Odds 'n Ends


A new competitor entered the Idaho market this year, with a different business model. The Mountain Health CO-OP is Idaho's first Consumer Operated and Oriented Plan - a type of nonprofit organization authorized by the Affordable Care Act and supported with federal seed money.

The co-op's first year in Idaho yielded about 19,000 members by mid-March, with an additional 2,700 who hadn't yet paid their premiums. Most enrolled through the state exchange.

Mountain Health CO-OP expects to charge premiums high enough to allow it to avoid losing money, said spokeswoman Karen Early. "We are trying to have the lowest administrative cost we can," she said. The co-op expects its overhead and profits to be "well under" the 20 percent allowed by the law.

So, that's 21,700 enrollees total for the Mountain Health CO-OP, of which 19K have paid up to date. That's an 87.5% payment rate, which happens to be precisely in between my own 88% overall estimate and the HHS Dept's 87%.

hCentive, the leader in health insurance exchange solutions, announced today that the company will offer state-based health insurance exchange (HIX) marketplaces for “lease”. The lease offers states access to hCentive’s WebInsure™ State Exchange, the same proven HIX technology that powers federal and multiple state marketplaces today “as-a-service”. By leasing the complete solution from hCentive, states can quickly and cost-effectively deploy a federally-approved HIX to serve individuals and small businesses in a more fiscally sustainable way without complex technology implementation or dependence on federal funds. The lease option also allows states to maintain federal subsidies and health coverage for the 2016 Plan Year, regardless of the outcome of the ongoing Supreme Court challenge to the Affordable Care Act (ACA).

hCentive is probably best known for being the company which replaced Massachusett's original, hopelessly broken exchange platform with their brand-new one, which seems to have worked very well for the 2nd open enrollment period. I'm not shilling for them here; I have no idea how honest or easy to work with they are, but the fact remains that they were able to replace MA's mess of a system with a working one within a very tight timeframe (basically 6-7 months from start to finish, as I understand it).

Not to play favorites, the other company to keep an eye out for on this front is Deloitte Consulting, which similarly replaced Maryland's also-broken system with the same platform that Connecticut's successful one is based on.

So, if any states are seriously interested in getting ahead of this June's King v. Burwell Supreme Court decision, now is the time to act; the clock is ticking...

A massive expansion of insurance programs like Medicaid and a drop in emergency room visits saved hospitals at least $7.4 billion over the last year, the Obama administration announced Monday.

With millions more people covered under ObamaCare last year, hospitals faced fewer bills from patients who lacked insurance and were unable to pay. Hospitals also saw fewer emergency room visits, which rack up far higher costs and often leave hospitals with the tab.

The other day, McKinsey & Co. released the results of a big national survey (3,000 adults) about the different categories of people after the end of the 2015 Open Enrollment period. It includes those who renewed their 2014 enrollment, those who were newly enrolled, those who moved from exchange coverage to other forms of heatlhcare policies, those who remain uninsured and so on.

I have nothing against this study or their methodology, and in fact it's yielding some useful info, such as yesterday's revelation that about 12% of those who are currently uninsured plan on enrolling during the special "Tax Filing Season" enrollment period going on now through the end of April...a percentage which actually matches up pretty closely to my own estimates.

However, there's an extremely important caveat included in their survey pool which cannot be stressed enough when it comes to parsing the results:

All findings reflect the rapidly evolving individual market through February 24. These self-reported findings cannot be directly compared to publicly reported exchange enrollment - we have reported enrollment trends across non-ACA and ACA plans (on- and off- marketplace), while public reports are focused specifically on the ACA on-marketplace enrollees. We have based our findings on how respondents described their behavior, attitudes, and demographics, and the descriptions may naturally include some subjectivity.

Did you catch that? Here, they reiterate this later on in the report:

The objective is to understand the intended actions, shopping, and purchasing behavior of consumers who are eligible to purchase individual coverage on the ACA exchanges or elsewhere.

Still not following? Here it is again, with the header "Caveats":

Caveats: Two important points help clarify how these survey findings should be interpreted.

  • Some of the reported 2015 ACA insured respondents purchased coverage through channels other than online exchanges. As a result, our survey numbers cannot be directly compared to publicly reported exchange enrollment.
  • Our survey was conducted only in English. Thus, it does not reflect the behavior or attitudes of those who would have preferred a survey in Spanish or another language. 

Got it now? This includes both exchange-based AND OFF-EXCHANGE policy enrollees, and some of the enrollees included in the study are enrolled in NON-ACA COMPLIANT POLICIES (that is, "grandfathered", "transitional" or other policies which aren't compliant with the Affordable Care Act.

Why am I stressing this so much? It's not to beat up on McKinsey & Co. Again, their survey appears to be completely on the up & up, and they're very forthright about this caveat, mentioning it several times quite prominently.

No, the reason I'm making a Thing about this is because of folks like Forbes' Avik Roy, who I got into quite a tussle with last spring after he used another McKinsey & Co. survey to claim that only 27% of ACA Exchange enrollees were previously uninsured, when in fact it turned out to be more like 57%. As with this survey, the error wasn't in the McKinsey survey itself, it was in Roy's complete dismissal of the fact that off-exchange enrollments were included...and that there was no way of knowing what the ratio of on- to off-exchange enrollees was at the time.

As it turns out, the actual on/off ratio was roughly 50/50...but again, there was still no way of knowing whether that meant 27% of each group was newly insured, or if it was 54% of one and 0% of the other.

Therefore, if anyone wants to use the current survey results to prove one point or another, make sure to take the on/off exchange (and compliant/non-compliant policy) factor into account first (as it happens, this doesn't really impact the "12% plan to use the #ACATaxTime SEP" data point since those folks aren't enrolled in any policy at the moment).