Beating expectations, President Barack Obama's health care overhaul was on track to sign up more than 7 million Americans for health insurance on deadline day Monday, government officials told The Associated Press.
...Two government officials confirmed the milestone, speaking on condition of anonymity because they were not authorized to discuss the matter ahead of an official announcement.
OK, I've updated the "official projection" to 7,080,180 just for the hell of it, but I'm not trying to pretend that I had this thing nailed to the decimal point; my last real projection was between 6.9M - 7.0M, so I'm willing to divide 7,000,000 into whatever the final number is to find out how far off I am.
Believe me, I'd be perfectly happy if the final number as of 11:59pm ends up being 7.1M, 7.2M or even higher.
Short and sweet...Alabama was at 55,034 as of 3/01, so this appears to be a spike of nearly 22,000 QHPs. It's technically feasible that the 77K figure includes the 18K Medicaid enrollees which Alabama (a non-expansion state) has added, but I doubt it; that would only leave 4K QHPs in March, and they had over 11K in February, so I think I'm safe here:
So far 77,000 Alabamians have signed up for health insurance through the marketplace.
A solid number, a fairly solid date (assuming 3/16) and a confimation that it's private QHPs only, since they include the 3/01 number:
Jarvis Dortch, program manager and staff attorney for Mississippi Health Advocacy Program, said federal figures show roughly 32,000 Mississippi residents had enrolled in health exchange coverage through mid-March. That's up from the 25,554 who had enrolled by the end of February, but still thousands short of the original projection that 46,000 would enroll in the first five months.
WV's Medicaid expansion has been absolutely astonishing. They've now added nearly 105K, up from 98K, meaning that 73% of the state's eligible population has now been enrolled in the program:
The total federal projection since Jan. 2014 in West Virginia was 63,000, said Jeremiah Samples, Department of Health and Human Resources assistant to the secretary. By Friday, 104,820 people had signed up, he said.
...Samples said the reason West Virginia nearly doubled the projected number of enrollment was by identifying potential participants using information on existing food stamps and Medicaid applications. Only one of four states with this kind of auto enrollment, the process garnered around 118,000 enrollees, he said.
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.
The numbers are tiny, but what the hell...DE was at 6,538 as of 3/01, so this is at least 1,463 higher...if it really is only 8,001, that's actually down 13% from the February rate, which I find hard to believe, but the numbers are so small it doesn't matter much anyway:
State officials initially had hoped to enroll 35,000 of the roughly 90,000 uninsured Delawareans for coverage under the ACA, but federal officials set a much lower target last fall of 8,000 enrollments, a benchmark that state officials say has been exceeded.
This is kind of a thin article; it doesn't give an exact number, doesn't specify the date of the conference (I'm assuming it was yesterday), and doesn't break out the total between QHPs, Medicaid...and the DC SHOP exchange. DC is the only exchange in which SHOP enrollments outnumber the Individual QHPs due to the to the wording of the ACA requiring Congressional staffers to use the DC SHOP.
The existing breakout was 7,926 individual / 12,743 SHOP and 14,379 Medicaid, or around 22.6% / 36.4% / 41%. I'm assuming the 37K figure is broken out similarly until I learn otherwise, which adds 443 QHPs, 710 SHOP and 800 Medicaid.
More than 37,000 have signed up for health insurance through the D.C. Health Link exchange under the Affordable Care Act, officials said during a news conference.
Connecticut chimes in, with nearly 192K total, including 74K exchange QHPs...
As of Sunday night, 191,961 people had signed up for coverage, with 74,000 in private health plans and the rest in government-funded Medicaid plans, said Access Health CT's CEO Kevin Counihan.
He said the exchange had been "swamped" on Monday, prompting the predictions of possibly 200,000 total enrollees since open enrollment began in October. It's unclear how many of those people were previously uninsured. An analysis is expected this summer.
Facing a flood of interest, the Covered California exchange plans to prevent some consumers from finishing their Obamacare enrollment so others can start the sign-up process to meet Monday's deadline.
Californians were waiting in line for hours Monday to get coverage and heavy consumer traffic was slowing down the state's exchange website at coveredca.com. Overall, health plan enrollment through Covered California surpassed more than 1.2 million by early Monday.
Peter Lee, executive director of Covered California, said the state plans to log off some online applicants to make room for other consumers to use the website. The state will tell people that they have until April 15 to complete their application.
Fortunately, as I noted earlier, HC.gov seems to be taking up the slack...
We hven't heard a peep from Rhode Island since way back on March 8th, an eternity ago. At the time, their exchange QHP total was 19,690. They've finally released their first update since then:
A total of 26,128 individuals signed up for private plans through the HealthSource RI marketplace through Sunday night since the start of enrollment Oct. 1, up from 19,690 as of March 8, HealthSource RI spokeswoman Dara Chadwick told WPRI.com.
...Those numbers...exclude the far larger number of Rhode Islanders who’ve used HealthSource RI to sign up for Medicaid, the government insurance program for low-income individuals, which totaled 48,602 as of March 8 – far above the state’s goal for the first year.
...Blue Cross did not immediately respond to an inquiry about how many others have signed up for coverage directly through its website, bypassing HealthSource RI.
I'm also rather amused at how stories like this are finally starting to talk about the number of off-exchange enrollments. Gee, I wonder what might have inspired that?
Nevada doesn't want to be left out of the craziness...OK, not exactly a major update but every one of those numbers is a human being (and one step closer to 7M)...about 4,500 more (although most of the new ones aren't paid yet...imagine that! They enrolled 2 days ago and still haven't paid? The horror!)
Update as of 3/29: A busy weekend for enrollment, 40,498 consumers confirmed Qualified Health Plan selections, 24,062 have paid. #GetCovered
"A second software glitch took HealthCare.gov offline on Monday as the site struggled to stay open during this year's final day of enrollment under the Affordable Care Act.
The new problem hit around 12 p.m. EDT and was preventing users from creating new accounts, said a person familiar with the matter. The glitch is related to the part of the system that processes peoples' identities, the person said. A user who visits the site now and tries to log in is told "Healthcare.gov has a lot of visitors right now" and is put into a queue."
..."The latest glitch comes as the site had been performing well, if not perfectly, during a time of heavy use. On Sunday, HealthCare.gov processed more than 160,000 enrollments—the highest daily number to date, the person said."
So, why do I still think they're not only going to hit the low end of my final range (6.9 million) but may actually still beat the high end of the range (7 million even)?
Yesterday there was an unofficial NY count of 100K total enrollments (QHPs + Medicaid) in the past week (which I estimated broke down to 12,920 QHPs on Friday & Saturday, or 6,460 per day).
Today they gave the official number (still not broken out, though): 812,033 combined.
ALBANY (March 30, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 1,162,795 New Yorkers have completed their applications and 812,033 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. More than 70 percent of those who have enrolled to date were uninsured at the time of application.
Obamacare sign-up closes at midnight and enrollment is surging, but a technical flare-up on HealthCare.gov Monday morning marred the administration’s momentum.
The online portal, which had been handling millions of visitors over the past few days as enrollment pushed past 6 million, was “down for maintenance” starting at around 3:20 a.m. Officials said it returned to functionality at 9 a.m.
Hmmm...well, on the one hand, this was indeed a "multi-hour outage by HC.gov". On the other hand, it doesn't appear to have been anything critical (ie, they're back online now and all appears to be well...it's not like the earth opened up and swallowed the server farm or anything), and it happened in the wee hours of the morning, so hopefully the impact was minimal.
Yeesh. Like I'm not scrambling enough this morning...
