Wyoming

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

With only 584,000 residents, Wyoming is the smallest state, with a population over 10% smaller than even the District of Columbia or Vermont. Last year there were only 2 insurance carriers offering individual policies on the ACA exchange, Blue Cross and WINhealth. The average rate increase for 2016 was right around 10% even.

Unfortunately, WINhealth, a not-for-profit organization which had been around for 20 years, ended up as one of the few NON-Co-ops to go belly up last fall due specifically to Marco Rubio's Risk Corridor Massacre:

WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program .

12 days ago, private Wyoming health insurer WINhealth, in business since 1996, was among the 5 (and counting) victims of the horrific Risk Corridor Massacre, which has already taken the lives of at least 4 ACA-created CO-OP insurers:

WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program .

Just hours ago I posted a lengthy screed about the first clear victim of the Great Risk Corridor Debacle of 2015. In that case, both the culprit (the GOP's insistence on cutting off government funding guarantees for the risk corridor program) as well as the victim (the Kentucky Health CO-OP) both originated with the Affordable Care Act itself.

This time around, however, the victim (well, in addition to its current enrollees) is a private company, albeit a not-for-profit one: WINhealth Partners:

We’re a not-for-profit managed care company founded by professionals, and we’re changing the way that healthcare works for you – because we believe your insurance should help you to be at your best in life.

Wyoming's total individual health insurance market in 2014 was just 27,000 people. While the total market likely increased somewhat this year, those gains are likely offset by perhaps 15% being either "grandfathered" or "transitional" policies.

Just over 18,000 were enrolled in effectuated exchange-based policies as of June 30 of this year, leaving perhaps 9,000 more enrolled in off-exchange plans.

According to Louise Norris of HealthInsurance.org, there's only two companies operating on the exchange in Wyoming this year: WINhealth Partners and BCBS of WY. WINhealth is asking for a 13.37% average rate hike; Blue Cross is asking for an uknown increase...except that it's under 10%.

Well, score one for the Koch brothers:

In December, Tennessee Gov. Bill Haslam, a Republican, got the deal he wanted from the Obama administration: Tennessee would accept more than $1 billion in federal funding to expand Medicaid, as allowed for in the Affordable Care Act, but Obama aides would allow Haslam to essentially write staunchly conservative ideas into the program's rules for the state. He dubbed the reformed Medicaid program "Insure Tennessee."

But the state's chapter of Americans for Prosperity, the national conservative group whose foundation is chaired by controversial billionaire David Koch, argued Haslam was just trying to trick conservatives into implementing Obamacare in their state by giving it a new name. AFP campaigned aggressively Haslam's plans for the next six weeks, even running radio ads blasting GOP state legislators who said they might vote for it.

On Wednesday, Haslam's bill died in a committee of the Tennessee state senate. The vote was one of the clearest illustrations of the increasing power of AFP and other conservative groups funded in part by the Koch brothers.

I've posted a few times before about the ACA Medicaid expansion situation in some deep red states; Tennessee, Utah and Wyoming among them:

Two of the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare.

...Gov. Matt Mead of Wyoming, where Republicans hold 78 of 90 seats in the legislature, acknowledged his opposition to Obamacare but said the statehad to be realistic by embracing Medicaid expansion in one form or another. “I don’t think we can say to those people in Wyoming who are working [and] who cannot get insurance that we’re not going to do anything,” he said.

...While the odds for expansion in Wyoming remain uncertain, Utah seems likely to move in the coming months. There, Gov. Gary Herbert made the case on moral grounds — as a duty to help people he described as “our neighbors, our friends and our family members.”

Alaska:

On the campaign trail, Bill Walker made expanding the state’s Medicaid program under the Affordable Care Act one of his top priorities. He said he could make the decision without input from the state legislature:

“It’s up to the Governor to accept that.”

But when Walker takes office next month, will it really be so easy to expand a program that has been a tough sell in other conservative states?

