Me, June 26, 2014:

As an aside, I also question the wisdom of not requiring everyone to re-enroll each year. Obviously HHS is trying to minimize the inconvenience/hassle factor, but it seems to me that this is just going to cause even greater confusion than it would if they simply issued a blanket statement: If you enrolled via an ACA exchange, you have to renew once a year even if nothing else has changed.

I don't see doing this as a big deal; people have to renew their license plates every year even if it's for the same car, for example. They don't have to make it that complicated...just have big Yes/No radio buttons once you log in that says "Have you had any significant changes in (income, dependents, etc...provide a list) since (date of existing policy enrollment)?" If no, then you click "Save" and you're done. If yes, then you go ahead and make whatever changes are necessary.

OK, they can't make it quite that simple on...

Yesterday, the Big News on the ACA front was a new state-by-state survey from Gallup which showed the overall impact to date on total uninsured rates across the country.

Not surprisingly, the main takeaway, as noted by Jeffrey Young over at the Huffington Post, is that states which have embraced the law (Medicaid expansion, their own exchanges) have done a much better job overall of reducing their uninsured numbers than those which shunned it.

It's an interesting survey and an interesting piece, complete with a color-coded map which shows how the different states have fared (although I really wish they'd used higher-contrast colors; it's hard for me to distinguish some of the ranges from others).

However, there's one state which really stands out to me, and it's smack in the center: Kansas.

Yesterday I put out an open call for off-season QHP data from California, New York and Rhode Island, none of whom have released this info since 4/19 (Connecticut hasn't either...they gave me their combined total for QHPs + Medicaid, but I can't use that for a proper projection until I know the actual breakout between the two).

Today, thanks to Dara Chadwick of HealthSourceRI, I can cross Rhode Island off the list:

We had 25,767 total paid QHP enrollments during the open enrollment period, including all individuals who enrolled by March 31 and paid by April 23. 

As of August 2, 2014, 26,686 Rhode Islanders are enrolled in QHPs. Of those, 25,892 have paid.

OK, I'll have to reverse engineer things slightly here, since the paid number is given for both August 2nd and March 31st, but the total number is only given for August 2nd. Looking back at my last entry for Rhode Island, the 3/31 total was 27,968.

NOTE: I originally posted this as an update to my Florida rate increase entry this morning, but it's important enough that I figured I should repost it as a separate entry.

Thanks to Caitlin Sweany of PricewaterhouseCoopers for explaining an interesting discrepancy I noted in at least one state (my own state of Michigan). This is another example of how difficult it is to nail down the actual impact of these rate changes (and remember, in many cases these are still just requests, not approved rates, subject to change). Case in point:

According to the Detroit Free Press's original story on the subject, Michigan's "average" premium rates are only going up 0.8%. Yayyyy!!!

A couple of caveats: This report from private online insurance broker eHealth Insurance a) only reflects off-exchange enrollments, b) only includes people who enrolled through their brokerage, not directly via the companies themselves, and c) is, frankly, kind of difficult to actually read as presented, but contributor Esther F. noted an important section:

Outside of open enrollment, health insurance shoppers may only be able to purchase individual and family major medical coverage when they experience a qualifying life event such as marriage, divorce, the birth of a child, the loss of employer-based health insurance, etc. A June 2014 analysis of eHealth shoppers has shown that nearly half (49%) of those who reported a qualifying life event selected "loss of coverage" as the qualifying life event which they had experienced. More than one-in-ten (11%) indicated that they had moved to another city or state, while six percent (6%) indicated that they were recently married or divorced and three percent (3%) reported the birth or adoption of a child.

Most of the states which have released their proposed (or final) 2015 rates have looked pretty good so far, with Rhode Island (4.3%), Connecticut (appx. 4.5%), California (4.2%) and Oregon (6.8%) only going up between 4-7% on weighted average, and Mississippi actually seeing an overall weighted average decrease of around 2%.

The exceptions to date include Michigan (9.4%), New York (13.4%)...and now, it appears, Florida:

Floridians who buy health insurance on the individual market for next year will face an average increase of 13.2 percent in their monthly premiums, according to rate proposals unveiled Monday by the state’s Office of Insurance Regulation.

Of the 11 returning plans, eight filed average rate increases ranging from 11 to 23 percent, and three filed rate decreases ranging from 5 to 12 percent, the state’s insurance regulator reported.

Minnesota keeps cranking along, up another 310 QHPs and 4,888 Medicaid/CHIP enrollments in the past week.

latest enrollment numbers

August 3, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 165,740
MinnesotaCare 60,435
Qualified Health Plan (QHP) 53,169
TOTAL 279,344

Things are slowing down now, but Michigan continues to slowly, gradually add to the Medicaid expansion tally. With appx. 500K people estimated to be eligible for the program, they've now hit 69% of that number.

