I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.
For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In some states I've been able to get more recent enrollment data from state websites and other sources.
Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.
Note: The CDC lists ~413,000 Massachusetts residents (12.3% of the total fully vaccinated) whose county of residence is unknown.
For Massachusetts, it's important to note several things: First, every county in the state voted for Joe Biden by a wide margin (Bristol is the closest thing the state has to a "swing district").
Second, there's very little variance in vaccination rates between them as of today...with two weird exceptions: Barnstable and Dukes/Nantucket...in which, according to the CDC, only 4% and 2% of residents have been vaccinated to date, which makes zero sense whatsoever.
I know that Dukes & Nantucket are often merged for purposes of county-level data, and have a far lower combined population than the rest of the state, so I assume there's some unusual "county classification" going on there, or that the residents are reported as residing elsewhere or something. I don't know what the deal is with Barnstable, however.
Combine this with the unusually high "unknown" vaccination rate (no other state I've seen so far has had more than half as many in that category) and I'm not sure what to make of Massachusetts.
Massachusetts Health Connector and member carriers agree to carry over out-of-pocket costs for mid-year moves to access new lower premiums on-exchange
Agreement allows carrier members to access to lower Health Connector premiums as a result of the American Rescue Plan without resetting deductibles in 2021
May 20, 2021 – All nine health insurance carriers who participate in the Massachusetts Health Connector have agreed to let their off-exchange members move from an off-exchange plan to an exchange-based plan mid-year without losing spent out-of-pocket costs in 2021. This flexibility can help Massachusetts residents access new lower-cost plans through the Health Connector.
Massachusetts Health Connector to Provide New, Additional Financial Help for Health Insurance Premiums
Extended enrollment to run through July 23 to maximize opportunity for residents to gain access to new premium support
March 23, 2021 – The Massachusetts Health Connector will be able to provide hundreds of thousands of people with new and increased help paying for their health insurance premiums as a result of the recently enacted American Rescue Plan, starting for May coverage.
The new law will make federal premium subsidies, known as Advance Premium Tax Credits, more generous in two ways: It will increase them for many of the Massachusetts residents who already receive them, and it will make federal premium subsidies available to more people who have never qualified before.
Huh...this is interesting. I noted a few weeks back that the Massachusetts Health Connector reported 11% fewer people had enrolled in Qualifying Health Plans (QHPs) for 2021 as of mid-January than they had during the 2020 Open Enrollment Period. At the time, they were running about 6% behind year over year, and attributed the enrollment drop (the first in the MA Health Connector's history since the first Open Enrollment Period back in 2013-2014) primarily to Medicaid enrollment:
Lower membership is primarily the result of decreased new enrollments rather than termination of existing members, likely due to Medicaid protections associated with the federal public health emergency.
February 3, 2021 – The Massachusetts Health Connector announced today a further extension of its Open Enrollment through May 23, providing residents impacted by COVID-19 the opportunity to get access to affordable, comprehensive health insurance.
The Health Connector previously announced an extension of Open Enrollment through March 23, two additional months beyond the original Jan. 23 deadline. Open Enrollment started Nov. 1, and the new deadline of May 23 aligns the Massachusetts health insurance exchange with the new open enrollment period for the federal exchange platform, healthcare.gov, which reopens Feb. 15 and remains open through May 15, and will be accompanied by a national marketing and awareness campaign.
January 22, 2021 – The Massachusetts Health Connector announced today it is continuing Open Enrollment until March 23, providing additional time for state residents to access affordable, quality health insurance, particularly those hurt by the economic impacts of COVID-19.
With Massachusetts just having become the 3rd state where COVID-19 has killed more than 1 out of 500 residents, this isn't surprising (New York announced an Open Enrollment extension thru the end of March yesterday; New Jersey is still set to end theirs as of January 31st as of this writing Maryland, where COVID has "only" killed 1 out of 900, is extending theirs thru March 15th).
With Open Enrollment ongoing, Massachusetts residents who do not have health insurance have a new opportunity to get coverage through the Health Connector. This includes commercial plans through the ConnectorCare program, which provides help paying monthly premiums, and also offers low co-pays and no deductibles.
As a reminder, "effectuations" have paid the first month premium and are good to go. Plan selections still need payment to start.
As I noted at the time, MA is one of just two states (the other is Rhode Island) which handles premium payments internally, which means they can easily track not just how many people have enrolled but how many have actually made their payments.
Yesterday I requested and received an update six weeks later, and was surprised to see the total number drop slightly:
It's turned into an annual tradition: The official annual ACA Open Enrollment Period (OEP) runs from November 1st - December 15th, but most of the state-based ACA exchanges have later deadlines. hThen, right around the 12/15 point, it begins: One by one, some of the state-based exchanges announce further extensions of their deadlines to #GetCovered for the upcoming year.
In some cases they simply bump out the deadline for coverage starting in January, with the final "hard" deadline for February or March coverage staying where it is. In other cases they were never allowing Open Enrollment start dates past January to begin with, so it's the hard deadline which is being extended.
In any event, here's this year's batch of announcements; note that this list could grow longer over the next week or two:
The Massachusetts Health Connector (MA's ACA exchange) doesn't generally post official enrollment data reports via press releases, but I have a contact there who sends me their latest numbers from time to time during Open Enrollment:
Here's where we are at, currently:
January effectuations: 275,003
Feb. and March effectuations: 5
Plan Selections: 9,143
Total enrollments: 284,151
As a reminder, "effectuations" have paid the first month premium and are good to go. Plan selections still need payment to start.
Massachusetts is a bit unique among the ACA exchanges--they, along with Rhode Island, are the only ones which handle premium payments as well as policy enrollments. This means that they don't just track how many people select policies, they also know how many of those who enroll have actually paid their monthly premiums.
