible for the expansion program, this means that Michigan has already reached 2/3 of the total in less than 4 months.

A whole lot more has been & is being written about the Halbig decision & implications for the future of the ACA exchanges; here's three pieces I find most noteworthy:

First, Joey Fishkin at Balkinization expresses my "domain & a splashpage" workaround solution far more eloquently than I did:

So one important practical question Halbig raises is this: what makes a state exchange a state exchange?  If the view of the 2-1 majority in Halbig were to prevail at the Supreme Court (a prospect I’d still consider unlikely, because the reading of the statute is so wildly implausible), then what is the minimum a state can do that counts as a “state exchange” for purposes of receiving the federal subsidies? 

Nice find by Esther F. The main focus of the story is that a 5th insurance company has decided to join 4 others on New Mexico's ACA exchange, which is of course good news for competition, the free market and so forth...

The newest insurer is CHRISTUS Health Plan of Texas, Franchini said during a meeting of the NMHIX board in Santa Fe.

“CHRISTUS is a nonprofit and they will be on the exchange. They will be the fifth carrier on the exchange,” Franchini said.

CHRISTUS will join New Mexico Health Connections, Presbyterian Health Plan, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico as the firms that will sell in the individual exchange.

...however, Esther notes a potentially far more significant section of the story farther down. The backstory is this: New Mexico has been planning on running their own exchange for the 2nd year of open enrollment, but has more recently been having second thoughts given the various technical issues faced by some of the other state exchanges. Therefore...

So, this morning's big Halbig-related development is that Reason.com has dug up a video of a presentation by MIT economist Jonathan Gruber from January 2012. Gruber was one of the main architects of the health insurance law in Massachusetts (RomneyCare) and the national version (the ACA, aka Obamacare). In his presentation, Gruber states:

What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this. [emphasis added]

OK, yup, that is indeed what he said at the time.

Some of the various state-run exchanges continue to experience assorted technical issues, ranging from minor to serious. I may be rooting for the ACA to work, but as a website developer and a member of the Reality-Based Community, I do need to fully acknowledge that it's not all sweetness & light on the tech side these days. These issues will be resolved eventually, but you can't just ignore them either. So, without further ado...

VermontVPR (Vermont NPR), 07/23/14: Lawmakers Angered By Continuing Problems At Health Exchange

 Snowballing technological problems at Vermont’s online insurance exchange are drawing new scrutiny. And advocates warn that the situation for many customers who bought plans through Vermont Health Connect is becoming increasingly dire.

Washington State: Union Bulletin, 07/22/14: Washington state health-care exchange sounds alarm

OK, with all the fuss about the Halbig decision, people have been flooding me with a bunch of stories about both that as well as other ACA-related topics. I can't address them all fully, so here they are in bite-sized format:

Tara Culp-Ressler, Think Progress, 07/24/14: Obamacare Has Helped Americans Save Nearly $2 Billion On Their Insurance Premiums

Millions of Americans can expect to get a refund from their insurance companies this year, at an average of about $80 dollars per family, thanks to a little-known Obamacare provision that’s helping people save money on their premiums. According to a new report released by the Health and Human Services Department on Thursday, Americans across the country have received a total of $1.9 billion dollars in rebates since this provision first took effect in 2011.

Amy Fried, Bangor Daily News, 07/24/14: Supreme Court already said DC Court was wrong on Obamacare subsidies

Normally this would be a lengthy entry, but given that there have already been 4 other major national surveys saying the same thing, the latest news is just locking things down.

The New England Journal of Medicine just published a new report which concludes (shocker) that there's been a net reduction in the number of uninsured U.S. adults by around 10.3 million since the ACA exchanges went into effect:

As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

OK, I've had a chance to download the actual Excel file with the raw data and a handy graph already set up; I've cleaned up and color-coded the graph, and it's fascinating to look at, both during open enrollment as well as since it ended The things which stand out the most:

  • The obvious dead zone in October and most of November, finally coming to live around Thanksgiving time
  • The gradual rise in December, culminating in a large spike on Christmas Eve (the "official" deadline for January 1st coverage, although that varied in some states)
  • The massive spike in late March, culminating in a nearly off-the-chart peak on the "official" open enrollment deadline of March 31st, which saw over 200,000 transactions by itself

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