At least 5 different people have sent me the link to the following story from yesterday's LA Times. Here's the key passage:
Precise figures on national health coverage will not be available for months. But available data indicate:
• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.
• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.
• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law's implementation.
I feel a little silly this morning after my overdramatic post last night which bumped my projection up from 6.72 to 6.78M, but I'm now thinking that exchange QHPs may, against all odds, manage to push over the 7 million mark by tonight after all.
Why? What accounts for my casually increasing it by 220K this morning after stressing so much over a 60K bump last night? Several things:
First (and I'm incredibly embarrassed to to admit this), but I made a basic, 2nd-grade arithmatic error last night. I was incredibly tired and had been pushing numbers around in my head and on the spreadsheet all day, along with my wife having the flu (she's feeling better this morning, thanks)...and I made a basic "forgot to carry the 2" type of mistake. Result? My projection table was way off. With the correction, I now have it at 6.86 million.
I was quite confident of my projections through the 5 million and 6 million milestones...however, since Wednesday, I admit that I've been somewhat "winging it".
My estimates for the past 4 days have been about 2/3 based on solid data...but the other 1/3 has been a mish-mash of anecdotal evidence and instinct. I could be dead wrong here, but I'm going ahead and bumping up my projection for 11:59pm on Monday, March 31st one more time, to just shy of 6.78 million exchange-based QHPs.
On the hard data side, it's the latest numbers out of New York and Washington State, both of which appear to have doubled their already-spiked March enrollment rates in the past few days.
On the instinct side, maybe it was those "Apple store opening"-like line photos that I posted this morning (although most of those folks will probably end up actually enrolling during the extension period, if you think about it).
Maybe I'm just getting swept up in the heat of the moment. Maybe I'll look like a complete schmuck on Tuesday, and my flavor-of-the-month will turn sour.
I don't like basing my estimates on "gut feelings" or "hunches". This is the antithesis of everything that statistical analysis and the scientific method should be based on (at least, I think...I'm neither a statistical analyst nor a scientist). However, when you don't have solid evidence, sometimes you have to go with instinct. In this case, it's a mixture of both.
So, very soon we'll know how good my instincts are on this.
The thing is, I have no problem being off here (and I will be to some degree)...as long I've underestimated the actual total.
NOTE: Hopefully everyone noticed the (?) next to "final". One more update tomorrow.
The headline is negative (shocker!), but the data is positive (imagine that!):
The Washington Health Benefit Exchange reported Thursday it had 131,000 private insurance sign-ups through its online portal, wahealthplanfinder.org.
The milestone comes on the eve of a major Obamacare deadline. Individuals not exempted by law due to low incomes must have health insurance by Monday or risk paying tax penalties next year.
The private insurance sign-ups are in addition to the more than 250,000 newly eligible adults who have enrolled in Medicaid since the exchange opened Oct. 1. Thousands more are enrolled in other Medicaid programs for the first time, according to the state Health Care Authority.
If they "reported" the numbers Thursday the 27th, I presume they were through midnight on the 26th at the latest. The previous tally (125,207 QHPs) was through the 23rd, so that's about 5,800 more in 3 days, or 1,933 per day.
This compares with WA's February rate of 654/day (nearly 3x) and their existing March rate of 816/day (over 2.3x).
Several people have noted that my estimated Exchange QHP number as of today (around 6.58M) has actually surpassed the "combined" Medicaid/CHIP number (6.49M). This is obviously a long way from just a couple of months ago, when Medicaid enrollments were outpacing QHPs by a factor of 3 or 4 to one.
However, this brings up two important points about estimated enrollments vs. documented ones.
I have to be careful about using this as an actual spreadsheet entry because it doesn't specify the start date, the end date or the QHP/Medicaid breakout, but things are moving so quickly now that I'm not sure how much difference it makes:
According to @NYStateofHealth Nearly 100,000 New Yorkers have enrolled over the last week.
NY State of Health had already reported 717K total enrollments as of 3/23, which had increased to 782K as of 3/28, which accounts for 65,000 of this number (call it 99K since they say "nearly" 100K). Call it 34,000 in the past 2 days.
If the QHP/Medicaid breakout is the same 38% / 62% that the other 65K from last week was (it should be very close to this), that's another 12,920 QHPs in 2 days, or 6,460 exchange QHPs per day.
I can't really use any of these numbers directly in the spreadsheet, but some excellent data to show the impact in Washington (state). Also note the point regarding many people enrolling directly with the insurance companies:
Statewide, about 375,000 people have insurance due to this law. That’s the net gain, counting those who had their policies “canceled” last winter (most simply signed up for a new one with their same company).
The Medicaid program in the state has grown 25 percent since October, from 1.2 million to 1.5 million.
...The private individual insurance market has also grown, by 19 percent, from 272,000 plans last October to 325,000 today. These figures include plans sold on the state exchange and directly by companies.
Whether that’s big enough to be stable and affordable remains to be seen. But before Obamacare it was shrinking.
Plus the state says there are 32,000 young adults on their parents’ policies due to the new law.
The line started forming at 5 a.m. in front of an enrollment center in Miami -- where trained workers have signed up 25,000 of their fellow Floridians since November. It was standing-room-only at a center in Houston yesterday.
The final deadline to get covered in 2014 is in just two days, and Americans are literally lining up at grassroots events across the country to make sure they're covered.
Some nice, solid numbers in an otherwise negative article about Maryland bailing on their existing software in favor of Connecticut's:
O'Malley said that as of Wednesday, 273,582 people have signed up for coverage. That includes 220,043 people (80% of the total enrollment) who had enrolled in Medicaid, and 53,539 people (20% of the total enrollment) who had enrolled in private insurance.
This brings MD's QHPs up from 49,293 on 3/22, an increase of 4,246 in 4 days; the Medicaid number hasn't changed.
A 1,000 increase in the number of paid exchange QHPs since 3/22:
Since Nevada Health Link opened, the state's exchange for insurance, there have been many problems in finishing the enrollment process.
More than 24,000 Nevadans have enrolled and paid, far lower than the projected estimates.
Meanwhile, Xerox (which botched the Nevada exchange just as Oracle botched Oregon's) thinks they'll be able to "convert" 57,000 of the partially-completed enrollments into full enrollees during the extension period (which actually runs all the way out until May 30th in Nevada's case...):
Xerox officials told the board that they’ve identified about 77,000 people they’ll target during special enrollment, which runs through May 30. Consumers eligible to sign up then include people who have selected an exchange plan but not paid for it, as well as people who qualified through the exchange for a federal premium subsidy but who have not bought a plan.
Company officials said they believe they could convert about 57,000 of the 77,000 targeted consumers into actual enrollees.
OK, not exactly a shocker or particularly relevant until after Monday (unless they're gonna be foolish enough to try and switch over to the new system during the deadline weekend frenzy), but worth noting:
Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.
I included the 80K in 4 days info yesterday, but didn't realize the implications of the second sentence until a commentor pointed it out:
The Covered California exchange said sign-ups have been building throughout the week with about 80,000 people picking a health plan Monday through Thursday. An additional 150,000 households created an online account and started the shopping process in the last three days, officials said.
That's 50,000 households--not individuals--PER DAY who JUST ceated an account for 3 days straight.
Pretty sure most of those are actually enrolling even as I type this.
I think this final weekend surge is going to be MUCH larger than even I've been projecting.
Gotta run for the moment, but I'm going ahead and calling it 6.7 million exchange-based QHPs as of now.
OK, I meant to post this yesterday but had to double-check a couple of things with the reporter first. He confirmed that a) the 750K figure was slightly outdated (NY announced a higher total enrollment figure shortly after he posted the story), b) these 10,000 people are indeed enrolled in New York's SHOP exhange for small businesses and are therefore not part of the individual private exchange QHP figure, and c) the 10K figure does include dependents as well as employees.
Therefore, NY's SHOP total just doubled, from around 5,000 as of January to 10,000 today.
Close to 4,000 small businesses across New York state have enrolled their employees in the state's online marketplace for buying health insurance.
The six-month-old market, called an exchange, has become a noteworthy part of the federal Affordable Care Act. The law aims to spark the largest expansion of health insurance nationwide sinceMedicare and Medicaid were created nearly 50 years ago.
Everything I said then is true now, only more so. I appreciate everyone who has helped me out with this project, including the regular site visitors.
Also, just for the hell of it, here's a little snapshot of the site traffic since the begining of the year (I don't have stats from last fall, as I didn't convert the site over from a simple spreadsheet to a true website until the end of December):
As you can see, the first mini-spike happened on Feb. 12, when the January numbers came in and I was absurdly dead-on with my exchange QHP projection. The huge spike at the end culminated yesterday with Paul Krugman's kind words, and traffic peaked at around 17,900 unique visitors.
Looks like the 39K on Monday & Tuesday continued at the same pace all week...supporting my "California 20%" rule (20K in CA = 100K nationally):
SACRAMENTO (AP) — California is seeing a late surge in the number of people signing up for healthinsurance coverage ahead of next week’s deadline – and state officials are encouraging more people to apply.
The state already reported surpassing 1 million enrollees. But Covered California Executive Director Peter Lee said Friday that another 80,000 people enrolled in the past four days alone.
20,000 per day in California is 4x the rate they hit in February.
I'm pretty sure California has now broken 1.2 million all by itself (which makes sense if the 20% rule holds...1.2M = 20% of 6M...)
Based on this and the Oregon entry, I'm increasing my projection from 6.54M to 6.58M as of 3/31.
Another quick update from Oregon; at this point I'm pretty sure that the "Net" QHP number (which removes "terminations & cancellations") is the same as Connecticut--purging the tally of non-payments, adding Oregon to the 100% Paid column:
Medical enrollments through Cover Oregon: 178,057
Total private medical insurance enrollments through Cover Oregon 1: 55,177
Oregon Health Plan enrollments through Cover Oregon: 122,880
Net enrollments: Net private medical: 52,372
This brings Oregon's exchange QHPs up from 50,137 just 3 days earlier, or 2,235...745/day. Compare this with an average of 179/day in February (or 472/day for the first 3 weeks of March).
Medicaid enrollments haven't changed in this report.
As usual for NY, the official press release doesn't include the QHP/Medicaid breakout, but based on past experience someone will point me towards a news story that has it broken out within the hour...anyway, the combined total in the Empire State is now over 782,000:
ALBANY (March 28, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 1,130,600 New Yorkers have completed their applications and 782,472 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. More than 70 percent of those who have enrolled to date were uninsured at the time of application.
A rough total number (which I suspect we'll see a lot of this weekend...things are moving very quickly now). Assuming a 20/80 split (typical for Kentucky) of the additional 17,600 total, this should mean roughly 3,500 more QHPs and 14,100 more added to Medicaid, to around 69,500 and 280,500 respectively.
We've been seeing a tremendous increase in the number of people applying and approved each day," says Gwenda Bond in the Kentucky Cabinet for Health and Family Services. "We've been seeing about 3,100 each day and I suspect that's even higher this week."
According to the state, an estimated 350,000 uninsured Kentuckians have enrolled in Medicaid or private coverage.
I posted an Arkansas update last night, but here's another...and the "private Medicaid option" numbers are either a little higher or a lot higher depending on the number you use; the wording from the AR DHS is confusing:
233,676 – Total number of private option applicants from state and federal levels.
Of those, 149,666 have been determined eligible for the private option so far and will begin receiving coverage.
Of those determined eligible for the private option, 106,324 have completed the enrollment process (as of 3/21/14). An additional 14,969 have been determined to be better served by traditional Medicaid for a total of 121,293 people who have fully completed the enrollment process.
It sounds like there's 28,373 who are still in the middle of paperwork or something, but the DHS is quite clear that one way or another all 150K will be enrolled in either the "private option" or "standard Medicaid", so I'm going with the higher number until they clarify otherwise. I normally err on the side of caution, but in this case the "will begin receiving coverage" is part of an official DHS press release.
Back when I assumed that I'd be pulling the plug on this website after March 31st, I didn't see the point of keeping track of the states which finally came around and added Medicaid expansion after the end of the Open Enrollment period. Not that I didn't think it was important, mind you; I just assumed that this site would be winding down in early April anyway, so it would be kind of pointless.
However, now that practically every state is extending their enrollment out to April 15 (or beyond, in a couple of cases) for those who started their application before Monday, along with the fact that Medicaid enrollment doesn't have a deadline anyway along with numerous other exceptions, it behooves me to make note of additions to the Expansion party as they come along.
Final report before the official 3/31 deadline...exchange QHPs are up to 49,293 from 44,836 (up 4,457), while Medicaid is up to 220,043, which includes 124,154 regular enrollments (up from 107,505) and 96K auto-transfers.
The impact on the projection chart is slight but positive; MD's increase over the February rate has gone from 50% to 66%.
Through March 22, 49,293 Marylanders have chosen to enroll in private health plans through Maryland Health Connection. As of March 25, 220,043 have gained Medicaid coverage in 2014 and remain active in Medicaid....This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
It's very late, I'm very tired and I haven't had a chance to review all of his math, so I can't comment specifically on his conclusions, but if nothing else he adds one more crucial factor to the subject: NOT EVERY INSURANCE COMPANY PARTICIPATES IN THE EXCHANGES AT ALL.
(CNSNews.com) – Major health insurance companies--Blue Cross, Aetna, United, Humana--have decided not to participate in various states in the Obamacare health-insurance exchanges that will be the only place Americans will be able to buy a health insurance plan using the federal subsidies authorized under the Obamacare law.
One more update tonight, out of Arkansas...nothing shocking either way, about a 21% increase over the February daily average; takes the projection down a smidge but nothing significant:
LITTLE ROCK, Ark. (AP) - Arkansas officials say more than 33,500 people have signed up for the health insurance exchange set up under the federal health law, well below the numbers they hoped to see before the enrollment deadline next week.
State officials on Thursday said the signup for the exchange, a marketplace where consumers can select health plans, has lagged in comparison to enrollments in the state's "private option" compromise Medicaid expansion. More than 106,000 people have signed up for the private option, the state's program using federal Medicaid funds to purchase private insurance for the poor.
A very nice little update from CT. Clean numbers, and this is the first specific reference to policies being subtracted from the total due to non-payment (presumably for policies that started in January, February and possibly March), which is perfectly fine.
I've said all along that I have no problem at all with subtracting any people who truly are deadbeats or cancel their policy for one reason or another...it's just that they shouldn't be subtracted until they actually are past due, that's all.
Connecticut’s health insurance exchange has been enrolling between 3,000 and 4,000 members per day as the sign-up deadline approaches, exchange CEO Kevin Counihan said Thursday.
As of Wednesday afternoon, 178,601 state residents had signed up for Medicaid or private insurance through the exchange, Access Health CT.
Of those, 62 percent, or 111,050, will receive Medicaid coverage. The other 67,551 signed up for private insurance. Among private insurance customers, 78 percent are receiving federal financial aid to pay their premiums.
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)
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
The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.
Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension.
