California

This LA Times story from 4/21 is chock full of good news:

First, apparently the ACA is such a "socialist, anti-capitalist" enemy of the free market that the private, for-profit insurance companies are just fleeing for the hills. Oh wait, actually...

Peter Lee, executive director of Covered California, said all 11 current health plans have indicated they plan to return next year. He also said three new plans have submitted letters of intent indicating they may compete on the exchange in 2015.

I was so caught up in the national tally implications, I forgot to actually devote a proper entry to California itself. There's some additional key numbers to look at here:

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.

As noted earlier, 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.

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.

According to L.A. Times reporter Chad Terhune, CoveredCA has confirmed enrolling another 70,000 people in private QHPs in the first 9 days of the extension period. They had 1,221,727 as of 3/31, so that brings their total to 1.29 million as of last night:

#CoveredCA added 70,000 (on top of 1.2M) who picked a plan in the 9 days of the "grace period" since March 31 to April 15. @charles_gaba

— Health Access CA (@healthaccess) April 10, 2014

#CoveredCA exchange: 70K more enrolled since 3-31 deadline after extending sign-ups to 4-15, adding to 1.2M already in #ACA

— Chad Terhune (@chadterhune) April 10, 2014

OK, this is why CoveredCA was holding off on announcing their numbers: Peter Lee had to testify before Congress today anyway:

Enrollment in Covered California private health insurance plans hit 1,221,727 through March 31. In fact, March was the highest single month of enrollment, with more than 416,000 people signing up for a health insurance plan.

...Medi-Cal enrolled approximately 1.9 million people through the end of March, including 1.1 million through the Covered California portal and county offices, approximately 650,000 former Low Income Health Program (LIHP) members who were transitioned to Medi-Cal by the California Department of Health Care Services (DHCS) and 180,000 individuals who applied through the state’s Express Lane program.

In addition...

OK, in addition to the appx. 7.041 million enrollments on the Federal exchange (HC.gov), I've brought CO, CT, DC, HI, KY, MD, MN, NY, RI and WA completely up to date, with all QHP data through midnight on 3/31 (some of the Medicaid/CHIP data is still missing, but that's a lesser concern at the moment).

However, I'm still missing the following exchange QHP data:

  • California: 22 hours (that's right...the current tally runs thru 2am on 3/31)
  • Massachusetts: 3 days (current is thru 3/28)
  • Nevada: 2 days (current is thru 3/29)
  • Oregon: 3 days (current is thru 3/28)
  • Vermont: 1 day (current is thru 3/30)

I can't tell you how frustrating it is to be this close to full data while still missing it.

So, how much is actually missing? Well, if these states were running at their prior average March daily rate, it would be

  • CA: 11,754
  • MA: 512 x 3 = 1,536
  • NV: 427 x 2 = 854
  • OR: 502 x 3 = 1,506
  • VT: 775
  • Total: 16,425

However, this obviously doesn't apply since the final weekend and especially yesterday were insane.

Without the final day's numbers, this update is both helpful and frustrating, because it's so close yet so far away. The QHP number is actually somewhat lower than I had thought a few days ago (not that I'm complaining; HC.gov more than took up the slack, and CA was going nuts on the final day anyway...which is why I'm so anxious to get the data from the 31st):

Consumer interest in Covered California has been strong, with 1,209,791 Californians signing up as of 2 a.m. March 31. From March 24 through 2 a.m. March 31, 155,988 individuals signed up for coverage. During the same week, 389,840 accounts were started — including 123,787 on Saturday and Sunday, as consumers hurried to meet the deadline.

“We’ve set records on accounts created five of the past six days,” Lee said.

OK, here we go: CoveredCA just announced their exchange QHP tally as of 2am this morning: 1,209,791

Huge consumer interest - As of 2 am, 3-31, #CoveredCA has enrolled 1,209,791 people in health plans. Open enrollment ends @ 11:59 pm tonight

— Covered California (@CoveredCA) March 31, 2014

The bad news is that this is about 70,000 lower than I estimated (1.28M), which is a bit disappointing.

The good news is that they're still chugging along without any outages (that I know of), and HC.gov just tweeted the following:

Record volume on http://t.co/eTfU7hBJUR today. 1.2M visits through noon and 125k+ concurrent users at peak so far today. #GetCoveredNow

— HealthCare.gov (@HealthCareGov) March 31, 2014

I included the 80K in 4 days info yesterday, but didn't realize the implications of the second sentence until a commentor pointed it out:

The Covered California exchange said sign-ups have been building throughout the week with about 80,000 people picking a health plan Monday through Thursday. An additional 150,000 households created an online account and started the shopping process in the last three days, officials said.

