2018 MIDTERM ELECTION

Time: D H M S

Yesterday I posted an entry on Nevada's enrollment numbers which was a problem because the Nevada Health Link claimed to have lower enrollment figures as of 1/11 than the official HHS report had them at as of 12/28.

I asked them to clarify why HHS had them at 22,566 Private QHP enrollments on 12/28 when they were claiming only 18,864 as of 1/11 (of which only 11,409 were paid).

Today, they responded in a pretty to-the-point fashion:

@charles_gaba Nevada Health Link provides HHS and the public the same stats on a weekly basis. We do not know why the HHS # is incorrect.

— Nevada Health Link (@NVHealthLink) January 16, 2014

Huh.

OK, then...I guess the total just dropped by 3,702, temporarily knocking us back below the 10M total line.

Three updates today, two of which are minor, one is significant; combine all three and we've hit 10 Million altogether (with caveats):

These 3 updates push the Private QHP enrollment tally up to about 2.4 million; add about 4.5 million Medicaid/CHIP enrollments and 3.1 million "sub-26'ers" added to their parents plan thanks to the ACA, and you hit just over 10 million total.

*So, why the asterisk in the title?

Well, it should be noted that:

A few days ago the New York exchange released an oddly-worded press release which mixed some numbers through December 24 with other numbers through January 12. My reading of it at the time was that the state had added roughly 53,000 (private QHP + Medicaid/CHIP combined) since 12/30.

However, today, the Deputy Director of the NY exchange stated that they've been enrolling "about 7,000 per day" total in January...which adds up to 98,000 if you assume that runs through yesterday, the 14th. Even subtracting the extra 2 days, this means her number is 31,000 higher than yesterday's press release, but I'm not about to argue with the Deputy Director of the exchange, so another 98K it is. Assuming this breaks down roughly 72% Private QHP to 28% Medicaid/CHIP (as prior numbers have in NY), that comes to about 70.6K private and 27.4K public.

In addition, this pushes New York over the top in terms of their original CMS projection of 218,000 private QHP enrollments by March 31st. They should easily double that number by the end of the enrollment period, and could potentially hit 2.5x at this rate.

I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).

As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.

Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.

As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.

Qualified Health Plans: 73,098

Medicaid Newly Eligible Adults: 134,700

Medicaid Previously Eligible but not Enrolled: 63,070

Qualified Health Plan Applicants – Need to Pay   76,058

Some slightly updated numbers out of Oregon today, revealed during a conference call with the director of the beleaguered Cover Oregon exchange. Private enrollments are up from 20K to 23K, and exchange-based Medicaid enrollments up from 39,711 to about 42,000.

In addition, some info on the method of the 115,000 "direct transfers" to Medicaid off of the exchange: Apparently they used food stamp income information to do so, which is pretty clever if you think about it.

More than 65k enrolled so far through exchange, he says, 23k in private plans

— Nick Budnick (@NickBudnick) January 15, 2014

Oregon has enrolled more than 115k in Medicaid via workaround to avoid exchange, using food stamp income info

— Nick Budnick (@NickBudnick) January 15, 2014

Something interesting going on in Nevada. On 12/26, the official Nevada Health Link posted this to their Twitter feed:

Update: As of the 12/23/13 deadline to enroll, 12740 consumers confirmed QHP selections, 6219 have paid. Payment deadline is 12/30/13.

— Nevada Health Link (@NVHealthLink) December 26, 2013

Fair enough; 6,224 paid, 6,521 unpaid through 12/23.

As we recall, HealthCare.gov and most state insurance exchanges moved their enrollment deadline for January 2014 coverage, first from 12/15 to 12/23, then to 12/28 or as close to the New Year as possible.

That, however, will not be the case for February coverage. That deadline is firm – and it is today.

Thus the number of enrollment days in January will be roughly half that of December. Or to put it in an amusing way: January is almost half a month shorter than December. We must bear this in mind when examining any statistics of how many people have ACA-compliant insurance on February 1st, not drawing overly hasty conclusions about the declining enrollment rate.

Yesterday, HHS extended its coverage of people in the Federal High-Risk Pool. The new deadline is March 15th, coinciding with the deadline for the ACA’s open enrollment. This adjustment will help ensure a smoother transition for patients with pre-existing conditions.

Already, more than 55,000 of the 85,000 people that were in the PCIP programs per October 1st have enrolled in other healthcare plans. This is a reduction of at least 65 %. According to HHS, less than 30,000 people now remain in the federal high-risk pool.

Since it was launched in late 2010, the PCIP program, has provided coverage for a total of 135,000 people with serious pre-existing conditions who would otherwise have unable to obtain insurance.

Kaiser Health News has an in-depth article on this topic by Mary Agnes Carey.