Well, first of all, I've gone ahead and increased my official 3/31 projection to 6.5 million exchange QHPs.
This may go up a bit more, but we're really into uncharted territory at this point. This is where I really am not the "Nate Silver of..." anything. I don't run 10,000 simulations across a complex computer model or anything like that, I can only rely on the existing data, and things are ramping up a bit more quickly than I figured a few days ago, so a lot of this is going to be "back of the envelope" guesswork going into the final weekend.
There's another huge factor to consider as well: The post-3/31 QHP enrollments.
These impact things in several ways:
First of all, since at least 43 states (I think...possibly more) are now doing the "as long as you start by 3/31 you have until 4/15 to complete" thing, some people who otherwise would have scrambled this weekend may ease up, start the process this weekend and then come back to finish the first week of April.
IF it's true that around 79,000 people per day have been enrolling nationally all of this week, that means that yes, we could indeed have already surpassed the 6 million mark...THIS week.
My current projection has exchange QHPs breaking the 6M mark sometime late today (Thursday) or early tomorrow (Friday), but it's conceivable that we did already pass it late last night or early this morning.
Sources who do not wish to be identified, contend last week that the ACA enrollment numbers surpassed the six million mark. A source also says ”People are swarming to the healthcare.gov website and enrollments are rising.” On Tuesday March 25, 2014 over 1.2 million people visited the healthcare.gov website. Enrollments have exceeded 60,000 per day since Sunday March 23, 2014.
The White House denied the claim, but her sources insisted that it was true:
As usual with Massachusetts, there's a lot of weird numbers flying around in this article (and therefore, no new hard enrollment numbers to add at the moment), but there's some other important stuff right in the lede:
BOSTON -- Massachusetts residents who have had difficulty signing up through the Health Connector for unsubsidized health insurance coverage will be given an extra two weeks to enroll under an extension plan to be presented Thursday, two days after President Barack Obama announced a similar reprieve for frustrated consumers on the national level.
...Residents who have had trouble completing enrollment to due technical problems with the website will be allowed to shop online for unsubsidized plans through April 15, with payment due April 23 for coverage starting on May 1.
OK, first, there's the standard "you get until 4/15 as long as you started by 3/31" bit which is all the rage (seriously, I think Connecticut is the only state not extending enrollment in one way or another at this point, while Rhode Island nor Hawaii are the only other states not to chime in one way or another...which is insane in the case of Hawaii).
A nice little update out of DC...they even did the net gain math for me! Unfortunately they didn't separate out QHPs from Medicaid (the 17,899 number includes both).
If I assume the a slightly lower 32/68 breakout of the new enrollments (it was 36/64), that should mean an extra 1,410 QHPs and 2,996 Medicaid enrollees.
That gives a total of 7,926 exchange QHPs and 14,379 new Medicaid total.
DC's numbers are so small that I'd normally say that even if my breakout is wrong, it won't impact the projection enough to worry about...but in this case, they were running 40% below the February rate, so this jump to 26% higher actually bumps the projection back up a smidge after all, to a solid 6.4M.
Since March 10 (the last data release), enrollment through DC Health Link increased significantly. To date a total of 22,305 people have enrolled through DC Health Link’s individual marketplace, up from 17,899 on March 10. This is an increase of 4,406 people just in the last few weeks. (Note this data does not include enrollment through the small business marketplace.)
Community health centers offering counseling for the Affordable Care Act (ACA) enrollment process say they are experiencing a surge in the number of people seeking help ahead of the March 31st deadline.
At the David Raines Community Health Centers corporate office in Shreveport, appointments are completely booked through next Monday's deadline, according to Community Development Coordinator, Calvin Young.
"Being in healthcare and kind of understanding how people work and think we anticipated a big surge at the end, but the surge has been a little overwhelming," Young says.
This is a great article for several reasons. Not only is it the first Georgia-specific update I've received, but the numbers are quite good (daily average over 2x that of February) and very straightforward (they don't explicitly state that the 178K are QHPs only, but they include the 3/01 total of 139K and I alrleady checked the 3/01 Medicaid tally, which is quite a bit more than 38K, so it's definitely not included here).
As a surprise bonus, it includes the Paid/Unpaid data for Georgia...which is over 81%, within the 80-85 range that most insurers have been reporting of late. Finally, the data comes directly from the state insurance commissioner, so there should be no mistranslations going on.
State insurance officials said Wednesday that 177,668 Georgians have completed applications for coverage in the health exchange as of March 15.
That number, reported by health insurers in the state, reflects a recent surge in enrollees from the latest figures released by the federal government. As of the end of February, federal officials said, Georgia’s exchange enrollment totaled 139,371.
Earlier this evening I ran an update on Illinois which claimed 323K total exchange enrollments. Since IL had 114K QHPs and 132K Medicaid enrollments as of 3/01 (246K total) that seemed like a decent, if unremarkable update...about 17% above the February daily rate.
However, contributor deaconblues tipped me off that other Illinois stories floating around today seemed to indicate that the 323K figure might actually be the 3/01 numbers, plus another 77K or so of unspecified enrollments. I double-checked with GetCovered Illinois, and sure enough, received this response:
@charles_gaba 113,733 in QHPs, the other 200K Medicaid (as of 03/01). Tricky in part because Cook County got advance dispensation to enroll.
OK, so never mind the earlier Illinois update; my apologies for the error. This also means that I can't use Illinois in the projection table at all, which is fine, since it was actually dragging the projection down anyway lol...
The site — the main portal for insurance marketplaces in 36 states — drew 1.2 million visitors Tuesday and 1.1 million visitors Monday, according to the administration.
Over the same period, call centers received more than 500,000 calls. California's state-run health insurance exchange reported a similar surge in interest, with nearly 40,000 people picking a health plan Monday and Tuesday.
Now, this is awesome news, as it suggests a national rate of around 100K/day (CA has averaged around 20% of the national QHP enrollments all along).
However, it also poses a slight dilemma for me, since there's an 8 day gap between the existing March data (03/02 - 03/15) and these 2 days (03/24 - 03/25).
In spite of their endless technical issues, Oregon is actually kicking serious butt in manually processing a mountain of paper applications. In addition, they're including some interesting extra info in their reports lately--including NET enrollments after cleaning out cancellations/etc (does this mean Oregon is now only including paid enrollments, then, like MA and WA??), as well as dental enrollments, which haven't gotten much attention from anyone:
Medical enrollments through Cover Oregon: 175,534
Total private medical insurance enrollments through Cover Oregon1: 52,654
Oregon Health Plan enrollments through Cover Oregon: 122,880
Total private dental insurance enrollments through CoverOregon 1: 10,628
Net enrollments Net private medical2: 50,137
Net private dental 2: 9,877
This number out of Illinois was as much of an eyebrow-raiser as the NC/LA incident a few nights ago. However, it looks like this is a combined total of QHPs and Medicaid, which were at 113,733 and 131,995 respectively as of 3/01. Combined, that's about 246,000, with a 46/54 split.
For now, I'm going to play it safe and assume that this has shifted towards the Medicaid side a bit since then by calling it a 43/57 split, or around 139K QHPs & 184K Medicaid enrollments.
If I'm fairly close on this split, this represents a modest 17% increase over February's rate, which actually drops the projection a bit...but if I'm underestimating the QHP number, then I'm also underestimating the projection impact (sigh)...
To date, 323,000 uninsured Illinois residents have enrolled in health insurance plans, according to Get Covered Illinois, administrator of the state's official marketplace. As the March 31 enrollment deadline approaches, officials with the agency believe they will meet the state's target of having 143,000 more enrolled.
