New York

Among the various provisions of the Affordable Care Act, the one which intrigued me the most was the creation of 23 "Consumer Operated and Oriented Plans", or "CO-OPs". The idea was to create non-profit quasi-public/private healthcare insurance organizations (similar in nature, I believe, to Credit Unions, except for health insurance), to compete with the private, profit-based insurance providers.

Unfortunately, as the Office of the Inspector General noted in a July report (in huge font size for some reason), after two Open Enrollment periods have come and gone, the ACA CO-OPs aren't doing very well for the most part, to put it mildly.

One of them, CoOportunity of Iowa and Nebraska, infamously melted down before the 2nd OE period was even halfway done.

After yesterday's ugly news about Alaska's private policy rate hikes, this is welcome relief:

Judge says Alaska Medicaid expansion can go ahead Tuesday

An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.

In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.

The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.

Not such great news in Nevada, however:

Nevada Health Co-Op to close, leaving thousands to find new insurance

Just 2 days ago I posted an analysis of the New York individual market rate increase requests for 2016. My takeaway was that the weighted average requested was 10.0%, with the usual caveats about rounding errors, estimates of the total individual market size and so forth. Plus, of course, these were just requested increases, not final ones.

Today, the NY Dept. of Financial Services has made most of my number-crunching announcing that they've already completed reviewing the requests and have knocked them down several points:


Individual Rates for 2016 Remain Nearly 50% Lower than Before Establishment of New York’s Health Exchange
DFS Rate Reduction Actions Will Save Consumers More than $430 million
New Essential Plan Will Lower Premiums to $20 or Less and Provide Better Benefits for Lower-income New Yorkers

Earlier today I posted about a mountain of data being released by the New York State of Health ACA exchange, including, among many other data points, the rough market share breakdown of the 19 insurance carriers operating on the exchange this year, like so:

  • Fidelis Care: 20%
  • Health Republic: 19%
  • Healthfirst: 10%
  • Empire BCBS: 10%
  • MetroPlus: 7%
  • MVP: 6%
  • Emblem: 6%
  • Oscar: 5%
  • Affinity: 5%
  • Excellus BCBS: 4%
  • UnitedHealthcare: 2%
  • North Shore: 2%
  • BCBS West. NY: 1%
  • CDPHP: 1%
  • Independent: 1%
  • Univera: <1%
  • Wellcare of NY: <1%
  • Empire BC (Upstate): <1%
  • BlueShield of NE NY: <1%

The New York State of Health (NY's ACA exchange) just released detailed numbers from the 2015 Open Enrollment Period.

Unfortunately, the data gets cut off as of 2/28/15, so this doesn't give any insight into the attrition rate since then (or a precise count of how many additional people enrolled during the #ACATaxTime special enrollment period which followed). However, it does give a lot of detailed analysis of the open enrollment period numbers, and does tack on an extra week's worth of private enrollments & 2 week's worth of CH+/Medicaid numbers (the official HHS report only ran through 2/21 for New York and the last press release with CH+/Medicaid numbers was as of 2/15).

As a result, the official numbers are slightly higher than what I had until now across the board:

Huh. This is kind of weird...two completely different stories, from two different reporters (although both are via the Associated Press) about the latest Medicaid expansion numbers from two of the largest states at opposite ends of the country: California and New York.

This wouldn't be surprising if there had been a major report/press release regarding Medicaid enrollment nationally broken out by state, of course, but as far as I know there hasn't been (the last report from CMS came out in early June, only runs through March and doesn't distinguish between "traditional" and "expanded" Medicaid anyway).

In any event, I'm happy to report that the numbers actually line up pretty closely with what I already had estimated for each state:

Over the past couple of weeks, I've posted a bunch of entries both here and over at about not freaking out when you see "OMG!!! MASSIVE OBAMACARE RATE HIKES NEXT YEAR WE'RE ALL GONNA DIIIIIIIIE!!!"-style headlines such as this giant one from CNN Money:

The angle being played is emphasized right off the bat with the big, scary-looking graphic above the story:

Even the sub-headline pushes the hair-on-fire meme:

After one botched vote, two years and an all-out resistance blitz by the Koch Bros and their ilk which was so obnoxious that they managed to alienate local Republicans, the Medicaid expansion provision of the Affordable Care Act has finally officially passed both the state House and Senate of Montana, and should be signed into law by the Democratic governor any moment now.

HELENA (AP) – The state Legislature has passed a bill expanding Medicaid eligibility to about 70,000 low-income Montana residents.

The bill approved Saturday heads to Gov. Steve Bullock, who is expected to sign it into law.

