Two Case Studies of what to look out for in ACA enrollment news stories

A reader brought this article over at The Hill to my attention this morning:

At least 1.1 million people have signed up for healthcare through ObamaCare outside of the federal marketplace, according to a review of state data by The Hill.

That tally is on top of the 2.5 million people who signed up for coverage in the 37 states using the federal exchange, putting ObamaCare on track to outpace its goal for 2015.

I have a confirmed total of just over 3.5 million private policy enrollments via the various exchanges (federal + state) to date, so when I read the first sentences, it made me think "Ah ha! They've been reading and also managed to find at least another 100K policy enrollments that I've missed! I was intrigued. But then...

Out of the 13 states that don’t use the federal exchange, 11 have reported data since Dec. 17 — a total of 1,142,124 sign-ups. Rhode Island and Idaho have not yet reported numbers.

Hmmm...OK, hold the phone. First of all, Rhode Island & Idaho both have reported their enrollment numbers: Over 74K for Idaho and 12K for Rhode Island. Perhaps they've managed to find 186K that I'm missing?

...California alone has reported nearly 600,000 people signing up and says the state is on track to beat its goal of enrolling 1.7 million people during the second year of open enrollment.

Ah. OK, there's the problem. Yes, CA did indeed "nearly 600K people signing up"...except that a) it was 592K, and b) that's how many were determined eligible for either private policies or Medicaid/CHIP. The actual number who have selected a private policy is 144,178, not "nearly 600K". The irony is that it's possible that the true number in CA really is 600K (or 400K, or 800K), because the 144K only refers to new enrollments, not renewals of current enrollees.

The Hill did similar mixing together of different numbers--QHP selections, Medicaid enrollments, determinations, etc--elsewhere in the article, making that "1.1 million" number kind of meaningless.

Here's the good news, however: The actual confirmed numbers as of this writing (ie, not including my estimates or projections) are:

  • Qualified Health Policy (QHP) Selections: 3.50 million (2.46 million via, 1.04 million via the state exchanges)
  • Medicaid/CHIP Enrollments: 803,000 (from just 16 states)
  • Combined Total Confirmed: 4,306,997

In fairness, 212K of these actually are technically "estimates": 144K for CA and 68K for NY; I'm operating on the assumption that there's easily a 1:1 renewal:new correlation in both of these states. Even if you remove these, however, that's still nearly 4.1 million officially confirmed, or 3.3 million if you don't include Medicaid.

I'm not trying to beat up on The Hill here. I actually applaud them for trying to tally up the state-run exchanges; it's important because most news outlets are only reporting the 2.5 million (actually, 2.46 million) QHP selections through the federal exchange reported last week by the HHS Dept...and even then, that only runs through December 12th, so it doesn't include the massive spike over the "deadline weekend". Again, I'm pretty sure that the total number of private plan selections (federal + state exchanges) through 12/15 will end up being around 4.7 million all told, and a good 7.7 million through December 19th (of which around 5.8 million should be through the federal exchange).

The point is that the mainstream media is throwing a lot of numbers around.

  • Some include Medicaid, some don't.
  • Some include the state exchanges, some don't.
  • Some include "applications/determinated eligible", some don't.
  • Some include both new enrollments as well as renewals, some don't.
  • Some are extremely up to date, while others can be a week or more outdated...which can make a big difference.

Again, The Hill deserves credit for calling attention to the state exchange enrollments, and the reports from the various exchanges can be confusing, but people should keep the above in mind when you see an article like this.

UPDATE: Hah! Right after I posted this entry, I spotted a similar story from the Motley Fool website. Again, it's a generally positive towards the ACA; this is not a case of a "hit piece" from NewsMax or the Daily Caller or whatever. Still, the writer makes similar errors with the numbers:

Based on its weekly update, an additional 618,548 people had selected plans during the third week of enrollment (Nov. 29 - Dec. 5), pushing the grand total of plan enrollees to 1,383,683, at least on In other words, Obamacare's impressive milestone is that it did in three weeks what took three months to accomplish in the 2013-2014 period: hit 1 million enrollees.

The numbers here are accurate, and he does specify that it only includes the federal exchange and only runs through the 3rd week...but this story was posted today, so I'm not sure why he didn't include the fourth week HHS report from Tuesday which updated the total to 2.46 million, which is more impressive still. My bigger gripe here is the discussion of the state exchanges:

Similar to the HHS' figures, these include new enrollees and returning members. New York has enrolled roughly 154,000 people, while Washington state has brought in nearly 56,000 enrollees thus far. The surprise? California, the state that led in enrollment last year, has signed up a mere 48,950 people through three weeks, although The Los Angeles Times notesthat 160,000 have signed up for Medi-Cal, the state's Medicaid program.

Well, again, this is mixing numbers together:

  • New York's 154K does include Medicaid but doesn't include "returning members"; they're all newly added (and was updated on Wednesday to 195K anyway).
  • Washington State's 56K is accurate through the 10th; it does indeed include renewals + new additions and doesn't have Medicaid mixed in.
  • However, the 49K in California does not include renewals (and again, has since been updated again to 144K anyway). His error here is reiterated a little farther in the article, when he states:

California's 49,000 enrollees are table scraps compared to the more than 1 million people it signed up in the 2013-2014 period.

Well, yes, that would be true if it included renewals, but it doesn't. Again, I actually appreciate both of these reporters trying to bring attention to the excellent numbers coming in so far; I just wish that they would double-check their data a bit better first.

In actuality, so far, just about every state that I have data for is outperforming my expectations so far (which in turn is already outperforming the HHS Dept's official guidance). The only exception I know of to date is Oregon, but even they aren't doing as badly as some feared they would given the mess last year.