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.
Minnesota was already doing pretty well, having surpassed their own internal goal of 135K QHP/Medicaid combined as of yesterday, of which over 36K were QHPs...but they released quite a jaw-dropper just a day later, with the QHP figure leaping up another 5,097 thanks to pushing through a mountain of paper applications.
Numbers released Wednesday at the MNsure board's regular meeting actually look better than those the agency highlighted in a Tuesday press release. On Wednesday, MNsure was able to add people who enrolled using paper applications – and now the exchange can announce it has enrolled 148,068 people, including 41,273 people who used the exchange to purchase private health plans.
This brings MN's totals to 41,273 exchange QHPs and 106,795 new Medicaid enrollees.
The impact on the projection table?
In February, Minnesota averaged 122 QHPs/day. Prior to today's update, they were averaging 180/day in March, a 48% increase over February.
With these paper additions, this has skyrocketed to 385/day...over 3.1x February's rate.
OK, things just went into overdrive. The media spotlight has been growing, and now Paul Krugman just said some very nice things about me in the NY Times. Believe me, I'm incredibly flattered, honored, etc etc...but I'm also getting overwhelmed, and have to make a few changes, at least until the dust settles on the enrollment insanity:
Oregonians now have an additional month to apply for private health insurance. New deadline to apply is April 30. The Oregon Insurance Division and Cover Oregon urge people to apply now to get coverage as soon as possible and avoid potential end-of-month rush.
I mentioned this briefly last night, but it's certainly worthy of its own entry.
I previously posted a whole bunch of entries about how various state-run exchanges are planning on extending their QHP enrollment deadlines for certain groups of people. The circumstances, revised deadlines and extension request process varies from state to state, but as of my last update, the list included Massachusetts, Oregon, Maryland, Nevada and possibly Vermont, Kentucky, Washington State and Colorado.
ST.PAUL, Minn. – Today, MNsure announced new procedures that will help people get coverage and avoid a federal tax penalty even if their enrollment isn’t complete when the deadline expires on March 31.
“It’s just like waiting in line to vote after the polls close; if a consumer can show that they have attempted to obtain coverage before the deadline, we will make sure they can complete their enrollment,” said interim CEO Scott Leitz.
I received the following yesterday, and was given the OK to post it publicly. Given my prior screeds about both a) off-exchange enrollments and b) insurance company billing systems being overwhelmed/backlogged, this is a perfect example of why both of these issues are so important to include when discussing the QHP numbers.
Obviously anecdotal stories can't be used as hard data, but I've read dozens of similar stories. Some refer to going off-exchange; some refer to billing problems with the companies; some, like this one, refer to both. Presented without further comment (emphasis mine):
I'm an independent contractor/consultant in Arizona. I have several friends in the same boat. We all had Arizona state-sponsored (but not supported) small business insurance that had no underwriting.
We were all basically locked out of the ACA website from early on and never got back on. BUT WE ALL BOUGHT insurance with BCBS directly, with ACA policies (none of us could have gotten through underwriting) because we all make too much for a subsidy. NONE of us, and the people like us, are being counted. But I'm sure BCBS is keeping track of these direct purchases, which have to be counted toward the total.
Eureka! Finally, some serious progress on the Massachusetts Mess front. Apparently the backlog of manual payment enrollments is seeing serious progress as people mail in their checks. As a result, MA's 15,140 exchange QHPs as of 3/19 have shot up to 25K. And yes, these all appear to be QHPs, not Medicaid (under any of the dozen Medicaid categores that Massachusetts seems to have), as all of those numbers are far, far higher than 25K.
I should further note that MA only reports enrollments to HHS if the first premium is paid.
In one shot, Massachusetts has gone from running 30% behind their February QHP rate to of three times higher, and my overall 3/31 projection has moved up from 6.26 million to 6.30 million.
Lefferts said some 25,000 people have enrolled in Affordable Care Act plans, with the bulk of those being former Commonwealth Choice enrollees, along with a small number of subsidized individuals from Commonwealth Care and about 2,000 people for new dental coverage.
In a nutshell, I never said that McKinsey's 27% claim was wrong, I just said that the methodology they used to come up with 27% didn't tell us anything about the previously uninsured percent of exchange QHPs because McKinsey mixed together both exchange and off-exchange enrollments...without noting how many of their respondents came from each pool. Since we have no idea how many off-exchange enrollments there are, and we don't know how many of the respondents came from either pool anyway, there's no way of knowing how much of that 27% comes from either. It could be 0% and 54%. It could be 54% and 0%. It could, in theory, be 100% of one and 0% of the other.
One final update for today, just under the wire: Kentucky reports that QHPs are up to 66K, Medicaid up to 266.4K. That's an increase of 1,509 QHPs and 8,911 Medicaid enrollments in 4 days. A slight slowdown from last week, but March is still well above 2x February's rate.
In KY, 49% of those enrolled in #kynect are under the age of 35: 266,388 have qualified 4 Medicaid; and 65,964 purchased private insurance.
A huge turnaround from last week, when it looked like WA was starting to slow down. Exchange QHPs are up from 112,225 as of 3/13 to 125,207 as of 3/23...an increase of 12,982 in 10 days (not quite the "past week" described in the press release, unless it took the first 3 days for 901 of them to go through).
The impact on the projection chart is equally dramatic: Washington State has now gone from running 37% below February's daily average to 25% higher than February did.
On the Medicaid side, new enrollments now stand at 250K "strict expansion" and 130K "woodworkers", up from 235K & 122K respectively, for a total increase of 23,000 new enrollees.
Lots of numbers here, but only one of any relevance here: 5,744 QHPs as of 3/22.
At just 350 higher than the 5,394 from 3/17, this is a bit of a slowdown from the first 2 weeks of March. Fortunately the HI numbers are too small to negatively impact the projection to any visible degree.
Total for the period of Mar. 16, 2014 through Mar. 22, 2014
7 Certified Kōkua or In-Person Assisters
2 Certified Kōkua or Certified Application Counselors (CACs)
11,216 Unique Visitors to HawaiiHealthConnector.com
2,997 Calls received by our Customer Support Center
Earlier today I posted CT's QHP total as "at least 65K", but didn't have an exact figure.
This new article lists the combined total (QHPs/Medicaid) as 170K.
Kevin Counihan says that Access Health CT now has a goal of signing up 185,000 individuals for health insurance by March 31. The exchange originally hoped to sign up 100,000 people but has already enrolled 170,021 individuals in private insurance and Medicaid plans.
UPDATE: HOLD THE PHONE...This just in from Access Health CT's Twitter feed:
Thank you to new contributor JTP for this CNBC article, which finally brings some clarity to the "how many already had insurance?" question.
Until now, the only hard numbers available were from New York and Kentucky, which were reporting 70% and 75% of all enrollees as not already having insurance respectively. However, these numbers included both exchange QHPs and Medicaid enrollees, which made it difficult to parse what percent of QHP enrollees only didn't have insurance prior to their enrollment.
This article is more specific: The number for NY QHPs is 59% of QHP enrollees (vs. 90% of Medicaid), and in KY is, surprisingly higher, at 75% for each!
Contributor deaconblues brings a very nice find. Massachusetts continues to be one hell of a mess, but this latest official briefing helps bring some clarity to the situation, while raising some more questions. Rather than restate it all myself, here's deaconblues summary, and the chart in question:
Yesterday, in response to a partially-reasonable, partially-not critique, I added something to The Graph: A prominent note that no, neither the spreadsheet nor the graph take into account the estimated 4.8 million non-compliant policies which were cancelled last fall (my own included). I concluded my response with the following:
However, you've [the commentor] chosen to completely ignore the single largest missing piece of the puzzle here, which I've discussed many, many times: OFF-EXCHANGE QHP ENROLLMENTS.
