Vermont

Once toothless, Cover Oregon board tackles an uncertain future

...After taking political heat for the exchange's technological failure, the appointees of Gov. John Kitzhaber are taking on a more significant role, transforming the agency for the future. At a time when critics of the agency say it should go away, it's the bureaucratic equivalent of an existential moment for an agency considered crucial to federal health reforms.

... The state's planned 2015 partnership with the federal exchange is called a "supported state-based" exchange. But it's supposed to be a temporary fix before setting up a full-fledged state-based exchange. It allows Oregon to keep insurer fees of about 2.5 percent of premiums for itself until the state resurrects its own website.

Vermont Health Connect shakes up practices, adds personnel

OK, the Medicaid number is a bit squirrelly since it isn't broken out by expansion/woodworkers/churn; the official number as of 4/19 was 27,268, so I'm estimating it at an even 30K.

Otherwise, the QHP total is for paid enrollees, up from 27,221, and the SHOP number is up from 33,614.

Vermont Health Connect has helped 144,500 Vermonters get health coverage. More than half, 80,400, were enrolled in Medicaid, many as a result of the program’s expansion under the Affordable Care Act.

However, the website was launched with significant problems, and eight months later it is still incomplete. State officials said this week that they will continue to rely on the two participating insurance carriers to enroll small businesses throughout the upcoming open enrollment period that begins Nov. 15. There are currently 34,800 people in that group.

There are also 29,300 people in the individual market who purchased commercial insurance. More than half, 62 percent, qualified for subsidies that lower the cost of those plans, though advocates say they are often still difficult to afford.

As I noted yesterday, there are three states which had unusually large discrepancies between the official HHS and state exchange QHP enrollments:

  • New York came in over 65,000 lower than the number I had for a simple reason: The New York exchange lumps enrollees in their Child Health Plus program in with QHPs, even though technically this isn't a QHP program. There were over 40,000 of these as of the end of February; this number has climbed to 65,028 as of 4/19.
    Since Child Health Plus is privately funded (and therefore isn't on the Medicaid/CHIP side), but also isn't officially a QHP either according to HHS, I've moved it over to the "Off Exchange QHP" column.

Latest Vermont Health Connect stats

• 52,156: Vermonters who used the Vermont Health Connect website, call center or navigators to shop for 2013 health insurance and now have coverage.

• 24,888: Vermonters who purchased commercial coverage through Vermont Health Connect.

• 27,268: Vermonters who shopped on Vermont Health Connect but qualified and are now enrolled in Medicaid. Eligibility expanded under the federal Affordable Care Act.

• 33,549: Vermonters previously covered by the Vermont Health Access Program and Catamount Health who the state enrolled automatically in Medicaid based on income information on record.

OK, looks like I completely misunderstood the Vermont figures from a few days ago; half of them were supposed to go on the Medicaid side after all. From a source at the Vermont Health Connector:

In the meantime, I can provide the enrollment figures: 48,150 are fully enrolled in a plan through Vermont Health Connect; 25,930 of those enrolled in Medicaid or Dr. Dynasaur, our CHIP program.

Doesn't impact the overall national total, but it does change the dynamic for Vermont to something...rational (prior to this it looked like they had hit a whopping 585% of their year 1 target!

This means 22,220 QHPs and 25,930 Medicaid.

OK, in addition to the appx. 7.041 million enrollments on the Federal exchange (HC.gov), I've brought CO, CT, DC, HI, KY, MD, MN, NY, RI and WA completely up to date, with all QHP data through midnight on 3/31 (some of the Medicaid/CHIP data is still missing, but that's a lesser concern at the moment).

However, I'm still missing the following exchange QHP data:

  • California: 22 hours (that's right...the current tally runs thru 2am on 3/31)
  • Massachusetts: 3 days (current is thru 3/28)
  • Nevada: 2 days (current is thru 3/29)
  • Oregon: 3 days (current is thru 3/28)
  • Vermont: 1 day (current is thru 3/30)

I can't tell you how frustrating it is to be this close to full data while still missing it.

So, how much is actually missing? Well, if these states were running at their prior average March daily rate, it would be

  • CA: 11,754
  • MA: 512 x 3 = 1,536
  • NV: 427 x 2 = 854
  • OR: 502 x 3 = 1,506
  • VT: 775
  • Total: 16,425

However, this obviously doesn't apply since the final weekend and especially yesterday were insane.

Vermont's numbers can be a bit squirrelly, but in this case they're very specific about 46.8K being exchange QHPs (VT doesn't allow off-exchange enrollments anyway, and the the 30-40K figure is the same from the last update).

As of Monday morning, 46,800 individuals had enrolled to be covered with private insurance either from Blue Cross Blue Shield of Vermont or MVP Health Care. An additional 30,000 to 40,000 people were enrolled through their employers, Yahr said. The federal target enrollment was 56,000 by Monday.

