Quite a day for Direct/Off-Exchange Enrollment news. First the Washington revelation, now this profile in USA Today of eHealth Insurance, a private web-based health insurance exchange that's seen tremendous success selling ACA-compliant plans to people who don't qualify for tax credits through the government-run exchanges.
Not exact numbers, but these are reasonable given the previous breakdown (49,662 Private / 181,705 Medicaid): KY Governor Steve Beshear announced that the combined total of enrollments in Kentucky has hit 244,000, broken out roughly 25% to 75%, which would be 61K private, 183K Medicaid. However, to be safe I'm erring on the side of caution and making it 59K Private / 185K Medicaid until a formal press release comes out.
[as of Thursday], 244,000 Kentuckians have signed up for coverage through Kentucky's exchange, Beshear said.
About three-fourths of them enrolled in the state's expanded Medicaid program and the rest in private insurance plans. The state's performance has earned praise from PresidentBarack Obama.
"Those aren't just numbers," Beshear said. "They represent ... real improvement in people's health."
This is significant for another reason. Previously, Kentucky's limited February data made it look like private QHP enrollments had plummeted, down to 20% of their January rate.
No fuzzy terminology here. Unlike some other Medicaid enrollment data which leaves you guessing as to whether it's "expansion", "base churn", "redeterminations" or "woodworkers", this AP article is pretty clear and to the point:
COLUMBUS (AP) — More than 23,000 low-income Ohioans enrolled in Medicaid last month under an expansion of the taxpayer-funded program supported by Republican Gov. John Kasich.
That's about 6 percent of the roughly 366,000 residents who the state projected would be newly eligible for coverage by the end of June 2015.
The state's monthly report on Medicaid caseloads does not include those who have applied to the health program for the poor and disabled. But the numbers released Monday provide the first glimpse as to how many people have successfully enrolled under the expansion. The report shows 23,156 residents have obtained coverage so far.
For months I've been trying to hunt down the ever-mysterious "Off-Exchange" private QHP enrollment data...people who have purchased new, ACA-compliant healthcare policies since October 1st, but have done so directly via the various insurance companies. These are, for the most part (at least in the states which haven't granted a 1-year extension of non-compliant policies) the same (or very similar) policies as those sold via the exchanges; the enrollment process simply bypasses the exchange websites, that's all. There are several reasons why people do this; the most obvious is if their taxable income is too high to qualify for an ACA subsidy. Why go through the hassle (on some exchange sites, not others) of jumping through the extra hoops of the Exchange process if you're certain that you aren't going to qualify for a tax credit anyway? In other cases, the insurance company itself may have made some sort of special offer for enrolling directly (or, in some unfortunate cases, they may have pretended that it was a better deal or not even mentioned the exchange as an option).
In any event, this data is difficult to hunt down because unlike the Exchange enrollments, the insurance companies are under no legal obligation to make it public (at least I don't think they are...possibly in their quarterly SEC filings or something?) Until today, I only had hard numbers from 2 companies: WellPoint, whose CEO revealed last month that about 19% of their enrollees since October 1st have been signed up directly. I don't have a more recent update on this, and he didn't break those numbers out by the half-dozen or so states that WellPoint operates in, but that's still 95,000 people. In addition, one other company, a Co-Op that operates in Iowa and Nebraska, cheerfully provided a full breakdown of their enrollments. Add these together and you have about 124,000 people...until today.
Hot off the presses (well...ok, hot off a CT Mirror reporter's Twitter feed, anyway): Connecticut is reporting an additional 3,000 private QHP enrollees over the past week (up to 53,673 on 2/18 from 50,665 as of 2/10), and an increase in Medicaid enrollment of around 1,600 people. They also apparently have a "paid" rate of at least 91% ("low 90%"):
As of midnight Tuesday, Access Health CT had 126,653 enrollees, including 53,673 signed up for private insurance.
So, how does this impact the "February Drop-off" factor? Well, previously CT's February enrollment was running about 39% below January; this has improved to only 19% lower per day, which has the effect of increasing the overall daily average a bit, even after adjusting to only include the 91% paid enrollments:
Eureka! That rarest of things, a mid-month enrollment update from a federally-run exchange state! Idaho reports hitting 38,000 private enrollments, up from 32,899 as of February 1st (I'm sure this is private enrollments only, because they were already at over 16K Medicaid enrollments as of 2/01. It's a short article and the whole thing is a gem, so here it is verbatim:
Idaho’s state-based health insurance exchange has now enrolled 38,000 people in health insurance, state Department of Health & Welfare Director Dick Armstrong told lawmakers today. And another 56,000 are “in the queue,” in the process of enrolling. “Our original target was 42,000,” he said, for signups by the end of the open enrollment period at the end of March. “Very rapidly, Idaho’s enrollment … has come up.”
When the exchange opened and faced problems due to computer system hang-ups in Washington, D.C., initial enrollment numbers were very low. “Everybody was just wringing their hands,” Armstrong said. “This is a breath of fresh air, to see that the enrollments are picking up this rapidly.”
One more very small update today. This isn't an official data release, but this press release from yesterdaymentions the total enrollment in Minnesota as being "nearly 95,000". This presumably includes enrollments through 2/17.
Assuming the same 32% / 68% ratio between existing private QHPs and Medicaid enrollments in Minnesota, this should break out to roughly 30,200 Private / 64,700 Medicaid, an increase of around 700 and 1,700 respectively.
Today, MNsure announced new TV and radio ads that tell the stories of Minnesotans who have used MNsure to find better, more affordable health care coverage. The ads highlight the affordability of MNsure plans and underscore the fact that MNsure offers the lowest premium rates in the country – with additional financial help available through tax credits. The ads are aimed at encouraging more Minnesotans to enroll in affordable, quality health coverage before the March 31 deadline. Nearly 95,000 Minnesotans have already selected health insurance through MNsure.
Yes, it's true...sort of. With the addition of the latest numbers from Colorado, Hawaii and especially California, if you include all ACA Exchange-based enrollments reported to date--both paid and unpaid--the total currently sits at a tad over 3.56 million people. The original CBO projection for exchange-based private QHP enrollment was 7 million, so we've finally hit the halfway mark. Of course, the enrollment period itself is actually over 77% of the way through, so this is more of a purely symbolic milestone than anything else, but it's still worth noting.
There's a few additional caveats as well, of course; if you remove all enrollments known to be unpaid (about 265K) from the 5 states which have broken that out, and then subtract another 10% from the remaining 46 states, you'll only have about 3.05 million enrollments which are paid (or unpaid due to billing problems on the insurance company's end,which can hardly be blamed on the customer or the exchange system). However, this works out nicely as well, since 3.05 million is still over 50% of the revised CBO projection of 6 million total!
A flood of new enrollment data today! Colorado just posted their latest update, which runs through 2/17. Private QHPs are up from 69,627 as of 1/31 to 79,779 as of 2/17 (an increase of 10,152), while Medicaid enrollments are up to 128,219 from 117,607 as of Jan. 31st (an additional 10,612).
This is also more good news for the "February Drop-off" issue, since this knocks the likely drop-off in average daily enrollment from 11% down to 10% even:
This moves the likely February enrollment up from 820K to 830K, based on 13 states representing 98.7 million people, or 31.4% of the country.
Since the grand total was almost precisely 3.3 million as of 2/01, adding 830K in February would bring the total up to 4.13 million.
There's so much info in today's California press release I've had to move the Medicaid info to a third entry. There's a ton going on in the following passages:
Additionally, 877,000 applicants were determined to be likely eligible for Medi-Cal coverage. DHCS also transitioned 652,000 individuals into the Medi-Cal program from the state’s Low Income Health Program. Automated enrollment allowed county human services agencies to enroll 106,000 individuals into Medi-Cal coverage, and another 65,000 were enrolled through the Express Lane program.
approximately 1.5 million additional Californians have enrolled or been found likely eligible for Medi-Cal since October.
** Does not include applicants for current Medi-Cal coverage through county human services agencies.
OK, let's break this out: The 877K figure is up fro 850K in the January HHS report, which itself was already up from 584K as of January 15, which means a ton of new people enrolled in the 2nd half of January alone.
OK, so this really does mean all enrollees. Fair enough. The downside is that I have to move 165,272 people over to the "Unpaid" category. The upside is that the "How many have PAID???" question just became about 12% cleaner.
Well THAT just figures! In the words of Emily Litella..."Never mind..."
Hot off the presses: California has released their first-half of February enrollment data: 100,228 people have enrolled in Private QHPs in "the first 2 weeks" of February (actually February 2 - 15, I assume, since the 728K number includes Feb. 1st). This breaks down to 7,159/day:
Nearly half of those covered [through 2/01] — 728,410 Californians — selected a Covered California health insurance plan. This strong enrollment trend is extending into February, where in the first two weeks more than 100,000 individuals enrolled in Covered California, increasing the cumulative total enrollment in Covered California to 828,638.
California's January enrollment rate was (728,410 - 498,794) = 229,616 / 35 days = 6,560/day, which means that their February enrollment rate is actually increased from that of January, by over 9%!
So, how does this impact the "February Drop-Off" factor? MASSIVELY! Take a look:
Hawaii's private QHP enrollments continue to crawl along, increasing from 3,879 as of 2/08 to 4,297 as of 2/15.
Total since October 1, 2013
18,752 Applications completed in the Individual Marketplace
4,297 Enrollments in the Individual Marketplace
444 Employers applied to SHOP Marketplace
They also list the number of employers enrolled in their SHOP system, but there's no update on the actual number of people covered by those plans, so it stays at 307. No Medicaid/CHIP update either.
The good news is that Hawaii becomes the first state of the 11 for which I have partial February data to actually increase it's enrollment rate over January. The bad news is, Hawaii's numbers are so tiny that this is a drop in the bucket, only reducing the overall drop percentage by 0.2%.
I know I've become a bit obsessive about this "February Drop-off" thing, but I couldn't help myself. Since the Jan. HHS report was simply wrong on New York's private QHP figure, I found the closest correct figure to Feb. 1st that I could--an official NY State of Health press release from 2 days later, Feb. 3, which gives the correct private QHP enrollment number as 241,242 as of Feb. 3.
Updating the "Feb Drop-off Chart" with this info as well as yesterday's Nevada update, we now have some more solid Feb-vs-Jan data to work with. I've modified the graph to show how many days are being counted for each state, as well as the starting & ending dates for each month:
This morning I noted that New York has seen a dramatic increase in the percent of their ACA enrollees who were previously uninsured, rising from 66% of the total on 1/10 up to 69% as of yesterday. While a 3% increase doesn't sound like much, this is especially notable because, as I demonstrated, it means that between 92 - 100% of the newest enrollees were previously uninsured (probably around 95%), since that's what it would take to raise the overall enrollment up with such a comparatively small number of additional enrollments.
However, I forgot another, earlier NY update which fills in this picture even further. Back on January 13, there was another press release which noted that as of December 24, 2013, about 50% of the 230,624 New York enrollees were previously uninsured: