Vermont

I haven't written much about the recent announcement by Vermont's governor that after years of pushing a single payer plan for the state, he's basically pulled the plug on it (at least for the time being). I noted the announcement but didn't have much to add myself.

Part of this is because I'm swamped with the actual ACA open enrollment itself, of course. Part of it is because it's too depressing a development for me to really think about right now. Part of it is because others far more knowledgeable than I am have much more to say about it.

One such person is Vox's Sarah Kliff, and she's written a fairly definitive explanation of what went wrong. The short version: Vermont's tax base is too small to support the initial costs, even if it would save gobs of money in the longer term.

In Vermont, this is massive: the state only raises $2.7 billion in taxes a year for every program it funds. Early estimates said that Vermont's single-payer plan might need $1.6 billion in additional funds — a huge lift. But $2.5 billion was impossible.

OK, strictly speaking this isn't directly ACA-related, but come on...

Shumlin: "The time is not right"

Vermont has long had a two-pronged approach to building a single-payer health care system. First, they would figure out what they would want the system to look like. Then, they would figure out how to pay for it.

The state passed legislation outlining how the single-payer system would work in 2011. And ever since, the state has been trying to figure out how to pay for a system that covers everybody. Most estimates suggest that the single payer system would cost $2 billion each year. For a state that only collects $2.7 billion in revenue, that is a large sum of money.

What Shumlin appears to be saying today is that the "time is not right" to move forward on the financing of the single-payer system. And that means putting the whole effort aside, with no clear moment when the debate would be reopened.

Ouch.

Thanks to Morgan True for the link to this PowerPoint report which explains why VT is pulling the plug on their ambitious Single Payer attempt:

As you can see from the graphic I posted yesterday (and had to revise several times throughout the day), the official enrollment deadline for private policies starting on January 1st, 2015 has now passed for all 37 states operating via HealthCare.Gov, as well as residents of DC, Hawaii and Kentucky. It's certainly possible that any or all of these will announce some sort of "special circumstances" allowance for those who didn't make the midnight cut-off (10pm in Alaska), but I'm assuming those would be done strictly on a case-by-case basis.

OK, so what about the remaining 11 states?

Well, 4 of them (MD, MA, RI & WA) had later deadlines for January coverage all along: Maryland on 12/18 (Thursday) and the other 3 on 12/23 (next Tuesday).

New York and Idaho bumped their deadlines out from yesterday until 12/20 (Saturday), although Idaho had previously claimed that their deadline was 12/23, but are now claiming that it was originally 12/15. I still don't understand what happened there, but so be it: 12/20 it is for ID.

Earlier today Connecticut and Minnesota announced deadline extensions; now CoveredCA has done so as well...

California’s health insurance exchange extended its deadline for consumers wanting Obamacare coverage in effect by Jan. 1.

Peter Lee, executive director of Covered California, said people who start the application process or make some “good faith effort” by Monday will have until Dec. 21 to finish signing up. Monday at midnight had previously been the hard deadline.

“We are providing this window to get people across the finish line,” Lee said at an exchange board meeting Monday. “We know many of the people applying have never had insurance before, and these are individuals who need to sit down and talk with someone.”

Lee said many insurance agents and enrollment counselors were already fully booked with applicants Monday. He said the deadline extension will allow people to make appointments through Dec. 21.

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Thursday, December 11, 2014.

Renewals: 21,788 individuals have been checked out into 2015 health plans.

New to Vermont Health Connect: 4,079 individuals have been checked out into 2015 health plans.

OK, so that's 25,867 total so far...of which 84% are renewals vs. 16% new enrollments.

I also can't resist including this rather, um, creative graphic representation of the numbers that the Vermont exchange has come up with:

This Just In, directly from the VT exchange...

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Wednesday, December 3, 2014.

Renewals: 15,595 individuals have been checked out into 2015 health plans (out of 38,704 in the renewal pool).

New to Vermont Health Connect: 2,140 individuals have been checked out into 2015 health plans.

Additional Notes:

The last update I had for Vermont listed "over 3,000" QHP renewals in the first 5 days, but didn't include any new enrollee data.

Today I've been informed that the renewal number reached 4,415 as of 11/23, plus another 3,588 new applications. It was also specified that an "application" represents a household, not the total number of covered lives for whatever policy is eventually enrolled in.