If that's not a typo or a misunderstanding on my part, it means that Vermont has just skyrocketed to 4.5x their February enrollment rate.

OK, after all of today's excitement it's back to the state-by-state grind...

More than 55,000 Vermonters have picked a health plan through Vermont Health Connect since open enrollment began in October and more than 43,000 are fully enrolled in new coverage. That means roughly 12,000 Vermonters have yet to pay their first premium or are having problems completing the process.

Contributor deaconblues has done the math for me this time, which I appreciate since my brain is fried today:

I know Vermont is a tricky beast, but this article specifically says 55K through the Vermont Health Connector (no bulk transfers or SHOP)

The current numbers on the spreadsheet say:

  • QHP: 28,950 (18,507 paid + 10,443 unpaid)
  • Medicaid: 21,525
  • Total: 50,475

This would imply they've newly added about 4,500. If you prorate the 55K across QHP and Medicaid (58/42), and use the paid QHP as a "hard number", you get

  • QHP: 31,900 (19,900 paid + 12,000 unpaid)
  • Medicaid: 23,100

This looks right to me, so there you go.

OK, the cutesy title is kind of a misnomer; my two previous entries didn't use that title originally...but they should have, and do now.

March 31st is supposed to be the final day to enroll in QHPs via the exchanges...but it's looking more and more as though that won't quite be the case in not two, not three...but possibly up to seven states now, including a couple whose websites have been working smooth as silk??

On March 7th I pointed out that due to Massachusetts having some 154,000 people stuck in health insurance limbo, they've been granted some sort of temporary extension, twice...out to as far as June 30th in some cases...

GAH!! OK, earlier today I read two conflicting stories about the Vermont enrollment situation. My conclusion was that the correct numbers were:

  • 18,507 Private QHPs (Paid) / 11,656 Private QHPs (Unpaid)
  • 20,312 Medicaid (Manual enrollment) / 33,549 Medicaid (Auto-Transfers)

However, I've had a chance to look at the actual VT exchange presentation, and it looks like I was partially correct. The actual numbers are as follows (bold-faced are corrected):

Vermont's method of enrolling people has always confused me.

There are 36,846 Vermonters who have enrolled in health coverage, 33,549 who were automatically transitioned to Medicaid and 30,000 to 40,000 in the small-group market who were enrolled directly by the insurance carriers participating in the exchange.

A second article, from the Burlington Free Press, confuses things because it says the 36.8K are households, representing 50.4K people:

a state official reported to lawmakers Tuesday that 36,846 households had signed up for 2014 plans....

Larson’s presentation Tuesday showed that 50,475 individuals applied for coverage using Vermont Health Connect between Oct. 1 and March 17. A significant number of these applicants, 20,312, found they qualified for Medicaid, which has expanded eligibility this year.

Earlier today, contributor Esther Ferington brought an old New York Times article from last October to my attention. The article is actually about off-exchange enrollments as an option to using the exchanges, but the opening line of the story includes an interesting snippet:

WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites.

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

Vermont continues to have impressive enrollment numbers (relative to their population size) despite their ongoing technical problems, partly due to an aggressive SHOP/Small Business enrollment program. Private QHPs have somehow more than doubled from 13,514 paid / 3,392 unpaid as of 2/10 up to 28,486 paid / 4,805 unpaid as of February 25th.

Meanwhile, the SHOP enrollment numbers are also impressive, jumping from 29,200 at the beginning of the year up to 40,000 as of 2/25.

In addition, the article claims that the 28.4K figure only represents policies, not people, which suggests that the actual number of individuals could be as many as 51,200, but I'm already finding it difficult to believe that they've managed to go from 13.5K to 28.4K in just 2 weeks in the first place, so I'm holding off on that factor for now.

The latest figures from the Department of Vermont Health Access, presented to lawmakers Wednesday, show 33,291 individuals have selected a plan and 28,486 are fully enrolled...

Until now, aside from the official monthly HHS reports, Vermont's enrollment data has been frustrating--not that it hasn't been available, it's just been released in confusing dollops (Massachusetts falls into the same category). Today, however, the Vermont Health Connect exchange released a detailed PDF that does a great job of answering the key questions--along with one bit of data I haven't seen for any other state so far: The breakdown not only of total Private QHP enrollments, but how many of these started in January, February and (upcoming) March.

Page 6 has the key data: A total of 16,906 QHP enrollees as of 2/10, of whom 13,514 are paid up. Overall, this points to an 80% paid rate, which is very good--but the monthly breakout is even more interesting: January-start enrollees have a 92% paid rate (which you'd certainly hope for by now, considering that we're into mid-February) and February-start enrollees are at 79% paid. The March-start enrollees (14%) are the ones providing the main drag on the total...but this is hardly shocking since the start date for that coverage is still over 2 weeks away.

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