That's 50,000 households--not individuals--PER DAY who JUST ceated an account for 3 days straight.

Pretty sure most of those are actually enrolling even as I type this.

I think this final weekend surge is going to be MUCH larger than even I've been projecting.

Gotta run for the moment, but I'm going ahead and calling it 6.7 million exchange-based QHPs as of now.

Looks like the 39K on Monday & Tuesday continued at the same pace all week...supporting my "California 20%" rule (20K in CA = 100K nationally):

SACRAMENTO (AP) — California is seeing a late surge in the number of people signing up for healthinsurance coverage  ahead of next week’s deadline – and state officials are encouraging more people to apply.

The state already reported surpassing 1 million enrollees. But Covered California Executive Director Peter Lee said Friday that another 80,000 people enrolled in the past four days alone.

20,000 per day in California is 4x the rate they hit in February.

I'm pretty sure California has now broken 1.2 million all by itself (which makes sense if the 20% rule holds...1.2M = 20% of 6M...)

Based on this and the Oregon entry, I'm increasing my projection from 6.54M to 6.58M as of 3/31.

Blammo. Remember how I noted that back in December, California managed to hit 30K exchange QHPs in a single day, and 20K/day for several other days between Christmas and New Year's Eve?

Well, it looks like we've hit the 20K/day mark. From today's L.A. Times:

The site — the main portal for insurance marketplaces in 36 states — drew 1.2 million visitors Tuesday and 1.1 million visitors Monday, according to the administration.

Over the same period, call centers received more than 500,000 calls. California's state-run health insurance exchange reported a similar surge in interest, with nearly 40,000 people picking a health plan Monday and Tuesday.

Now, this is awesome news, as it suggests a national rate of around 100K/day (CA has averaged around 20% of the national QHP enrollments all along).

However, it also poses a slight dilemma for me, since there's an 8 day gap between the existing March data (03/02 - 03/15) and these 2 days (03/24 - 03/25).

Oregon has been talking about this for weeks, but now it's official:

Oregonians now have an additional month to apply for private health insurance. New deadline to apply is April 30. The Oregon Insurance Division and Cover Oregon urge people to apply now to get coverage as soon as possible and avoid potential end-of-month rush. 

Colorado said something about this the other day, but now it's official:

DENVER - Colorado will give health insurance applicants extra time to finish the enrollment process, if they start before the March 31 deadline.

Connect for Health Colorado will make an official announcement about the extension Wednesday afternoon.

Add New York to the list as well:

While waiting to see whether I was right about the national exchange-based QHP total hitting the 5.5M mark yesterday (and bear in mind that there's no guarantee that HHS will make an announcement about it even if I was correct; they didn't do so for 3.5M or 4.5M...I just figure that they will since it's a logical milestone and would be a nice momentum-building PR move going into the final stretch), I just wanted to call attention to this article from yesterday out of KTVU/Fox in California:

SAN FRANCISCO — One week from Monday is the open enrollment deadline for Covered California. The insurance exchange hit the one million mark for sign-ups last week, and is expecting about 20,000 people a day to sign up in the final push.

I've already contacted the reporter who wrote the story to make absolutely certain this doesn't include Medicaid enrollees, but the context makes me pretty sure they're talking about exchange QHPs only. Also, "expecting" 20K/day doesn't necessarily mean they've already ramped up to that; it could just mean that they're preparing for that volume just in case.

Contributor Ruth 37 sent a link to this open letter from Peter Lee from 2 days ago, regarding California's 1M QHP milestone and what CoveredCA's plans are going forward.

The number of people who have picked a Covered California health insurance plan now tops 1 million. This is an amazing accomplishment, and it means that with two weeks to go we have exceeded the highest “enhanced forecast” for the entire open-enrollment period. The health insurance companies report that more than 85 percent of those who have enrolled are paying their premium and getting coverage. That means 850,000 Californians are on their way to coverage through Covered California, which surpasses the top projection of 830,000....

There we go; I originally projected California to hit 1M last Tuesday or Wednesday, but didn't realize at the time just how bad the mid-February outage had hit the exchange. It ended up taking them 2 extra days to hit the 1M mark (Friday night). Fortunately, it looks like they've bounced back nicely:

Covered California’s enrollment reached the 1-million mark late Friday. By the end of Saturday, enrollment reached 1,018,315 in the health care exchange marketplace. The figure represents the number of people applying for coverage and selecting insurance plans for themselves and their family members through the exchange.

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