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 345,533
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of August 4, 2014 

Usually I'm able to track down my data either by myself or with the help of several people who send me data links on a fairly regular basis. This has resulted in my being able to fill in off-season QHP enrollment data for almost 20 states.

However, there are several states whose data has eluded me so far...and unfortunately, this includes the two largest state-run exchanges: California and New York. I've contacted both exchanges; CoveredCA told me that updated enrollment numbers would be released "soon" but that was a good month ago. The New York State of Health exchange flatly stated that they, like HHS, would not be giving out any sort of official off-season enrollment update. There's also the Rhode Island exchange, which hasn't responded to my requests at all. (Update: Never mind that last one; just heard directly from the RI exchange, hopefully they'll be able to provide an update soon...)

Sometimes you just have to go straight to the source. I flat-out asked Access Health CT (Connecticut's ACA exchange) if they could provide an off-season enrollment update, and here's their response:

@charles_gaba our total as of July 22nd is 250,633 overall enrolled. That's all I can share now, but more coming near OE

— Access Health CT (@AccessHealthCT) August 2, 2014

They weren't able to provide a breakdown between private QHPs and Medicaid/CHIP enrollment, but I can make a pretty good guess.

According to the final HHS report, Connecticut's official exchange QHP total as of 4/19 was 79,192, and Medicaid determinations were 138,908, for a combined total of 218,100. Since then, this total has gone up 32,533. The QHP/Medicaid ratio during open enrollment was roughly 36/64, which, if consistent during the off season would mean around 11,700 more QHPs to around 20,800 Medicaid enrollees.

Thanks to my friends over at Eclectablog for this one:

With the recent conflicting rulings by federal courts over whether subsidies for health insurance can be used by residents in states relying on the federal health insurance exchange created by the Affordable Care Act, there is discussion of revisiting the creation of a state-run exchange in Michigan.

The key significance here is that unlike, say, Delaware or Illinois which have Democratic administrations/legislatures but still chose to stick with Healthcare.Gov until now, Michigan's government is currently completely controlled by Republicans...yet even they seem to be coming around to the reality that the ACA, for all of its flaws, is actually working pretty damned well so far:

Republican Jim Marleau chairs the state Senate Health Policy Committee. He says the federal health exchange has worked well for Michiganders since problems with the website were fixed late last year. But he says he’s still interested in a state-run exchange – especially if issues pop up again.

Hmmmm...ok, yesterday I reported that "over 37,000" Nevadans had fully enrolled & paid for QHPs to date, based on a story in the Las Vegas Sun. Today, a similar story over at KTNV (ABC Channel 13) gives the estimated number as 38,000, about 900 higher than the 38.1K I figured yesterday. Everything else is pretty much the same.

The couple is among an estimated 38,000 Nevadans who purchased plans through the health link website but will have to re-enroll between Nov. 15 and Feb. 15 because of the state's switch from Xerox to the

Oregon is, I believe, the 5th state to release their approved ACA exchange premium rates for 2015, after Rhode Island, Connecticut, California and Mississippi. Like most of the others, it's a mixed bag, with some companies raising their rates by up to 10% but others reducing theirs by as much as 20% (or even 26% for the small group market, although that's not the one that I'm primarily looking at).

About 80,000 Moda Health members who buy their own insurance will see their monthly premiums climb an average 10.6 percent next year, while many other insurers are dropping their rates to compete.

Insurance rate decisions were issued by the Oregon Insurance Division Thursday and announced today, showing a tighter range of premiums in the individual market for people not covered by employers or Medicare.

Moda's once market-leading rates have jumped to middle of the pack. For a silver plan, a 40-year old in Portland can find four insurers with lower premiums approved by the state.

Until this month, Maryland's reports were a bit irritating in two ways: First, they were running a month behind; second, the "thru dates" for the QHP numbers never quite lined up with the Medicaid number for some reason. With today's report, they've corrected both issues, bundling both June and most of July in and matching up the dates:

Enrollment Data
As of July 26, 2014, 332,504 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

Beginning this month, we will also report net changes in Medicaid enrollment. This figure takes into account the fact individuals lose Medicaid coverage because of changes in household, age, and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of July 26, 2014 is +273,245.

As of July 26, 78,930 individuals have enrolled in a qualified health plan.

I've already taken apart Heritage Foundation shill Sharyll Attkisson for her mind-bogglingly embarrassing FAIL at trying to claim that the uninsured total has only dropped by 3.4 million since the ACA exchanges and ACA Medicaid expansion kicked in on January 1st, when in fact it's actually around 12 million, give or take...a number which has been proven by surveys by not just one, not two, but five well-respected sources, including Gallup, the Urban Institute, the RAND Corporation, the Commonwealth Fund and the New England Journal of Medicine.

Now, it seems, I'm going to have to tackle the Heritage Foundation itself directly. A couple of days ago they released a study which claims that (here's the Abstract)...