Nevada

I addressed Nevada's apparent attrition rate about a month and a half ago. At the time, it appeared to be a fairly ugly 7.7% per month...relative to the "high water mark" of paid enrollments they had achieved in July of around 38,000.

However, since then I've realized that given the high amount of churn during the off-season as people enter and leave the marketplace, a far more accurate measure is the number of current enrollees relative to the April tally, since that was the "8.02 Million Total / 7.06 Million Paid" figure that everyone was focusing on anyway. Doing it this way is also far more consistent, since there's a hard 4/19 number to compare against for every state instead of it being all over the map.

In the case of Nevada, I've just received word that the current number of people enrolled in exchange QHPs is exactly 32,460 as of mid-October.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

COLORADO: Exchange COO joins exodus, new system late

Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.

And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins.

VIRGINIA: Funds to help Va. health care coverage signups

Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance.

Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15.

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

Three important pieces of information about Nevada's exchange out of this article:

1. NV's move to HC.gov will be permanent. The original plan was to only move to the federal exchange for 2015, then moving back to their own (2nd attempt) platform for 2016, which frankly always sounded a bit silly to me. There were lots of reasons for the states to run their own exchanges originally (federal cash to do so, autonomy/local control, etc.), but the federal funding will have dried up by then, and if everything is running smoothly at HC.gov, I'm not sure I see the point in uprooting the whole system at that point. Frankly, there's really only one major reason I could see to move back to their own platform, but...

2. While NV will be using the HC.gov software platform, they'll still legally be considered a state-run exchange, which means that they're safe from any potential SCOTUS Halbig/King fallout. This is basically the entire point I was making way back on July 2nd with my "Domain and a Splashpage" solution.

Whoops...found even more slightly-outdated ACA-related articles worth noting...

OREGON: Cover Oregon officials hope to repair broken state health insurance exchange for 2016

For those who assume Cover Oregon will go away when the federal government takes overthe state exchange's job of enrolling people in health coverage, think again.

Even as Oregon works on hooking up to the federal website by November, some Cover Oregon board members hope the engagement with Uncle Sam will be only a one-year affair.

I found one quote in particular to be a bit of an eyebrow-raiser:

But the idea is controversial on both sides of the political aisle in Salem.

"Hell, no," says Sen. Brian Boquist, R-Dallas. He thinks Oregon should leave the job to the federal exchange and Cover Oregon as a stand-alone agency should go away. "Cover Oregon, the whole structure is bad from beginning to end. I don't trust the federal government. But I do trust the federal government more than I do the state of Oregon."

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 hits:

HEALTHCARE.GOV: Lack of Back End Software for Federal Exchange

One of the big news stories in 2013 and early 2014 was the botched launch of the federal Exchange (and several key state Exchanges), which led to many Americans having to wait to be enrolled in an ACA-sanctioned health plan.  Although some technical snafus have been addressed, many still remain.  For example, a top White House official told Congress recently that the automated system to send payments to insurance companies is still under development, and didn't offer a completion date. The lack of an electronic verification process is only one part of the "backend" of the software that is still problematic five years after the Act was passed.

NEVADA: After health care debacle, Gov. Brian Sandoval reluctantly extends Nevada’s ties with Xerox

Hmmmm...ok, yesterday I reported that "over 37,000" Nevadans had fully enrolled & paid for QHPs to date, based on a story in the Las Vegas Sun. Today, a similar story over at KTNV (ABC Channel 13) gives the estimated number as 38,000, about 900 higher than the 38.1K I figured yesterday. Everything else is pretty much the same.

The couple is among an estimated 38,000 Nevadans who purchased plans through the health link website but will have to re-enroll between Nov. 15 and Feb. 15 because of the state's switch from Xerox to the healthcare.gov.

There hasn't been a real QHP update out of Nevada since they shut down their extension-of-an-extension period at the end of May.At the time, their total enrollment figure was still stuck at 47,245, but their paid number had inched up to an unimpressive 35,700 people.

