Holy Crap on a Stick!

From April 1-15, 205,685 consumers – including a one-day record of more than 50,000 on the final day – completed their applications and selected health plans through the Covered California exchange, bringing the total to 1,395,929 at the end of the historic, first open enrollment period. The total exceeds the base projection for Covered California for the entire six-month enrollment period by more than 815,929.

Let's assume that "over 50,000" means, say, 50,100.

To put this in context, they're saying there were (205,685 - 50,100) = 155,585 QHP enrollments in the first 14 days (about 11,100/day)...followed by 50,100 on the last day. That's 4.5x the rate it had been.

Until this, I was estimating that the national 4/01 - 4/15 average would be around 45K - 55K/day nationally during the extension period, or around 675K - 825K total, for a grand total of around 7.77- 7.93 million exchange QHPs total. I settled on 7.78M as my "official" projection to be on the cautious side.

Just a reminder: Assuming that Inside Health Policy has it right, the official HHS report should be released sometime today and should include about 99% of the exchange QHP enrollment data through 4/15.

In the past, they've usually released the monthly reports around the 11th or 12th of the following month. In this case they've obviously been delayed because of a) the insanity at the end of March and b) thankfully, they apparently want to squeeze in the first half of April as well (as you know, I was deeply concerned that they might lop off the last 2 days of the month and roll them over to an April report next month, which would cause no end of confusion among sloppy media outlets which can't take a glance at the calendar and do basic math).

They generally release these reports around 4pm. I know this because there've been at least 2 cases where the conference call with Kathleen Sebelius started up right as I was waiting for my kid to get home from school, so we'll see if that holds true today as well.

This is a guest post by Paul Mullen, Consultant Economist, Austin, TX; former Economic Advisor to the UK Minister for Local Government, Minister for Housing & Secretary for the Environment:

I would love to believe RAND's estimated 8.2 million increase in ESI between September and March but my experience in commissioning similar polls suggests to me that it is not real but due to an unanticipated side effect of the poll methodology.

We know that there is a pretty large "churn" in insurance status. Some people will gain jobs with insurance, while others lose them. Some people retire, get sick, or die. But one would expect the number gaining and losing employer coverage would be about equal. RAND's 8.2 million increase is the difference between 14.5 million estimated to have gained employer sponsored insurance and 6.3 million estimated to have lost it (with an estimated 102.4 million having employer coverage in both polls).

Yesterday I posted a poll asking whether people found the term "woodworker" (used to describe new Medicaid enrollees who were already eligible to be enrolled even without the expansion provisions of the ACA) to be offensive. The thinking is that "woodworker" makes it sound like you're an insect creeping around under the floorboards and so forth; not the prettiest image.

Anyway, the poll is now closed, and the results are in...out of 505 votes total:

  • 83% felt that I should keep using the term "woodworker" enrollees
  • 10% felt that I should switch to the friendlier-sounding "welcome mat" enrollees
  • 7% felt that I should use some other term

This led to a robust discussion about what seems to be a pretty minor issue, but apparently means a lot to people. Other suggestions included:

I'm debating whether to actually plug this number into the spreadsheet or not. On the one hand, I'm reluctant to do so without hard official numbers being given (this is just a survey, only runs through mid-March and doesn't include kids anyway).

On the other hand, doing so wouldn't change my total projection of around 7.78 million exchange QHPs; it just reduces the "unsorted" number at the bottom. Plus, I'm almost certain that the March HHS report is going to be released sometime tomorrow (Thursday) anyway, so if I'm wrong, it'll be easy enough to correct it at that point.

You may remember Georgia Insurance Commissioner Ralph Hudgens as the jackass who actually bragged about blocking his own constituents from gaining access to healthcare last August:

“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”

After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

Washington State is doing a fantastic job of tracking pretty much every data point about health insurance in the state (I already had the 146K number):

OLYMPIA, Wash. – The individual health insurance market has grown to more than 324,900 people in Washington state, according to updated enrollment information reported by health insurers to the Office of the Insurance Commissioner this week.

This number includes 178,981 enrolled outside the Exchange and 146,000 enrolled inside the Exchange, Washington Healthplanfinder, as of March 31. The total is expected to increase as late enrollments through the Exchange are processed and reconciled.

...Before open enrollment began on Oct. 1, 2013, approximately 278,000 people were enrolled in health plans in Washington state’s individual market. Some 238,000 people received discontinuation notices from their insurers and had to find new coverage by Jan. 1, 2014. Estimates were made earlier this year that 113,000 of those who received notices would qualify for subsidies and 30,000 would qualify for the state’s newly expanded Medicaid program, Apple Health.

Avera reported about 8,950 South Dakotans had both enrolled in its plans and paid their first premiums since the enrollment period began in October. Sanford reported 1,443 and DakotaCare 59. The total is 10,450, but the government relaxed the March 31 deadline and some enrollments are still coming in. The insurers also have some applicants who enrolled but didn't complete the purchase by paying their first premiums.

Avera, in earlier phone surveys, found that 54 percent of enrollments effective in January and February were people without coverage. Avera is studying the issue further and is working with Augustana College to explore what consumers care about most in a decision to buy.

Read that carefully--54% of the January and February-start policies were previously uninsured. That means people who enrolled between 10/1/13 - 1/15/14. All indications (and logic) are that those who enrolled later than mid-January are more likely to be newly-insured than the earlier enrollees.

I can't really use this number in the spreadsheet since it's less than the total for the state, but this is extremely telling news (besides, how often am I gonna get to post a Texas-specific entry?):

HOUSTON (AP) — More than 177,000 Houston residents have signed up for health insurance through the federal marketplace, far exceeding expectations for the city.

According to an email obtained by The Associated Press, as of April 5 177,825 Houston residents enrolled for insurance under President Barack Obama's signature law. The email was written by Marjorie McColl Petty, the regional director for the U.S. Department of Health and Human Services in Dallas.

The expectation had been that 138,000 Houston residents would sign up. Petty told Houston officials the numbers reflect a successful 13-county regional effort.

The quotes around "final" are there because DC also announced that they're bumping out the extension period one more time, to April 30th:

The exchange had 699 people enroll for coverage in the two weeks after open enrollment was originally supposed to close, with 22 percent of those signups coming on Tuesday, the final possible day. That brings the total number of private health coverage enrollments to 10,630, Medicaid signups to 19,217, and small business enrollments to 13,118.

A bunch of people have sent me this link to the latest Gallop poll, which is certainly welcome news but isn't exactly unexpected:

WASHINGTON, D.C. -- The uninsured rate among adults aged 18 and older in the states that have chosen to expand Medicaid and set up their own exchanges in the health insurance marketplace has declined significantly more this year than in the remaining states that have not done so. The uninsured rate, on average, declined 2.5 percentage points in the 21 states (plus the District of Columbia) that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

So, this is awesome news. Aside from the obvious, though, let's look at the other key stats:

Key "final" numbers as of 4/15 (MN is actually allowing another week, through 4/22, for final stragglers):

QHP: 48,157

Medicaid: 140,678

SHOP (from Dashboard) 726 x 1.8 = 1,306

This is actually pretty impressive; NY had been averaging around 4,200/day up until yesterday, when they hit 949,428, so this means they racked up another 11,334 in the final day (around 5,600 QHPs and 5,700 Medicaid):

.@charles_gaba @charlesornstein final NY Enrollment total: 960,762 Medicaid: 525,283 Private: 435,479

— Dan Goldberg (@DanGoldbergCNY) April 16, 2014

OK, this doesn't really change the numbers beyond a couple hundred, but it's encouragingto see that my "15% in Non-Expansion States" rule of thumb for estimating the number of people who fall into the "woodworker" category seems to be pretty accurate, at least in Indiana:

Even without expanding eligibility for Indiana Medicaid, the program had enrolled 40,577 more Hoosiers as of March than it had in the same month last year.

More than 15,000 of that year-over-year increase occurred in March alone this year, as a flood of people here and nationally sought coverage before Obamacare would hit them with a tax for going uninsured.

If you take a look at the Medicaid Spreadsheet, you'll see that I currently have the "woodworker" tally for Indiana at 40,951...only 374 more than the number reported above.

That 40,951 is 15% of the combined total number of new Medicaid enrollments for Indiana from both the HC.gov website as well as through traditional state Medicaid agency offices (273,005).

OK, the various ACA exchanges are just messing with my head now.

First, Nevada announced that they've extended their enrollment out to May 30 for those who started by March 31st.

Then Oregon announced that they've extended full open enrollment out to April 30.

Then I found out that anyone who submitted a paper application by April 7th in any of the 36 states run by HC.gov still have until April 30 to finish.

Colorado, I've discovered, is allowing people who applied for Medicaid but were denied up until May 31st to finish their enrollment process.

And, of course, Massachusetts has over 200K "Limbo Status" people who may (theoretically) get squared away as late as June 30.

Late last night I learned that Hawaii has bumped their extension deadline out to April 30.