2018 MIDTERM ELECTION

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Hawaii

Yesterday I publicly declared that total QHP selections nationally had reached the 9 million milestone. I based this on 4 data points:

  • The 6.59 million confirmed by the HHS Dept. for the 37 states run through HC.gov,
  • The 980K confirmed by the 14 assorted state-run exchanges,
  • The unreported renewals (both active and automatic) from California & New York, and
  • Another roughly 150,000 scattered amongst all 50 states & DC since the date of their most recent updates until today (which varies from as little as 1 day to as much as 25 days in the case of Idaho).

If you do the math, you'll see that the biggest missing piece here is the 3rd item above: Covered California and New York State of Health have, to date, still refused to give out any re-enrollment/renewal data for 2014 QHP enrollees. Not just autorenewal numbers, but active renewals as well.

Huh. OK, this one is unexpected, mainly because they waited until 4 days after the original 12/15 deadline to make the announcement:

The Hawaii Health Connector has extended the deadline for residents to enroll in health insurance that takes effect on Jan. 1.

The extension will be until noon on Dec. 31. The original deadline was this past Monday.

The state's health insurance exchange created by the Affordable Care Act, also known as Obamacare, signed up 3,500 residents in the first month of open enrollment , which started on Nov. 15. To enroll, call 1-877-628-5076 or go to www.hawaiihealthconnector.com.

So, that makes 3 states now which have bumped their deadline for January 1st coverage out until 12/31: Hawaii, Vermont and Minnesota.

Hawaii's updates are particularly frustrating because they have a tendency to only give the cumulative plan selections to date, mixing together 2014 & 2015 numbers regardless of whether they've actually enrolled/re-enrolled for 2015 or not. Therefore, it's refreshing to see a (relatively) straightforward update out of the Aloha state:

The Hawaii Health Connector enrolled 3,500 people in its first month of open enrollment, which ended on Monday, the exchange confirmed Tuesday.

The state's online health insurance exchange saw more than an eleven-fold increase in enrollment in comparison to its first month of enrollment last year, when the just 300 signed up for health insurance on the Connector.

Of course, they couldn't help but mix numbers together later in the story:

...To date, roughly 13,500 residents have signed up for health insurance coverage that will begin on Jan 1.

Kissel noted that the Connector has also connected 50,000 to the expanded Medicaid program, which came in with the Affordable Care Act at no cost to the state.

I'm actually a bit curious about the "new" specification here. Last week the head of the HI exchange gave an interview in which he gave the number as being 12,000, but it turned out that was a cumulative number which included all of the enrollments from last year (whether they had renewed yet or not) as well as the new additions. I thumbnailed it as being around 1,200 enrollments for 2015.

Therefore, I'm not sure how to take "nearly 1,500 new residents" in this case; that may mean "new for 2015 including renewals" or it may mean "new for 2015 not including renewals". Either way, the number isn't large enough to impact my spreadsheet/projections, but it's still a bit irritating:

Hawaii: Hawaii Health Connector has enrolled nearly 1,500 new residents as of Dec. 5. Last year glitches to the website caused enrollment to be delayed by two weeks. According to HealthInsurance.org, the state’s uninsured population has gone down from 8 percent of the population to 6 percent of the population since Obamacare went into effect..

I spent a few minutes this morning poking around all 15 ACA exchange websites (HC.gov plus the 14 state-run websites). Obviously I didn't go through and actually create an account or enroll/renew in any of them (although my wife and I did renew our own coverage via HC.gov on Saturday, and everything went fine). However, I at least visited all of the sites and clicked through as far as I could go without actually setting any accounts up.

For the most part, everything went smoothly. Yes, some of the sites have more confusing layouts/navigation than others, but my main concern was whether they load at all, how quickly pages load, whether any glitches or broken links pop up and so on.

Well, this news is either moderately interesting or jaw-droppingly awesome, depending on what the actual number is.

@charles_gaba The total number of individual enrollees in the Hawaii Health Connector is over 12,000. More info here: http://t.co/ertrxWh6n4

— HI Health Connector (@HIConnector) December 10, 2014

When you visit the link, it goes to a video interview with the executive director of the HI exchange, who states, when asked "do we know how many signups there've been so far?" that "it's about 12,000; we were at 250 this time last year, so we've made a lot of progress."

Now, hold the phone a minute. According to the Kaiser Family Foundation, Hawaii only has around 53,000 residents total who are even eligible to enroll via the ACA exchange to begin with.

Just a few things to note...

MASSACHUSETTS: The MA Health Connector allows for online premium payments (and in fact, payments have to be made to the exchange, not to the insurance company itself). The good news is that the website & billing system appear to be working properly this year, a vast improvement over last year's disaster. The bad news (or, odd news anyway) is that for some reason the system requires you to pay using only direct electronic fund transfers or a written check--it does not accept credit card payments!

I don't know if this is for technical reasons (which I doubt) or policy reasons (avoiding the 2.5% transaction fees or whatever), but it seems very odd to me.

HAWAII: Not only hasn't the HI Health Connector provided any enrollment updates since open enrollment started again on November 15th, they haven't even updated their enrollment report section since July 26th! Guys, either post an update or at least remove the link entirely; keeping it as is, locked in on 7/26 is just embarrassing.

Top contributor deaconblues is back in action with three updates today: First up, Hawaii:

HONOLULU — Hawaii's health insurance exchange enrolled more than 40 people on the first day clients were able to sign up to be covered next year.