Today, some 2 months later, it looks like that number still isn't all that impressive (I'm assuming "more than 37K" is around 37,100). Adding insult to injury, all of them will have to re-enroll via HC.gov, although to be honest I kind of figured as much; I'd be very surprised if Oregon isn't facing the same issue, and as I've already noted, it's probably a good idea to have everyone re-enroll anyway just to make sure that they aren't surprised by changes in their tax subsidies:

More than 37,000 Nevadans who signed up for health care plans on the state’s insurance exchange will have to do so again.

The decision is the latest in a series of ongoing changes at the exchange as it tries to recover from a tumultuous first year of signing up consumers for plans that comply with the Affordable Care Act.

Three stories which didn't seem worthy of their own full blog entry but each of which are pretty interesting...

Washington State, 06/25/14: Kreidler calls for health insurers to end discrimination based on gender identity

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is asking all health insurers doing business in Washington state to end discrimination in health insurance based on gender identity and related medical conditions.

In a letter sent to health insurers this morning, Kreidler reminded health insurers that exclusions and denials of coverage on the basis of gender identity are against the Washington Law Against Discrimination (RCW 49.60) and the federal Affordable Care Act (Section 1557).

...“Transgender people are entitled to the same access to health care as everyone else,” said Insurance Commissioner Mike Kreidler. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”

Good.

Finally, we have Nevada; while their QHP enrollment was pretty lame, their Medicaid expansion has done quite well. They have an estimated 304,000 people eligible for expansion, of which the state has already enrolled about 27%:

There were 467,000 Medicaid enrollees as of the end of April — 50,000 more than anticipated, said Mike Willden, director of the state Department of Health and Human Services. Of those 83,000 people are newly eligible childless adults who did not previously qualify.

Willden projected Nevada's Medicaid numbers will reach 600,000 by the end of the year.

"That is substantial," he said.

A rather depressing end to Nevada's first open enrollment period. The state pushed their extension period far beyond any other state (most states stopped at 4/15; Oregon's was 4/30...Nevada kicked it out another month beyond that to 5/30), and still didn't come close to either their initial target or even my own "fair share" target of 73,000 QHP enrollees:

About 35,700 consumers have purchased insurance coverage through the program. Enrollment is far less than an initial target of 118,000.

(and yes, that 35,700 figure is paid, not total; the total number stood at 47,245 a couple of weeks ago).

First Oregon told Oracle to go pound sand after paying the company hundreds of millions of dollars for a useless website; now Nevada has officially done the same thing to Xerox:

The Silver State Health Insurance Exchange board voted unanimously Tuesday to end its relationship with Xerox, the vendor contracted in 2012 to build the exchange’s Nevada Health Link website.

In place of Xerox, the exchange will adopt the federal Healthcare.gov exchange’s eligibility and enrollment functions for the sign-up period that begins Nov. 15, though it will keep its status and funding as a state-controlled system. The exchange will also issue a request for proposals to evaluate replacement systems in coming years. A new platform could come from a state with a functional marketplace, or from a vendor with a similar, proven program.

Unlike Massachusetts, which is taking a dual-path approach (they're scrambling to replace their own crappy site with a new one while simultaneously preparing to move over to HC.gov just in case the first plan doesn't pan out in time), Nevada is sort of doing the opposite: They're moving over to HC.gov this year, but reserving the right to try a do-over on their own exchange for 2016 and beyond.

Minor update out of the only state whose ACA exchange is still officially open: QHPs up around 1,400, paid up around 200 since last week:

Update as of 5/10: 47,245 Nevadans confirm Qualified Health Plan selections. 35,034 have paid.

— Nevada Health Link (@NVHealthLink) May 14, 2014

Nevada is the only exchange still officially open for "normal" private QHP enrollments (although of course SHOP, Medicaid, etc. are all year-round). WIth this update, Nevada's paid QHP rate jumps from 71% up to 76% (still not great, but an impressive spike in one week...more the existing enrollees catching up with their payments than new ones being added):

The board overseeing Nevada Health Link was told Thursday that nearly 35,000 people had enrolled in a qualified health plan as of May 3, halfway through a two-month special enrollment period that ends May 30.

Another 11,000 have selected plans but not yet paid for them.

Managers believe they had QHP enrollment information and premium payments for 34,820 residents as of May 3.

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