Yesterday, Charles Gaba examined the big numbers in the most recent HHS report, an unanswered question in the Medicaid numbers and sorted states according to how they’re doing relative to their (admittedly debatable) enrollment targets. Here I would like to briefly mention some rather interesting outliers and other data points, and share a few observations.

There is an 8 % difference between the genders: 54 % of those who have selected a Marketplace plan are women, while men account for only 46 %. Men are in the majority in only two states: Connecticut (54 %) and Hawaii (51 %), whereas the District of Columbia was evenly split per 12/28.

It’s also worth noting that in the District of Columbia, so-called “young invincibles” (enrollees between 18–34 years of age) account for 44 %, while in Massachusetts HHS pegs the portion to be 31 %. Nationally, people 34 years of age or younger account for 30 % of the enrollment, and 18–34 year olds account for just over 24 %.

I've already noted that the State-Level CMS Projection Numbers are, for 40 out of the 50 states (plus DC), not particularly well-arrived at. However, for good or for bad, those are the numbers that the states are "supposed" to be striving for, so let's take a look at how they're doing.

With the official 12/28 HHS numbers in hand plus more recent updates for 13 states, here's where things stand purely on a "% of CMS projection attained" basis.

This is important to understand in cases like Kentucky, which has actually been operating quite successfully but which shows up as performing "poorly" due purely to the absurdly high "projection number" that it was assigned in the first place.

The official HHS ACA Exchange Medicaid enrollment figure for Illinois released earlier today was 82,286. However, contributor sulthernao noted that the actual number of people enrolled in Medicaid under the ACA in Illinois is at least 53,714 higher. As he/she put it:

Illinois is a partnership state for Medicaid enrollment, has used SNAP autoenrollment, and early expansion experiment in Cook County. For this reason, the numbers reported by the Federal Government (ASPE) are a severe underestimate of the enrollment. People who apply directly through the state's website may not be counted.

I realize that this probably has no connection to the "mystery" 1.24 million Medicaid/CHIP enrollments that I just wrote about an hour or so ago, but it's been a very long day and I'm extremely tired, so until I hear a better explanation for those 1.24M, I'm lopping the 53K difference out of that "unspecified" total at the bottom of the spreadsheet.

OK, the Medicaid situation is, to put it mildly...confusing. For most of the states I simply swapped out whatever numbers were there from the November report for the Dec. 28 total. However, there are easily a dozen states which either have one-time bulk automatic transfers from an existing state-run program (such as the 630,000 transferred from California's LIHP program, which was itself created in preparation for the ACA's Medicaid Expansion program); earlier mass enrollments in Medicaid which were quietly put through via other ACA elements long before the actual Exchanges launched (see DC and Minnesota); "special" cases such as Arkansas' unique "private Medicaid option" program; or simply updated numbers which have been released since 12/28.

Even with all of this, there's still roughly 1.24 million "unspecified" Medicaid/CHIP enrollments which are necessary to make up the other "3.9 million" figure which the HHS Dept. has been touting since around December 20th. I am simply unable to determine exactly what these "unspecified" enrollments are, since the "normal" Exchange-based Medicaid/CHIP numbers only add up to about 1.58 million.

In short, as best as I can figure, it breaks down as:

Whew! OK, after plugging in the numbers from the December HHS report (which actually only runs through 12/28, which is important to keep in mind), I now have the spreadsheet as up to date as it can be. There are 12 states which have released more up-to-date enrollment figures since 12/28. When you add these more recent numbers to the 2.153 million in the HHS report (which, again, only covers through 12/28), you get the following total: 2,347,097

Now, some of this may be questionable, which is why it's clearly italicized on the spreadsheet. Specifically, there's 72,178 enrollees in Washington State who hadn't made their first payment as of January 2nd, and another 1,999 who haven't paid yet in Rhode Island. Finally, there's the confusing case of 22,000 people in Massachusetts who have apparently been approved but are just waiting on some paperwork processing to be completed; in the meantime, they've been put on some sort of temporary state-financed healthcare plan until this is resolved.

OK, I'm gonna be scrambling to review the data and fill in/update everything, but here's what I can say right now:

  • If you look at Week 13 on the spreadsheet, you'll see that ACASignups.net had 2,137,630 private enrollments as of 12/31.
  • According to the official December HHS report, the total number of exchange-based private enrollments was 2,153,421 as of 12/28.
  • ACASignups.net was, therefore, appx. 99.2% accurate (ok, knock 0.2% off for the missing 3 days of data...call it 99% even).
  • I have no idea why the HHS report doesn't include the last 3 days of the year; perhaps a lack of personnel during the holidays? Will post something about this if/when I find out what the deal was there.

OK, I've plugged the numbers into the spreadsheet, but since most people's browsers won't be wide enough to view it, here's the state-by-state breakdown; remember, these numbers are only through 12/28:

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