Minnesota just broke through their own goal of 135K total enrollments. The 36,176 exchange QHPs are only up 566 from 35,610 from 4 days earlier, but the combined Medicaid number (100,598) is up 4,731 from 95,867.
ST. PAUL, Minn.—Today, MNsure announced 136,774 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s health insurance marketplace, exceeding its open enrollment goal.
“We are thrilled that more than 136,000 Minnesotans have enrolled in quality, affordable coverage through MNsure,” said interim CEO Scott Leitz. “We’re not done yet. There are six days left in open enrollment and we want to make sure every Minnesotan has the ability to obtain health insurance coverage.”
MNsure’s original goal of enrolling 135,000 Minnesotans during the 2014 open enrollment period was established at the MNsure Board of Directors meeting on October 16, 2013.
To date, MNsure has enrolled 36,176 in a Qualified Health Plan, 27,512 in MinnesotaCare and 73,086 in Medical Assistance.
A very nice find from a contributor: This press release which just came out today, detailing privateoff-exchange online insurance broker eHealth Insurance's demographic breakdown of ACA-compliant QHP enrollments since January.
You may recall that eHealth Insurance makes up about 25% of the total known off-exchange QHPs I have listed on the spreadsheet so far; the 148K entered from them so far only runs through the end of December.
While this new press release doesn't include their updated enrollment numbers, it does prove, once again, that off-exchange enrollments are vitally important:
In an editorial piece from the The Courant newspaper, a non-exact QHP update is revealed: 65K, up from 62K as of 3/13:
Even without that money, Connecticut created a model portal in http://www.accesshealthct.com. This state should take pride in being among the most successful in enrolling at least 65,000 consumers in private health insurance plans. Maryland is reportedly considering abandoning its own dysfunctional portal and using Connecticut's in the next open enrollment period in November.
It looks like I was right to be suspicious of the seemingly fantastic QHP enrollment numbers reported out of both North Carolina andLouisiana.
Thanks to Jed Graham (via Twitter) for pointing me towards Page 21/22 of the February HHS Report. Normally I only focus on the 3rd and 4th columns ("Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace" and "Number of
Individuals Who Have Selected a Marketplace Plan", since these are the actual exchange enrollment numbers through the end of that month.
I've updated The Graph as I'm doing every evening, and while there's nothing terribly dramatic to see, there are two notable changes:
First, I've changed my mind from a few nights ago and have decided to remove the 217,000 "Massachusetts Limbo Status" enrollees after all. These have been troubling me for some time, but on further reflection they really fall into the same category as other people who got halfway through their enrollment process before getting stuck. The difference in these folks case is that some of them (all of them?) have actually paid for their policies already, and are facing a ticking clock. However, I'm just not comfortable including them until their situation is settled.
Second, my "polite critic" this morningdid have one valid point: I should acknowledge the 4.8 million cancelled non-compliant policies on The Graph. So, I've added a large, prominent note about them...but, as I explained, I'm not going to subtract them from the total until I also document the millions of Off-Exchange enrollments which are absolutely still remaining out there among 47 states. I'm guessing that there's a good 4 million or so, but without knowing for sure I can't list those either...so instead I'm just listing the two missing numbers next to each other, one positive, one negative, in the interest of total transparency.
OK, I either have some very good news...or one heck of a misunderstanding here.
Earlier today I updated both New York and Colorado's QHP numbers...and while both were very fine, they were actually down somewhat from last week (large drop for NY, small one for CO). This may actually make sense, as both of these state exchanges have been running very smoothly for months now; it's possible that they've simply started to reach the end of the line in terms of residents actually signing up (or perhaps they'll both experience a final mini-surge right at the tail end this weekend).
However, the apparent news out of both North Carolina andLouisiana has me thrown for a heck of a loop (visit the links for details).
Another find from Stevef101 (and this one, while impressive, is not setting off any warning bells with me either): Colorado breaks 106K QHPs as of this morning, up 6,000 from 100,112 as of a week ago:
As of Monday morning, Connect for Health chief executive Patty Fontneau said, 106,000 Coloradans had signed up for private insurance. About 24 percent of enrollees were in the prized young (and presumably healthier) adult category of ages 18-34.
...More than 151,000 Coloradans had been added to Medicaid rolls by March 17.
This keeps Colorado's QHP rate at around 91% higher than February...which is actually down slightly from the 93% increase it had been earlier in the month.
OK, not only are the numbers here as hard to believe as North Carolina, but the source is the same: Dr. Renard Murray of CMS:
In Louisiana the numbers put the state near the back of the pack. Dr. Renard Murray with the Centers for Medicaid and Medicare services say there needs to be a late surge in enrollment.
''We've got well over 100,000 who have signed up but well over 800.000 are eligible,'' said Murray.
As of March 1st, HHS only had Louisiana down as having 45,561 exchange QHPs, plus another 9,105 new Medicaid enrollees (again, LA is not an expansion state). Just like with NC, even if the 100K includes both (and he says it's "well over" 100K), assuming an 83/17 split between the two, that would still be an increase of 37,627 QHPs for a total of 83,188...an 83% increase in just the past 3 weeks...at a daily rate 3.8x that of February.
And, just like with North Carolina, if that number doesn't include Medicaid, that would mean a more than doubling of the total through 3/01...at a rate 5.5x that of February.
Good gravy. 391,000 people in North Carolina?? They were only at 200,546 as of 3/01. Even if you assume this number includes Medicaid enrollments, that's still only another 55,691 as of 3/01...and NC is not an expansion state. Assuming that 391K includes both...and assuming the same 78/22 split between the two...that still suggests that QHPs have gone up to around 305,000, a 105,115 increase over the end of February, and over 3.8x the February daily rate.
If it doesn't include Medicaid (which seems likely from the wording of the article), then it's a whopping 190,454 increase--a doubling of their 3/01 total, and a near 7x increase over February.
I find either of these rather difficult to believe, so for the moment I'm only entering it into this blog entry. If I can confirm the QHPs as either of these I'll change it tonight or tomorrow.
While waiting to see whether I was right about the national exchange-based QHP total hitting the 5.5M mark yesterday (and bear in mind that there's no guarantee that HHS will make an announcement about it even if I was correct; they didn't do so for 3.5M or 4.5M...I just figure that they will since it's a logical milestone and would be a nice momentum-building PR move going into the final stretch), I just wanted to call attention to this article from yesterday out of KTVU/Fox in California:
SAN FRANCISCO — One week from Monday is the open enrollment deadline for Covered California. The insurance exchange hit the one million mark for sign-ups last week, and is expecting about 20,000 people a day to sign up in the final push.
I've already contacted the reporter who wrote the story to make absolutely certain this doesn't include Medicaid enrollees, but the context makes me pretty sure they're talking about exchange QHPs only. Also, "expecting" 20K/day doesn't necessarily mean they've already ramped up to that; it could just mean that they're preparing for that volume just in case.
A lengthy comment in response to my "5M as of Sunday" post from yesterday criticizes the work done at ACASignups.net for a variety of reasons. For the most part these are the same issues which I've already addressed repeatedly, but he's more polite about it than the prior critic and some of his points are new (or at least I haven't really talked about them before), so I've decided to respond:
Let me start by saying that the work you have done is truly impressive but it is beyond comprehension that we can not get this type of granular info from the people who are actually responsible for designing, implementing and running this program. They are either completely incompetent or intentionally withholding the detailed data and simply releasing the more favorable headline numbers.
Just throwing that out there again. Since it's a Sunday, I wouldn't expect an HHS announcement until tomorrow. I could be wrong, of course; as I keep stressing, I'm NOT Nate Silver...and judging by the reactionto Mr. Silver'srelaunched FiveThirtyEight site the other day, even he doesn't seem to be acting like Nate Silver at the moment, at least when it comes to climate science. Hopefully this is all a big misunderstanding, but as a long-time fan of his, I admit to being extremely disturbed by this development.
Anyway, back on topic: Regarding my 5.5M projection for today (Sunday, 3/23), it's pretty simple: If QHPs haven't hit 5.5M by today, the odds of hitting 6.2M by 3/31 are worse; if they have, then I'm virtually certain that 6.2M will be reached by 3/31...and in fact could be somewhat higher. The 6.2M number has held pretty firm until today, but now we're entering the real crunchtime as we head into the final week--that number could start jumping around quite a bit.
If I am correct about 5.5M today, however, reaching 7M by 3/31 would be pretty much a pipe dream, as QHPs would have to shoot up to over 187,500 per day for the entire final week. I noted last week that 100K - 150K is conceivable for a few days based on California hitting 30K in a single day on 12/23...but it's been another week with the average appearing to hold steady at around 60,000/day, and sustaining 187K for 8 days straight just seems pretty implausible. 6.5 million, on the other hand, would "only" require 125K/day for 8 days straight...which, while also pretty implausible, isn't too crazy.
On a related note, I do figure that I've earned the right to archive my accuracy record a bit at this point, so I've added a permanent link to my Greatest Hits to the site, right under the March Projection link. Each projection is in turn linked to the earliest source I could find containing my projection (this was more difficult than you'd think, since I wasn't really making a big deal out of the estimates until the past month or so).
This article contains a breakdown between "strict expansion" (30,000) and "bulk transfers" (51,000), modified from the 13,000 and 55,000 prior estimates (not sure what happened to the other 4,000 who were listed as being transferred from IowaCare previously). Still a net gain of 13,000 people.
In addition, state officials say about 81,000 Iowans have enrolled in the new Iowa Health and Wellness Plan or Marketplace Choice Plan, which are Iowa’s versions of an expanded Medicaid program.
About 51,000 of those people used to have limited coverage from IowaCare, a program that ended Dec. 31.
Interestingly, there's even a reference to a specific "woodworker" figure
In February, 403,609 people were enrolled in the program. That represented an increase of 0.5 percent from the 401,582 who were in the program in February 2013.
When I first read this article submitted by contributor Maurice H., I was pretty concerned, as it made it sound like Arizona's exchange QHP total was only around perhaps 60,100 as of March 18 (the artilce was posted on the 19th):
Final numbers for Arizona enrollment will not be available for a few weeks, but more than 80,000 Arizonans have enrolled in Medicaid and more than 60,000 have enrolled in private health care plans through the site, said Herb K. Schultz, regional director of the Health and Human Services Department.
This concerned me because Arizona already had 57,611 QHPs as of March 1st...and had 43,495 on February 1st. That means that AZ's February average was 504/day.
If the 3/18 number was only around 60,100, that would mean they were only at 2,489 for March, or only 146/day…a 71% plummet from February.
Nice find out of South Dakota from contributor Maurice H.; SD was at 6,765 on 3/01. This represents only an 8% increase over February's rate in March so far, although I'm not sure how much "just over 8K" is or what date that number runs through (I'm assuming 3/20).
Just over 8,000 people have signed up for health care coverage in South Dakota. Those signing up in the last week will also need to pay their first month's premium to get coverage. But those premiums may be lower than people expect.
"In the state of South Dakota about 90 percent of the people purchasing insurance are getting subsidies from the federal government," Krystolpolski said.
Excellent news out of West Virginia: Medicaid expansion has increased yet again, from 87,000 to 98,000 residents. This is particularly impressive considering that the total number of people in WV who are eligible for Medicaid post-expansion is about 143,000, according to the Kaiser Family Foundation.
Doris Selko, Southern Regional coordinator for the West Virginians for Affordable Health Care, said over 98,000 residents had enrolled in the Medicaid expansion by March 15 and an estimated 105,000 are expected to be enrolled by the end of the month.
Selko said three southern counties — Nicholas, Summers and Wyoming — have all enrolled over 100 percent of the anticipated enrollment numbers, and Raleigh County has enrolled 99 percent.
Tavenner’s involvement made a difference in other ways, too. Beginning this summer, Mississippi will have one of the nation’s few state-run small-business exchanges. Federal officials approved the request even though Chaney doesn’t have the support of Gov. Phil Bryant, a Republican who doesn’t want anything to do with the law. Bryant didn’t expand Medicaid and shunned creating a state insurance exchange, which he called a portal to a “massive and unaffordable” new federal entitlement.
In addition to the 15 state-run exchange SHOP programs (only 12 of which are actually operational right now), Utah and New Mexico are actually running their own SHOP exchanges; this means that Mississippi will join them.
The number is given in a negative context, but NM is up to 18,691 from 15,012 as of March 1st...263/day, up nearly 2.2x from February's 121/day:
As of March 15, 18,691 New Mexico residents had enrolled in the exchange, Ezekiel said. After already adjusting enrollment expectations for 2014 downward from 83,000 to 50,000 because of problems with the federalhealthcare.gov portal, the state is struggling to reach its target.
Nice find by deaconblues: OH Sen. Sherrod Brown was pushing people to enroll at an event on Thursday. His office had a press release posted on the site on the same day, so I presume that the 97K figure was as of Wednesday at the latest.
More than 5 million Americans, 97,000 in Ohio, have entered the health insurance marketplace, but more than 115,000 Ohioans are eligible to enroll with financial assistance.
This gives Ohio a daily QHP average of 1,004 in March, up 50% over the February rate of 672.
More than 321,000 Kentuckians are now enrolled in new healthcare coverage through kynect, and that number is expected to keep growing in the final 10 days of open enrollment. A preliminary analysis has found that approximately 75 percent of all enrollees report that they did not have insurance before signing up for healthcare coverage through kynect.
Some states have extended open enrollment deadlines because of glitches in their exchanges. Davis said Colorado won't extend the deadline but will give credit to those who attempted to enroll by the end of the month.
This is also a perfect opportunity to work in a special Guest Post by contributor Esther Ferington, who gives a nice roundup of just what will happen to the ACA Enrollment situation after March 31st:
What Happens after March 31st? Guest Post by Esther Ferington
For some reason Maryland's thru-dates are different for QHPs and Medicaid; not sure why. Anyway, they're up to 44,836 QHPs (up over 4,100 from 40,693 on 3/08) and Medicaid enrollments are up to 107,505 from 97,781 on 3/11 (up 9,700).
From October 1, 2013, through March 15, 2014, there have been more than a million unique visitors to the Maryland Health Connection website. 197,818 Marylanders have created identity- verified accounts. Through March 15, 44,836 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
As of March 18, 203,394 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
On the March Surge side, Maryland is ramping up from 116% of their February rate the first week of March to 150% when you include the second week.
A bit of an update out of Massachusetts; the article is another rundown of the MA Mess, but there's actually small enrollment update included as well: Exchange QHPs have gone up from 12,965 on 3/01 to 15,140 as of "this week" (I'll call it Wednesday the 19th).
As of this week, only 740 Massachusetts residents have been able to enroll in newly subsidized plans under the act, Health Connector Authority spokesman Jason Lefferts said.