Another 60 applied for financial assistance to pay for premiums as of mid-afternoon, Jeffrey Kissel, the CEO of Hawaii Health Connector, said Saturday.

The insurance exchange expected to serve over 1,000 clients, either online, over the phone or in person by the time it closed for the day at 8 p.m.

As db notes, and as I noted in my Vermont/Massachusetts post this morning, the numbers may be tiny but it's symbolically very important, especially for the exchanges which had so many technical problems last year. Hawaii didn't get nearly as much press as OR, NV, MA, VT or MD, but they did have severe problems as well.

Combine that with the fact that it's such a small state which already had such a low uninsured population to begin with, and enrolling "only" 40 people or so on Day One is still an important starting point for their 2015 narrative.

With Open Enrollment 2.0 coming up fast, here's some quick hits from the various state-run ACA exchanges:

Massachusetts: State vows easier time on rebuilt Mass. Health Connector site

When people shop online for health insurance through the Massachusetts Health Connector next month, they will have a radically different experience than the trouble they encountered last year, state officials promised Thursday.

Last year’s website, redesigned to meet the terms of the Affordable Care Act, never worked properly, leaving people unable to buy subsidized health insurance. This year, officials say, the newly rebuilt website will enable users to cruise smoothly from log-in to plan choice.

Vermont: Thousands directed to shut-down health exchange website to pay bills

Thousands of Vermont Health Connect customers who signed up to pay health care premiums online recently received email notices directing them to pay through a website that is offline.

For all of the flaws with their implementation of an ACA exchange, Hawaii had at least one thing going for them during the off-season: They kept providing enrollment updates (as small as the numbers were) on a regular basis...through the end of July, that is. Since July 26th I haven't heard a peep out of HI before today:

The exchange, created by the Affordable Care Act, also known as Obama­care, has struggled with participation over the past year, attracting just two medical insurers -- Hawaii Medical Service Association and Kaiser Permanente Hawaii -- and signing up just 10,750 individuals, the lowest in the nation.

Hmmm...on the one hand, 10,750 is actually a reasonably decent increase since July (1,087 people added over about 2 months, or 18/day). On the other hand, it's entirely possible that this number includes the 1,057 SHOP plan enrollees...in which case it isn't an update at all, or (scarier) it would mean Hawaii has only added 30 people to QHPs since 7/26.

Three ACA-related stories which are all interesting but which I don't have a whole lot to add to:

The trouble with trying to sign people up for health insurance when care is already free

It’s hard work trying to get people to sign up for health insurance when their care is mostly free to them. Andrea Thomas is working to get Alaska Natives in Sitka, Alaska, to do just that. She’s the outreach and enrollment manager at SouthEast Alaska Regional Health Consortium (SEARHC), and it’s her job to sign people up for health insurance coverage through exchanges created as a result of the Affordable Care Act.

To get a sense of just how uphill Thomas’s battle is, consider this: Of the more than 100,000 people who live in Alaska and self-identify as Alaska Native or American Indian, only 115 had signed up for health insurance through an Affordable Care Act exchange as of March 31.  Alaska Natives and American Indians are exempt from tax penalties for not signing up for health insurance.

While the technical overhauls/transfers of exchanges in states like Oregon, Nevada, Massachusetts and Maryland have been taking up all of the "ACA tech problem" news (the former two are moving to HC.gov for 2015; the latter two are completely overhauling their own websites), Hawaii's technical woes seem to always have operated in something of a news vacuum. The Hawaii website problems were always just as bad as some of the other states listed, yet not once have I received any indication of whether they were abandoning their software like OR & NV or fixing it like MA & MD.

Over the past couple of weeks, the answer seems to have revealed itself: The Hawaii Health Connector website has been revamped...as a WordPress-based site. However, this appears to only be the "welcome/info" portal; actually clicking the "Enroll" links takes you to a different domain name at ConnectHawaii.com which seems to be the actual HI exchange.

Yes, 49 people is pretty tiny even for a state with as low an uninsured population as Hawaii, but it's still further evidence that the drop in QHP enrollments in the first week or so of July was either a typo or a data entry glitch, as the total has since risen for 2 weeks straight. SHOP enrollments haven't changed since 7/15:

Connector Updates as of July 19, 2014

33,042 Applications completed in the Individual Marketplace
9,724 Individuals and families enrolled in the Individual Marketplace
689 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*

* as of July 15, 2014

Huh. A week ago I posted a Hawaii update which noted that exchange QHPs for Hawaii had actually dropped by 156 people from 6/28 through 7/05. This was quickly followed by similarly huge enrollment drop-off figures out of both Oregon and Minnesota.

However, check it out today...

Connector Updates for July 12, 2014

Total since October 1, 2013

32,991 Applications completed in the Individual Marketplace
9,675 Individuals and families enrolled in the Individual Marketplace
675 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*
* as of July 15, 2014

When we last checked in on Hawaii's ACA exchange on 6/21, the QHP tally stood at 9,586 people, and another 965 SHOP enrollees.

There have been 2 updates from the exchange since then; QHPs went up another 12 over the next week (6/28)...but in the most recent update, the number has dropped down to 9,442...a loss of 156 people:

Connector Updates for July 5, 2014

Total since October 1, 2013

32,959 Applications completed in the Individual Marketplace
9,442 Individuals and families enrolled in the Individual Marketplace

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