Medicaid expansion would allow around 40,000 low income Alaskans– mostly childless adults, to receive health benefits. The federal government will pay 100 percent of the program until the end of 2016. After that, the state’s share will slowly increase to 10 percent by 2020. Walker has said the decision is a no-brainer, at least while the federal government is providing full funding.

Wyoming:

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.

A few days ago, news broke that Pennsylvania's Governor Tom Corbett, whose re-election numbers are in the toilet and who is desperate to get Pennsylvanians to like him, has finally agreed to the Medicaid expansion provision in the Affordable Care Act.

While "doing a single decent, human thing after a couple of years of being a jerk about it" shouldn't really count as being praiseworthy, I suppose he deserves at least a small golf clap, just as Michigan Gov. Rick Snyder and Ohio Gov. John Kasich did.

Anyway, next up to bat would appear to be Tennessee Gov. Bill Haslam:

In a move that could mean health coverage for thousands of Tennesseans, Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee's Medicaid program but did not release any new details on how it might work.

Wyoming's QHP enrollments didn't add up to much (understandable given that the entire state only has 576,000 people), but the state insurance commissioner states that around 92% of those who did enroll have paid up so far:

Nearly 12,000 people in Wyoming have enrolled in a plan on the federal marketplace created by the Affordable Care Act, according to the latest data announced Monday at a legislative committee meeting.

About 11,000 of them have begun paying their premiums, Wyoming Insurance Commissioner Tom Hirsig told members of the Joint Labor, Health and Social Services Committee at Casper College.

“I’m surprised, frankly, that there’s this many,” Hirsig said. “I was thinking 7,000 or 8,000.”

The actual number of exchange QHPs in Wyoming is 11,970, so yep, 11K would be about 92% of that.

(To clarify the last statement: Contributor Esther F. also gives a link to another story which clarifies that the "7-8K" quote refers to how many people he thought would enroll, not how many he figured would pay):

OK, no hard numbers here, but how often am I gonna be able to post any sort of update out of Wyoming? Anyway, very encouraging anecdotal/fractional news:

Jackson insurance agent Lisa Reeber said she has also seen the last-minute stampede.

“I’ve been completely overwhelmed,” Reeber said. “I’ve been turning down appointments for a week and a half.

“My goal was 200 applications when I started,” she said, but “it’s been like 450.”

About two-thirds of her recent customers, she said, have been people who came to her with no insurance.

Insurance company WINHealth, one of only two in the state participating, is reporting a similar situation. The company reports it has already exceeded its expected enrollment by 20 percent and is still seeing new clients every day.

“We’ve had a significant increase,” said John Gardner, chief business development officer at WINHealth. “I wouldn’t even hesitate to use the word ‘surge’ in the last 10 days.”

Also be sure to note that line in the middle: 2/3 were not previously insured.

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

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!

Mississippi: Private up to 2,000 from 802 (h/t Steve Mullinax, aka rsmpdx)

Transcript from Jeffrey Hess of Mississippi Public Radio, NPR Audio:

Only two insurance companies are offering plans in Mississippi, and they only overlap in four of the state’s 82 counties. However, those two companies appear to be betting that the web site problems and skepticism about the exchange in general are passing. One of the two companies, Humana, launched a late-December ad campaign to drive more people to the site, says spokesman Mitch Lubitz. “There’s been a ramp-up as the HealthCare.gov web site has gotten easier to use and there have been other options for people to go on and get information and enroll.” Mississipi’s Insurance Commissioner Mike Chaney says the improvements to the enrollment process are good, but he’s still skeptical they’ll be able to get enough people signed up this year. “From zero to ten, I’d give it a confidence level of about a three.” Hess: “That’s still not very good.” Chaney: “That’s not, but it’s better than where I was, a one, a week before last. “Chaney says the unofficial count is around two thousand people enrolled, but he says if the confidence trend continues upward, his confidence will rise to a five.”