Now that the King v. Burwell Supreme Court oral arguments are out of the way (with radio silence expected until they announce the decision sometime in June) , the next Big Development to keep an eye on ACA-wise is...Tax Season! There will be plenty of stories about how many people have to pay back some/all of their 2014 tax credits, how many will receive additional tax credits...and, most germane to this site, how many additional people enroll via the exchanges to avoid having to pay (most) of the higher tax penalty next year for not being covered in 2015 during the Tax Filing Season Special Enrollment Period (SEP), or #ACATaxTime as I prefer to call it.

Once the ball started rolling on #ACAOvertime extension periods, there was no stopping it; within a few days, all 50 states (+DC) had announced either full or "waiting in line" enrollment extension periods.

The same thing seems to be happening with additional "Tax Season" enrollment periods for people who didn't realize they owed/will owe a tax penalty for not having proper health insurance coverage. Washington was the first to make their announcement; Minnesota and Vermont quickly followed; this morning Healthcare.Gov (which covers 37 states) made it official; a few hours ago, California joined the club, and just now, New York chimed in:

Busy day! New York has issued their enrollment update:

Press Release: NY State of Health Ends Second Open Enrollment with More Than 2.1 Million Enrollees

Feb 18, 2015

ALBANY, N.Y. (February 18, 2015)—New York State of Health, the state’s official health plan Marketplace, today announced that more than 2.1 million people signed up for health insurance by the end of the second open enrollment period, which began on November 15, 2014 and ended on February 15, 2015. Eighty-eight percent of Marketplace enrollees reported that they were uninsured at the time they enrolled. New Yorkers who have enrolled in coverage through the Marketplace have overwhelmingly reported that they are satisfied with their health insurance (92 percent) and are using their coverage to access care (84 percent).

I've confirmed that Rhode Island's weather-induced enrollment extension is indeed state-wide and is of the "full" variety (ie, people can start the application process, not just finish it), through February 23rd. This is exactly the same policy that the Massachusetts exchange announced the other day.

Also, a late-breaking extension announced from Maryland.

11:45pm: OK, add the DC exchange to the pile.

9:00am 2/16/15: OK, HHS/CMS has clarified the specifics for the 37 Healthcare.Gov states.

11:50am 2/16/15: Idaho's policy took some work to decipher...

2:24pm 2/16/15: ...and Minnesota...

And so, the Open Enrollment Period extensions are officially underway. I was expecting underperforming states like Washington and Minnesota to be the first out of the gate, but instead, the first three states to make formal announcements are California, Massachusetts and now, New York:

  • California: Yesterday, CoveredCA announced a 5-day "Waiting in Line" extension policy (ie, as long as you've started the enrollment process as of midnight on Sunday 2/15, you'll have until Friday, 2/20 to complete the process.
  • Massachusetts: Just a few hours ago, the MA Health Connector announced that due to getting slammed with 3 massive snowstorms in the past few weeks, as well as a 4th major one sweeping in right now, they're bumping out the full enrollment period (ie, no "have to be in line already" caveat) by a full 8 days, until February 23rd.
  • And just this moment, the New York State of Health has announced that like California, they're going the "Waiting in Line" route: Anyone who starts the process by midnight Sunday will have until February 28th to actually select a plan and check out. It's important to note that NY residents who enroll between 2/16 - 2/28 won't have their policy kick in until April 1st, however.

So, who'll be next? Anyone? Anyone? Bueller??

Huge enrollment news day--this is unexpected but welcome on top of the report:

Press Release: Governor Cuomo Announces NY State of Health Hits Benchmark of Two Million Enrollees

Governor Andrew M. Cuomo today announced that the New York State of Health (NYSOH) Marketplace has enrolled more than two million New Yorkers in affordable health insurance coverage. This is the latest record enrollment for New York’s health exchange, and 89 percent of enrollees have reported that they had no coverage at the time they joined the Marketplace. New Yorkers who have enrolled in coverage through the Marketplace have overwhelmingly reported that they are satisfied with their health insurance (92 percent) and are using their coverage to access care (84 percent).

Latest enrollment breakdown:

· Total cumulative enrollment: 2,004,827
· Total Medicaid enrollment: 1,491,859
· Total private coverage: 512,968

· Total new 2015 enrollment: 429,972
· Total new 2015 Medicaid enrollment: 297,423
· Total new private coverage: 132,549
· Renewal rate in private coverage: 85 percent

Yesterday, Peter Lee of Covered California held a phone press conference in which he gave out updated data for new QHP enrollments (bringing the total up to over 217K), but refused to give out any numbers whatsoever when it comes to renewals / re-enrollments of 2014 enrollees...whether these were done actively by the enrollee or automatically by the system.

Needless to say, I was pretty irritated by this and wrote a cranky screed about it.

Just now, I've learned that the other major state exchange missing data--New York State of Health--has apparently stated that not only are they not giving out their renewal/re-enrollment data either, they aren't even going to give out any new updates until February 1st: