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.

OK, I feel a bit silly posting this several days after HHS Sec. Burwell stated it officially, and it may seem especially anticlimactic given that I had already posted similar numbers from not one, not two, not three, not four, but five different respected national health insurance coverage surveys a couple of months ago (RAND Corp, Gallup, Urban Institute, Commonwealth Fund and the New England Journal of Medicine, to be precise), but it still seems like a good idea to lock this down for the record:

Taking questions yesterday from reporters for the first time at a White House news conference, HHS Secretary Sylvia Mathews Burwell said insurance programs created by the Patient Protection and Affordable Care Act have reduced the nation’s uninsured population by 26 percent. She called the reduction “the most important number” to measure the law’s success.

OK, the number-crunching gets a little complicated here, and isn't helped by some sloppy wording on the part of the reporter (though it's a highly useful article overall).

First, let's start with the headline: "Thirty-percent attrition bites into exchange revenues"

Health exchange managers expect to lose about 30 percent of enrollees due to attrition by year’s end.

That means they’ll carry over about 114,000 existing customers as they head into the 2015 open enrollment season.

Connect for Health Colorado managers expect enrollments to slide back from a total of 146,000 so far.

...Of the 146,000 people who signed up by the end of August, exchange managers said 10 percent dropped out right away, never paying their first month’s premium. Then about 20 percent more leave in subsequent months.

Holy cats.

A couple of weeks ago, a GAO report concluded that a dozen or so insurance companies, along with the Washington State ACA exchange, weren't fully complying with the "no federal funding of abortion" provision within the Affordable Care Act:

The new GAO study shows that, instead, taxpayers are subsidizing abortions. Customers in five states have no abortion-free plans available to them, and in many states, customers can't tell which plans cover abortion and which don't.

...Fifteen issuers and the Washington Health Benefit Exchange ... did not itemize the premium amount associated with non-excepted abortion services coverage on enrollees’ bills nor indicate that they send a separate bill for that premium amount.

One of last week's big ACA stories was the news that the largest insurance company on Minnesota's exchange, PreferredOne, was dropping out of MNsure.

ACA critics pounced all over this news as Yet More Proof That Obamacare Is Failing®, even though pretty much every "proof" they've presented to date has turned out to be nonsense or, at best, vastly exaggerated (never mind, either, the fact that overall, 77 new insurers are joining the ACA exchanges while only 15 are dropping out, for a net gain of 62 companies nationally).

The official toll as of 9/22 is slightly lower, at 395K...

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 395,547
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 22, 2014

...but there's an even more recent figure given today, as GOP Governor Rick Snyder tries to take credit for the program (note that the article doesn't mention "Obamacare" or "the Affordable Care Act" anywhere in it):

LANSING, Mich. (AP) — Just over 400,000 low-income adults in Michigan have signed up for Healthy Michigan, the state’s Medicaid expansion program.

In addition, the original estimate of the maximum eligible number of MI residents was apparently a bit high (500K); evidently the actual number is slightly lower...meaning that the percentage reached is even better by comparison:

...The state expects enrollment to eventually reach 477,000.

A couple of weeks ago, I reported that Maryland, which was one of the states which had embarrassingly bad technical problems with their ACA exchange--and which ended up scrapping their platform completely and moving to an all-new system based on Connecticut's excellent platform--was making some very wise decisions for 2015 based on lessons hard-learned from 2014:

BALTIMORE (Tuesday, Sept. 16, 2014) — The second year of Maryland’s health insurance marketplace for individuals and families begins on Nov. 9 when consumers will have access to a newly redesigned website that enables “anonymous browsing,” the ability to compare plans — without registering personal information — before enrolling. This feature is being launched earlier than originally planned to enhance the shopping experience for Marylanders.

One of the bigger concerns about the ACA was that the reduction in uninsured rates wouldn't be felt among the Hispanic community in particular. Instead, that demographic appears to be outpacing the general populace:

The federal healthcare law has dramatically increased coverage among Latinos, according to a new report that provides a comprehensive look at the effects of the Affordable Care Act on a historically underinsured community.

Overall, the percentage of Latinos ages 19 to 64 lacking health coverage fell from 36% to 23% between summer 2013 and spring 2014.

That's a reduction of 13 percent points, or 36% among non-elderly adults.

By comparison, the overall reduction nationally has been from around 20% down to 15%...or roughly a 25% drop.

Annnnnnd another ACA attack point bites the dust.

The Washington Post's Jason Millman reports:

The Obama administration is projecting that hospitals will face $5.7 billion less in uncompensated care costs than they otherwise would have in the first full year of the Affordable Care Act's coverage expansion.

Millions more people with health insurance means fewer uninsured patients are coming through hospitals' doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation's hospitals in 2012.

OK, so obviously the hospitals are thrilled about this, but what about the rest of us? Well, in theory, those savings should be in turn passed along in the form of lower premiums/co-pays/etc. (or at least a slower rate of increase, anyway):

Thanks to contributor Bob H. for bringing my attention to a new ACA budget study which claims that the Healthcare.Gov federal exchange has cost more than $2 billion to date, and that the total cost of the ACA since 2010 has reached $73 billion:

The total price tag for ObamaCare's main enrollment portal now stands at more than $2 billion, according to a new analysis by Bloomberg Government. 

The new total, released Wednesday, includes efforts to construct and then fix HealthCare.gov after serious technical problems threatened to shutter the site last fall.

In all, implementation of the Affordable Care Act has cost more than $73 billion since its enactment in 2010, the analysis found. 

I'm not going to get into the "$73 billion" part, since that includes a lot of questionable budget items such as around $14.5 billion of it being exchange premium subsidies (that is, I'm not saying those amounts are wrong, but it's highly questionable whether they should be counted as the "cost" of the law itself). This point is made in the same article by CMS itself:

OK, kind of a snarky headline I realize. This is actually a very good article by the Washington Post's Jason Millman, which goes beyond the actual number of people newly added to the Medicaid rolls since January thanks to the Affordable Care Act (by my count it's up to around either 6.5 million or 9.7 million, depending on whether you include "woodworkers" or not), but the quality of that coverage.

The good news is that, unsurprisingly, people are pretty relieved to finally have decent healthcare coverage, in many cases for the first time in their lives:

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