2018 MIDTERM ELECTION

Time: D H M S

Washington State just released their latest official update, and as usual, they do a fantastic job of breaking down the numbers in an easy-to-follow manner, especially on the Medicaid/CHIP side.

Private QHP enrollments are up from a total of 149K (73,098 paid, 76,058 unpaid) as of 01/09 to about 168K (86,031 paid, 81,872 unpaid) as of 01/23, a 12.7% increase in 2 weeks.

Medicaid enrollments are up from a total of 198K (134,700 via Medicaid Expansion + 63,070 "Out of the Woodwork" folks who were previously qualified but weren't already enrolled) as of 01/09 to a total of almost 238K (160,587 expansion + 77,144 "woodwork") as of 01/23. This represents a 20% increase.

Between these and the other recent updates, the grand totals now stand at 3.16M Private QHPs and 7.38M Medicaid/CHIP enrollees. It's also important to stress that the Medicaid number does not include renewals of existing Medicaid/CHIP recipients.

I've written about this in passing before, but after repeated requests about the subject, I've decided to devote a full blog entry about the serious problems inherent in the CMS's state-level Private QHP projection numbers.

As far as I can tell, while the national "7 million" private enrollment projection figure issued by the CBO was based on solid analysis of the demographic situation at the time, the state-level CMS projection breakdown is, in many cases, based on little more than educated guesswork.

As the CMS put it in their own report: 

 In general, the enrollment targets provided by state- based Marketplaces are more ambitious than the initial Department enrollment targets for those specific states. As a result, using the publicly available SBM targets without adjusting other states would have raised the projected number of 2014 Marketplace enrollees by 1.4 million; therefore, the Marketplace ramp-up rates for other states were revised downward accordingly to maintain the 7 million total. 

Contributor deaconblues provides an interesting Rhode Island update. While the standard Private QHP and Medicaid/CHIP numbers haven't changed from what I already had listed (although the paid QHP number has increased slightly), there's also the addition of 4,311 RIte Care parents automatically enrolled in RI's non-profit Neighborhood Health Plan.

As deaconblue notes, "Rite Care looks like it fully covers the premium for up to 150% FPL and offers premium assistance to those between 150% and 250%...the context implies that all of the 4,311 should be somewhere under QHP - if some of these plans were fully paid by the state, would they have appeared as an asterisked note under the Medicaid Enrollments section?"

I see his point, but at the same time, seeing how it fully covers the cost up to 150% FPL while even the ACA's Medicaid expansion only goes up to 133%, it really sounds like the vast majority of these folks should be categorized on the Medicaid/CHIP side. I'll look into it and may move some or all of these over to the Private QHP side later, but for the moment I'm listing them as "Medicaid/CHIP".

Hmmm...the same article uses 2 slightly different numbers (368 and 370)...I'll split the difference for the moment :)

New Mexico is also noteworthy in that while their individual ACA market is being handled by the federal exchange (HC.gov) for the first 2 years, they're already running their own small business (SHOP) market themselves.

Meanwhile, I've been informed that Washington State only has their SHOP program running in 2 counties, while Maryland's won't be operational until April (SHOP enrollments are open year-round, while individual/family enrollments are only available through 3/31).

As of Jan. 15, 368 people had purchased insurance through New Mexico’s SHOP (Small Business Health Options Program) exchange for small businesses. 

...So far, 370 people have enrolled in insurance plans on the SHOP exchange, according to the NMHIX. A total of 1,542 employers have set up accounts on the exchange and they represent 3,962 employees.

Kentucky continues to slowly but steadily increase their tally, hitting 19% of their CMS projection target with 42,000 private QHP enrollees as of last Thursday. The 2,200 new additions have been subtracted from the "Not broken out by state" pool, bringing that total down to 486,500. Again, any new exchange enrollees which are added up through Jan. 23 will be subtracted from this since it fills out the "3 million" total announced by Kathleen Sebelius last week.

Meanwhile, on the Medicaid side, Kentucky added another 12,000 new enrollees, bringing them up to 189,000 when you add the 55K direct additions. It's important to note that according to the CMS reports, these people should all be new to Medicaid, not renewed accounts.

As of Thursday, according to the state, 176,000 Kentuckians have signed up for health insurance.

So far 42,000 have signed up for private insurance, or roughly 14 percent of the total number of uninsured Kentuckians. That compares to 134,000, or 44 percent of those eligible, who have signed up for Medicaid.

Some minor updates buried in the MNsure Board of Directors report; thanks to an anonymous tipster for calling my attention to it. Nothing major, but some small updates to both the Private QHP and Medicaid/CHIP enrollment figures (27,775 and 52,225 respectively). The most noteworthy addition is the 475 SHOP (Small Business marketplace) enrollments noted on page 27 of the report.

The story itself is pretty negative on the SHOP Small Business exchanges--apparently the Federal one (at HC.gov) won't be ready until this fall--but it at least gives the SHOP enrollment number for New York.

Exchanges in larger states aren’t doing much better with their business plans. In New York, about 5,000 employees of small businesses have enrolled in the SHOP exchange, James O’Hare, a spokesman for the state’s Department of Health, said in an e-mail.

...in which we find the third ACA-created SHOP (Small Business Health Options Program) addition of the day. 2,155 employees is a pretty miniscule number (especially for the largest state in the country), but it's something. Note that it says "2,155 employees", which most likely means about double that when you include dependents, but as always, I'm leaving it here unless I find specific sources stating otherwise.

A total of 289 small employers have signed up for coverage through Covered California’s Small Business Health Options Program, better known as SHOP. These employers will provide coverage to a total of 2,155 employees.

If you take a look at the Private QHP spreadsheet you'll see a new column: "Private SHOP Market". This is for enrollees in the ACA's Small Business Health Options Program, basically the small business (fewer than 50 employees) counterpart to the individual/family exchanges getting so much attention.

This is one of those cases where percentages mask the real picture. Yes, Hawaii has seen their Private QHP enrollments increase by an impressive 43% since December 28. However, they only had 2,192 people enrolled in the first place...the actual increase is only 934 people, to 3,126.

Furthermore, those 934 have to be subtracted from the almost half-million "Not Broken Out By State" tally at the top of the spreadsheet, since they came in before 1/24/14.

On the other hand, this also gives the first SHOP (Small Business Exchange) entry for Hawaii...another 307 people.

Hey, a person is a person...

As of Jan. 18 the Connector enrolled 3,126 people, though 13,000 applicants were deemed eligible for tax credits to reduce the cost of coverage. Of the 373 small-business groups that applied, only 75 employers were enrolled with 307 workers selecting plans.

A very nice bump in Oregon's numbers today, especially given their ongoing technical issues. Private QHP enrollments are up from 23,800 as of Jan. 15 to 30,157 as of Jan. 24. However, since yesterday's HHS Dept. announcement of appx. 3 million total enrollments was "as of this week", this doesn't impact the overall total; it simply subtracts about 6,000 from the "Unspecified" number. Expect a lot of this over the next week or two until the enrollment updates "clear" the Week 16 point.

OK, yesterday's update was apparently a bit premature; MD is actually up to over 25K, though they're still under 17% of the CBO projection figure. The Medicaid tally hasn't changed since last week.

Through January 18, 25,177 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

93,514 Marylanders signed up through the Primary Adult Care (PAC) program were automatically enrolled in Medicaid coverage on January 1, 2014, and now have full Medicaid coverage. As of January 14, an additional 29,517 individuals were newly enrolled in Medicaid effective January 1.

No details or full source as of yet, but this is obviously an important update. Will provide additional details/sourcing as available.

Three million Americans have enrolled in #Obamacare private plans, @sebelius says in Jacksonville, FL. +800,000 so far in January.

— Alex Wayne (@aawayne) January 24, 2014

UPDATE: OK, now I have it directly from HHS Director Kathleen Sebelius' official Twitter feed.

A key milestone: about 3 million Americans have now enrolled in a private Marketplace plan. RT to share the good news!

— Kathleen Sebelius (@Sebelius) January 24, 2014

In addition, here's the official press release/blog entry at the Health & Human Services website:

Since the beginning of open enrollment, millions of Americans are gaining access to health coverage–many for the very first time—thanks to the Affordable Care Act. The most recent data indicates that approximately 3.0 million people have now enrolled in a private health insurance plan through the Federal and State-based Marketplaces since October 1.

It's also important to note that the press release specifies that this only includes enrollments through the exchanges, and does not include people enrolling directly through the insurance companies themselves. This is a potentially huge number. More to come on this soon (I hope).

UPDATE: From Sarah Kliff:

Important detail on new numbers: Admin. official tells me they represent sign-ups through Jan 15, so not the whole ball game for this month.

UPDATE: OK, strike that; apparently the 3M figure is through "this week", not through the 15th:

"@samsteinhp: HHS clarifies. 3m figure is "as of this week" it is NOT as of Jan 15, CC @sarahkliff and @philipaklein"@charles_gaba

— Stephen Francis (@Stevef101) January 24, 2014

Looks like Maryland has bumped their private enrollments up by over 10% from 20,358 as of Jan. 11 to 22,500 within the past couple of days.

Only 22,500 people have enrolled in private health plans through the Maryland exchange. That’s 15% of the state’s enrollment goal of 150,000 by March 31.

The December report released Jan. 21 by Covered California shows that from Oct. 1-Dec. 31 the exchange received 1,107,229 electronic applications for health care coverage through both private plans and Medi-Cal. Multiplying that number by 1.8, "based on an average of 1.8 individuals per application," it was estimated that the number of applications represented 1,993,012 individuals.

The 1.8 factor was not used for "completed applications." From Oct. 1-Dec. 31, there were 771,008 completed applications for health care coverage through Covered California (including Medi-Cal) for 1,456,909 individuals. If the 771,008 completed applications had been multiplied by 1.8, there would have been only 1,387,814 individuals. This indicates that individuals, not households, were counted in the completed applications.

From Oct. 1-Dec. 31, there were 500,108 enrollments in a Covered California health plan (this did not include Medi-Cal). Of the 730,449 individuals who were "determined to be eligible for enrollment in Covered California", more than 2/3 enrolled. Clearly these were enrollments by individuals, not households.

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