I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:
MARYLAND: An Amazing Healthcare Revolution Is Happening In Maryland — And Almost No One's Talking About It
The Maryland ACA exchange has been one of the "middle-tier" models in my view; not an utter disaster like the ones in Oregon or Massachusetts, but still riddled with technical problems like the ones in Minnesota & Vermont. However, the state has apparently had a different healthcare-related initiative which has been a huge success so far:
Through innovative methods and a data-centric approach, Western Maryland Regional Medical Center, has become the cornerstone in Democratic Gov. Martin O'Malley's ambitious makeover of the state's healthcare programs.
Until this month, Maryland's reports were a bit irritating in two ways: First, they were running a month behind; second, the "thru dates" for the QHP numbers never quite lined up with the Medicaid number for some reason. With today's report, they've corrected both issues, bundling both June and most of July in and matching up the dates:
Enrollment Data As of July 26, 2014, 332,504 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
Beginning this month, we will also report net changes in Medicaid enrollment. This figure takes into account the fact individuals lose Medicaid coverage because of changes in household, age, and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of July 26, 2014 is +273,245.
As of July 26, 78,930 individuals have enrolled in a qualified health plan.
The good news: While Maryland's enrollment numbers are still way below their expectations due primarily to a screwed-up exchange website, they're continuing to crank out smaller numbers of enrollees, and have now hit the 75K milestone:
Maryland enrolled about 75,000 people in private health plans, about half as many as the state initially aimed to sign up in private insurance plans. However, the state ended up enrolling about 300,000 people through Medicaid. The Connecticut health exchange technology was chosen largely because it was effective and preserves Medicaid enrollments.
The 300K Medicaid number is impressive, but I already have that number plugged in so no changes there.
On the down side, MD's move to an all-new exchange website platform (purchased from Connecticut), while a welcome move, will also require everyone who's receiving subsidies to re-enroll this November:
As I noted this morning, the Maryland Health Exchange has released an updated enrollment report running through the end of May (the June report will be out at the end of July):
As of May 31, 300,310 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
As of May 31, 72,207 individuals have enrolled in a qualified health plan.
Compared with the previous report, MD had a 4,300 QHP increase from 5/10 - 5/31, and an increase of 4,450 since the end of the open enrollment period. This means that they're averaging around 106 per day, or 31% of their average rate during open enrollment...which has had a significant impact on the Off-Season Projection Chart that I started posting yesterday (as you can see, MD had been only running 2% of the OE rate until now).
Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:
After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.
The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.
...United's participation also could help lower rates for consumers, a key concern among the law's supporters.
While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.
Regular readers of this site know that the ACA Signups project started over at Daily Kos. This is the first time I can recall using dKos as a primary source for a story link. I'm sorry to say it's not exactly a flattering one as far as Maryland's ill-fated state exchange is concerned:
Maryland's health exchange website, which is best known for falling to pieces on Oct. 1, will be scrapped after $129 million in spending. In April, the Maryland Health Exchange board voted to adopt Connecticut's web application.
At the time officials refused to say they were junking the Noridian-designed system. It was a just revamping ... right.
However, the state can't transfer data from one system to the other.
The fix? Contact 275,000 Medicaid enrollees -- about 75% of the people on the exchange -- and have them log onto a new system and put their information in again.
A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:
As of April 29, 2014, 275,090 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
As of May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.
It seems a bit odd to me that Maryland is issuing a formal press release today when their extension period doesn't end until tonight or tomorrow (why leave a couple days of stragglers?), but whatever; the increase in exchange QHPs from 4/09 to 4/14 was only 1,017, so I guess they figure that it won't be more than a few hundred from 4/15 - 4/18 anyway.
In any event, they say they aren't issuing any more updates until mid-May, so for all practical purposes, this closes the books on Maryland for now:
Please note, we will begin reporting on a monthly basis, on the third Friday of each month. Our next report will be May 16, 2014.
As of April 15, 2014, 262,619 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
As of April 14, 2014, 66,203 individuals have enrolled in a qualified health plan.
However, I also tried to be cautious in my "official" estimate, keeping it to around 4M or so since I didn't know how many there really were beyond the 300K (later 560K) or so I had documented at the time. After all, other states would likely have a much lower ratio of Off- to On-exchange QHPs; In Wisconsin, for instance, Off-Exchange QHPs were only about 23% as high as exchange-based.
Maryland's press releases are getting shorter and more abrupt. With the enrollment period wrapping up and their exchange site still an utter mess (and about to be completely scrapped and replaced), this isn't terribly surprising.
Still, this is up another 2,184 QHPs and 16,420 Medicaid enrollees in the past week, which isn't too bad, all things considered.
Through April 9, 2014, 65,186 Marylanders have chosen to enroll in qualified health plans through Maryland Health Connection. As of April 8, 248,495 have gained Medicaid coverage in 2014 and remain active in Medicaid.
Enrollments in qualified health plans since March 31 include 2,229 enrollments completed with assistance from a dedicated team responding to Marylanders who contacted our 1-800 hotline and other channels to request additional help.
O’Malley points out that despite the problems, Maryland exceeded its overall enrollment goal of 260,000. As of Tuesday night, that number had hit 295,077. It includes people who have enrolled in private plans (which has dramatically lagged expectations) and Medicaid (which has exceeded expectations).
...Sharfstein said in late February that a more accurate projection is 75,000 to 100,000 private enrollees.
As of Tuesday evening, there were 63,002, with hundreds or thousands more expected to finish their applications in coming weeks.
Maryland's exchange may be a mess, but this article gives solid, no-nonsense totals: 60K QHPs and 232K Medicaid through 3/31.
Sharfstein provided updated enrollment numbers on Tuesday. He said the state enrolled 60,003 people into private health plans. The state initially hoped to have 150,000 enrolled in private plans. O’Malley has tried to offset the disappointing private plan enrollments by highlighting a higher numbers of Medicaid enrollments through the federal Affordable Care Act. Sharfstein said Tuesday that 232,025 have been enrolled in Medicaid. The state’s goal of total enrollments was 260,000.
Some nice, solid numbers in an otherwise negative article about Maryland bailing on their existing software in favor of Connecticut's:
O'Malley said that as of Wednesday, 273,582 people have signed up for coverage. That includes 220,043 people (80% of the total enrollment) who had enrolled in Medicaid, and 53,539 people (20% of the total enrollment) who had enrolled in private insurance.
This brings MD's QHPs up from 49,293 on 3/22, an increase of 4,246 in 4 days; the Medicaid number hasn't changed.