Assuming an average of 1.8 people per household, and further assuming that roughly 50% of those who apply had also already selected a plan as of the date in question (this has been a consistent rule of thumb based on the Massachusetts data to date), that suggests that those applications represent roughly 6,400 actual people, and roughly 3,200 of them should have already selected their plans. Knocking 100 off in the interest of caution gives roughly 3,100 new enrollments on top of the 4,415 confirmed renewals, or around 7,500 total enrollments as of the 23rd.

Yes, these are renewals, but this is still extremely impressive, especially seeing how the number has doubled since Monday night:

A new open enrollment period began Saturday, and since then the system has taken in more than 600 new applications and processed more than 3,000 renewals of existing policies.

Vermont Health Connect spokesman Sean Sheehan says the system's performance hasn't been flawless, but he described its improvement over last year as like night and day.

I'm not sure whether the 306 "new coverage applications" refer to actual enrollments or not; going by my own post yesterday, I'll assume not until I hear confirmation otherwise:

The exchange processed 32 new coverage applications by 11:30 a.m., officials reported. By the close of business Monday, that number climbed to 306.

“We have not had any problems reported today,” said Lawrence Miller, chief of Health Care Reform, on Sunday.

...The exchange processed 1,515 renewals as of Monday evening. Those are a mix of people who submitted changes early and those being automatically reenrolled in their current plans.

For comparison, last year Vermont only had 38,000 QHP enrollees total.

Update: I've confirmed that, as I suspected, the 306 "new applications" are just that, not necessarily actual enrollments.

OK, the numbers are small, but it's a start--and the fact that both are being released by states which had horrible technical issues last year is quite telling:

VERMONT: 201 in first 8 hours: 

Vermont Health Connect processed 50 new applications and 201 renewals by Saturday at 1 p.m. The exchange was working well with some isolated minor issues in the morning that were quickly resolved, he said.

MASSACHUSETTS: 1,704 in first day:

#ACA coverage update: 2,660 enrolled in @MassHealth; 3,307 eligible for @HealthConnector coverage with 1,704 plans selected. Total: 5,967

— MA Health Connector (@HealthConnector) November 16, 2014

An hour or so ago I posted this tweet from HuffPost's Jeffrey Young, who writes:

HealthCare.Gov processed 23,000 completed applications during the first eight hours, @SecBurwell says. pic.twitter.com/COAJpKFftV

— Jeffrey Young (@JeffYoung) November 15, 2014

Unfortunately, I'm not sure whether "processed completed applications" means actual enrollments or just accounts created. Presumably HHS will provide better clarity on this sort of language (and quickly) going forward. Plus, of course, a single policy enrollment could have 2, 3 or more people in a household.

However, I'm happy to report the very first official enrollment update is also already available, and it's out of Vermont, one of the states with a highly-troubled exchange last time around!

Hold on to your hats, here it is:

VT Digger, September 16:

The Vermont Health Connect website went down Monday night and will remain offline for several weeks to allow for improvements to the user experience and data security, state officials said Tuesday.

Customers who need to report changes in income or make changes to their coverage or personal information will need to contact the customer service call center.

Vermont Governor Shumlin, November 7th:

Gov. Peter Shumlin is “hopeful” that Vermont’s health care exchange website will be online in time for the open enrollment period that begins Nov. 15. But he didn’t sound certain Friday that his team will make the deadline.

“I’ve been discouraged so many times by this website that I’ll believe it when I see it,” Shumlin said on Vermont Edition Friday. “What I’ve been told by my folks who are working really hard on this is that we’ll be ready for open enrollment on Nov. 15.”

VERMONT: Federal Law Raises Questions About Who Can Bid For IT Projects That Support The Exchange

A provision of the Affordable Care Act precluding health insurers or companies in the “same controlled group of corporations” as a health insurer from holding exchange contracts raises questions about Optum working on Vermont Health Connect.

Concerns regarding Optum were raised at the federal level by Sens. Orrin Hatch, R-Utah, and Chuck Grassley, R-Iowa, the ranking members of the Finance and Judiciary committees respectively.

IDAHO: Your Health Idaho to launch sign-up system

Basically just an overview of the new Idaho ACA exchange; ID is the only state moving from HC.gov to their own website for the 2nd year, giving them a unique perspective. Most interesting to me is that they're spinning the "autonomy/states-rights" angle, which was the whole reason for pushing states to set up their own exchanges in the first place:

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.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

ILLINOIS: Clock Ticking For Illinois To Form State-Run Obamacare Exchange

Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help.

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