For months now, for off-season enrollments, I've been looking at 3 major numbers: The gross additions (which I settled on being around 9,000 per day); the 1st month payment rate (which I had estimated at 90% before dropping this to about 88% a few weeks ago), and the average attrition rate (that is, how many people drop their policies after the first month).

When HHS Secretary Sylvia Burwell finally revealed that 7.3 million people were enrolled in policies as of August 15th, most of my assumptions were confirmed...except that the attrition rate, which I had been assuming was around 3% per month, now seemed to be even lower, at 2%. However, I wasn't sure about this until now.

Today I added a whole slew of updated state-level current enrollment numbers, and now I have these for 10 states, comprising nearly 3.2 million of the original 8.02 million enrollees through 4/19/14, or almost 40% of the total. This strikes me as being a pretty good base to extrapolate the other 40 states (+DC) from.

I addressed Nevada's apparent attrition rate about a month and a half ago. At the time, it appeared to be a fairly ugly 7.7% per month...relative to the "high water mark" of paid enrollments they had achieved in July of around 38,000.

However, since then I've realized that given the high amount of churn during the off-season as people enter and leave the marketplace, a far more accurate measure is the number of current enrollees relative to the April tally, since that was the "8.02 Million Total / 7.06 Million Paid" figure that everyone was focusing on anyway. Doing it this way is also far more consistent, since there's a hard 4/19 number to compare against for every state instead of it being all over the map.

In the case of Nevada, I've just received word that the current number of people enrolled in exchange QHPs is exactly 32,460 as of mid-October.

Rounding out today's "Net QHP Attrition Rate" Trifecta is Indiana, which, while not as deep-red as Tennessee, a) also has a Republican administration; b) hasn't expanded Medicaid; and c) refused to set up their own exchange.

This makes it all the more of a positive surprise to see that their ACA exchange QHP attrition rate is even lower than Tennessee--in fact, it's under 1%!!

The April 19, 2014 total for Indiana was 132,423 Hoosiers. Assuming an 88% payment rate and you get about 116,500.

I just learned that the number currently enrolled as of mid-October stands at 115,800...a drop of just 0.6%.

Excellent news!! I've posted exactly one (1) Tennessee-specific blog entry since I started this site a year ago, having to do with TN's possible caving on Medicaid expansion. Aside from that, I've had bupkus outside of the official monthly HHS reports during the First Open Enrollment period (OE1)...until today.

Today I learned that the number of Tennesseans currently enrolled in QHPs (as in currently in-force policies) via the federal ACA exchange stands at 125,704.

This is significant because the official 4/19/14 total for Tennessee was 151,352 people.

Assuming 88% of the original number paid their premiums, that would be about 133,200 as of last spring, which means Tennessee has only had about a 5.7% net attrition rate over the past 6 months.

Minnesota's exchange (called MNsure and pronounced to rhyme with "insure") has had it's share of technical problems, but they haven't been nearly as bad as the 4 state-run exchanges undergoing full overhauls (OR & NV are scrapping theirs entirely; MA & MD started over from scratch). They got hit with some bad news recently when the largest insurer on the exchange decided to bail, although that appears to have had more to do with that company's poor business decisions than anything on MNsure's side.

However, they've continued to keep chugging along, quietly adding more enrollees to both private QHP policies (via qualifying life events) as well as Medicaid and MinnesotaCare (neither of which have any deadlines involved). Most relevant to myself, they're also the only exchange which has continued to provide consistent, regular enrollment data updates on a near-daily basis, which is manna from heaven from my POV.

Last year, New Hampshire had but a single participant in the federal ACA exchange: Anthem BCBS. This year, not one, not two, not three, but four other companies have joined in

Two more insurance companies say they plan to sell policies in New Hampshire’s health exchange in 2015, bringing the total to five carriers. The suddenly crowded field is a sharp contrast to this year, when only Anthem is offering policies through healthcare.gov.

Harvard Pilgrim and Minuteman Health, both based in Massachusetts, announced their intentions to join the exchange earlier this year, and now the New Hampshire Insurance Department says Assurant Health and Maine Community Health Options have also submitted plans for regulatory review.

We don't have a full average-premium percentage breakdown like there are for other states, but this is certainly promising:

Hey, all. Just some assorted notes in no particular order...

  • OK, so the 1-year anniversary of ACASignups.net came and went a week or so ago without any major announcement from me...although the fact that I've started writing occasional pieces for healthinsurance.org should count. I've posted 3 entries so far and the feedback has been very positive from both them and their readers so far.
  • I had been mulling over writing a book about the experience of the past year, and I may still do so, but at this point the 2nd open enrollment period is coming up too quickly for me to deal with that; if I was going to do so, it probably should have been over the summer. However, I'll keep it in mind over the next few months and will revisit it after the 2nd OE period (OE2) closes in February.
  • I still have to update/overhaul the FAQ on the website; obviously it's a wee bit out of date at this point. Also, while I haven't been sending mailings out very often during the off-season, I do plan on nightly (or at least weekly?) "digest"-style mailings from 11/15/14 - 2/15/15, so if you want to be removed from the mailing list, just click the link at the bottom. FWIW, the mailing list has grown to over 400 members since I opened it up to all visitors.

Only 66 more QHPs added over a 4 day period, but nearly 1,800 more added to either Medicaid or MinnesotaCare:

latest enrollment numbers 

October 26, 2014

Health Coverage Type Cumulative Enrollments
Medical Assistance 228,825
MinnesotaCare 78,770
Qualified Health Plan (QHP) 55,630
TOTAL 363,225

For five months now, I've been trying to unscramble Kentucky Senate Republican Minority Leader Mitch McConnell's word salad about what his post-Obamacare-repeal intentions are for the people of Kentucky.

To recap:

Repeal Obamacare > Repeal the ACA > Repeal kynect > Tear healthcare from 527K Kentuckians.

Today's New York Times has a pretty in-depth overview of how the ACA is doing. Overall it's very well done, though I do have a few quibbles about the sub-header "After a year fully in place..." because the law hasn't been "fully in place" for a year now, mainly because the employer mandate portion doesn't kick in until January (and most of the SHOP small business exchanges haven't been launched yet either).

Aside from that, though, it asks and tries to answer 7 major questions about where things stand:

Has the percentage of uninsured people been reduced?

Answer: Yes, the number of uninsured has fallen significantly.

Has insurance under the law been affordable?

For many, yes, but not for all.

Did the Affordable Care Act improve health outcomes?

Data remains sparse except for one group, the young.

Will the online exchanges work better this year than last?

Most experts expect they will, but they will be tested by new challenges.

Back in 2003, when the second round of the utterly unnecessary Bush Tax Cuts were doled out (jacking up the federal deficit for decades to come), I received my very own check from the IRS for something like $300 or so. I distinctly remember that it had, typed in the lower left-hand corner, "TAX RELIEF FOR AMERICA'S WORKING MEN & WOMEN".

As it happens, I donated the entire $300 to charity, since I had never asked for it and didn't want it. However, I always remembered the shamelessly partisan promotional nature of how it was done. A physical check with the actual dollar amount and a big, bold slogan referring to "relief" (the implication being, of course, that taxes are by their very nature a negative, awful thing which one needs relief from).

Little-Known Benefits of the ACA, Exhibit A:

When you think of the flu, the cost of getting sick probably isn’t the first thing that jumps to mind. But coming down with the virus can prove pricey.

A visit to the doctor’s office can run $80 to $100—or more. If you need to head to the ER on a night or weekend for care, the tab can easily total $500.

...The good news is that you probably don’t have to pay a penny for the best defense against the flu. Under Obamacare, a flu shot is free as long as you have health insurance (though plans that were in place before the law passed in 2010, known as grandfathered policies, are exempt). It’s one of the preventive services that insurers must fully cover without charging you a co-pay or co-insurance—even if you haven’t met your annual deductible yet. Under Medicare, you also pay nothing.

Little-Known Benefit of the ACA, Exhibit B:

Thanks to Margot Sanger-Katz for bringing this KFF study to my attention; Tricia Neuman has done an interesting study to try and predict how many of the appx. 7.3 million current ACA exchange policyholders are likely to make the move from their current policy to a different one (either through the same company or a different one).

She goes pretty deep in the weeds on some of it, but her takeaway is that, based on 3 other government healthcare programs (Federal Employee Health Benefits, Medicare Part D and the Commonwealth Care program in MA), it's likely that only about 7 - 14% of enrollees are likley to switch:

This is a rather awkward post for me, because it cuts to the heart of the main thing I don't like about the Affordable Care Act. As a single-payer advocate, and one who knows all too well the abuses by the health insurance industry in the past, I'm not exactly thrilled about this development. On the other hand, this news also shoots down Yet Another Talking Point® that FOX News/etc. have had about the law: That it would "ruin" the private insurance industry. The ACA has always been a strange hybrid of left-wing/progressive provisions (Medicaid expansion, tax credits to enrollees) and right-wing free market capitalism (the individual mandates and private, for-profit marketplaces). As such...

Even after the disastrous rollout of the healthcare.gov web site a year ago, health insurance companies and providers of medical care are reporting more promising profits as third quarter earnings emerge.

The Halbig/King federal suit cases have been off the radar for awhile now, but they're still swirling around in the ether, and will pop up again sooner or later. While a final ruling (by the SCOTUS either taking up one of the cases or refusing to do so) likely won't happen until next summer or so, the insurance companies and the HHS/CMS Dept. are understandably concerned about the ramifications of the possibile outcome, so they've taken some steps accordingly:

The agreements to participate in the federally-facilitated marketplace (FFM) that CMS sent to issuers last week include a new clause assuring issuers that they may pull out of the contracts, subject to state laws, should federal subsidies cease to flow. CMS did not say if the clause is meant as a safeguard against the potential impact of various high-profile lawsuits -- including Halbig v. Burwell -- that could end up in the Supreme Court next year, but stakeholders assume that is the point.

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