He said 14,400 people were able to enroll in unsubsidized plans on the private market by using the connector's website. Their success rate is tied to not needing to go through the income eligibility process, Lefferts said.
I just posted a lonnnnnng explanation the details of the "But how many have PAID???" situation. It gets kind of deep into the weeds, so I'll stop now, but I do just want to simplify things with a shorter, separate post:
Let's be clear about this: SOME of the people who haven't paid ARE going to prove to be deadbeats. That's inevitable in any industry that serves millions of people, just as shoplifting is a real problem that retailers have to deal with (and as I noted earlier, what was the insurance industry norm for cancelled/unpaid premiums prior to the ACA? Probably fairly low, but how low? 1%? 2%?).
The problem is that the "But how many have PAID???" attack seems to be based on the premise that ALL of the non-payments are deadbeats (or, alternately, that they're ALL due to exchange technical problems).
Here's the thing, though: There's 5 reasons I can think of why the first premium might not be paid yet:
(Reposted with updated numbers and additional info given that NewsBusters has decided to launch a hit piece on me using the "But how many have PAID???" attack point)
I've written about the "But How Many Have PAID???" issue many times before, but going into the final stretch, I wanted to explain my reasoning as clearly as possible.
The following chart only includes states which have broken out Paid vs. Unpaid Enrollments. If you only use these 10 states as a guideline, it looks like the paid rate is around 85%:
NOTE: This represents the Paid vs. Unpaid enrollments out of all enrollments reported to the HHS as of the Thru Date listed.
Massachusetts doesn't report unpaid enrollments at all, and Washington lists unpaid enrollments separately in their press releases but does not included them in HHS report data. As a result, both states are actually at 100% paid (in terms of the numbers in the HHS reports, which is what we're talking about here).
OK, this is a tiny number but every data point helps...in an article about the final crunch-time outreach efforts is this bit about the Nevada Health CO-OP's success:
The CO-OP sells plans both on and off of the exchange, but the “vast majority” of consumers who ask about plans are subsidy-eligible and buying on the exchange, Egan said. The CO-OP has actually sold more plans through the exchange than any other insurer: It’s responsible for 37 percent of plans sold, beating out industry titans UnitedHealthcare and Anthem, the state’s two biggest insurers. The CO-OP had sold about 9,500 plans on the exchange and just under 1,000 off of it as of Tuesday.
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...
Minnesota issues yet another "mini-update"...no exact numbers or breakout, but QHPs were around 34,942 as of 3/17 while Medicaid was at 90,062 so it's up from around 125K to 128K in only 3 days. Assuming a 25/75 QHP/Medicaid split (down from 28/72?), that would bring Minnesota up to around 35,750 QHPs and 92,250 Medicaid.
This would also suggest that Minnesota's March QHP rate is running about 60% higher than February, up from 50% a few days earlier. (see update below)
As of today, more than 1,000 enrollment opportunities have been organized by certified MNsure navigators during the month of March; and more than 128,000 Minnesotans have enrolled in health insurance coverage through MNsure. 32% of Qualified Health Plan enrollments are from people through age 34. 16% are from the “young invincible” target of 26 – 34 year olds.
Cover Oregon just posted an unexpected update (wasn't expecting this until tomorrow). They've added a couple of very interesting new features this week: First, they've started including dental policies, which has been pretty much ignored by everyone (including myself). I think Kentucky is the only other state that I've seen call any attention to the dental plans.
Of more interest to me for this site, however, is the fact that they've added net enrollments, explaining that these are the final number after people have "cancelled or terminated" their accounts. They don't specify the reasons for these terminations/cancellations (is it by the customer due to a change in status? is it by the exchange or insurance company for nonpayment?), but it's still a good thing overall as it helps give a truer picture of the situation.
Over the months, I've made numerous changes to my methodology and calculations of some of the "fuzzier" numbers which aren't locked down precisely in the HHS, CMS or state-run Exchange reports. For the most part, this refers to the Medicaid/CHIP enrollments, which are difficult to define since there's a lot of variables involved (including the "motive" of the enrollee in the case of "woodworkers").
On the Private QHP side, you have Paid QHPs (or Unpaid for Legit Reasons); Unpaid QHPs; SHOP Enrollments; and Off-Exchange QHPs.
On the Medicaid side, you have "Strict Expansion" and "Woodworkers" (which both count) as well as "Redeterminations (renewals)" and "Baseline Churn" (neither of which is counted, though the "churn" is very difficult to pinpoint).
However, there's one number which I've pretty much left alone throughout this process: The 3.1 million "Sub26ers"...that is, the 19-25-year olds who are now (and have been, for up to the past 3 years) included on their parents policies specifically due to the provision in the ACA which requires all policies to allow for this.
Example: If California experiences a massive 5-day outage like they did in February (which dropped their daily average, which had been 7,200/day the first half of the month, down to only 5,000/month overall), that will drop the needle dramatically. This isn't just idle speculation--yesterday Healthcare.gov apparently was offline for half an hour for some reason or another. Things happen, though obviously I hope everything will run smoothly throughout the next two weeks. Conversely, if CA announces an astonishing 30K/day day like they did back on December 23rd, that will move the projection up higher.
Contributor Ruth 37 sent a link to this open letter from Peter Lee from 2 days ago, regarding California's 1M QHP milestone and what CoveredCA's plans are going forward.
The number of people who have picked a Covered California health insurance plan now tops 1 million. This is an amazing accomplishment, and it means that with two weeks to go we have exceeded the highest “enhanced forecast” for the entire open-enrollment period. The health insurance companies report that more than 85 percent of those who have enrolled are paying their premium and getting coverage. That means 850,000 Californians are on their way to coverage through Covered California, which surpasses the top projection of 830,000....
This is a much bigger deal than it might appear to be. The title is a bit misleading; NM's Medicaid tally hasn't suddenly shot up 10x overnight, it's just that until now, I've only had New Mexico's ACA-enabled expansion number pegged at around 14,400 (10,300 Strict Expansion, 4,100 Woodworkers) because NM mixes together new enrollees with renewals (redeterminations) when they report the data to CMS. This means I couldn't use any of the CMS data (witness the red bar on the NM section of the Medicaid spreadsheet).
Today, I can replace both numbers with this one; the article is pretty damned clear that all 103K are specifically due to the expansion provision alone, but I'm willing to concede that perhaps 10% of it might be "woodworkers". Thereferore, "woodworkers" goes up to 10,300 while "strict expansion" increases to 92,700:
Two different people sent me two different articles which help piece together more of the off-exchange puzzle.
From January, this article about Independence Blue Cross of Pennsylvania:
Independence, the region's largest health insurer, with 13 plans on the marketplace, reported enrolling 52,278 people from Oct. 1, when healthcare.gov opened, through Dec. 24, the last day to buy for the new year....
Just over half of Independence's new members - 27,528 - went through the federal marketplace; 24,750 of them used the company's website, telesales, or the mobile Independence Express and brokers.
OK, that's 24,750 (47.3%) off-exchange enrollments through 12/24.
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.
A couple of weeks ago I pointed out that at least two states, Massachusetts and Oregon, may end up extending their enrollment period beyond the official March 31st "deadline" due to their exchange websites still being partially or completely hosed.
In Massachusetts' case, there's about 219,000 people currently stuck in coverage limbo; the HHS Dept. has granted an extension of some sort to as far out as June 30th to get these people squared away, although I'm pretty sure the extension only applies to those folks, not anyone who's just trying to enroll now...but that's still a hell of a lot of people.
Now that we're hitting crunch time and I'm getting some national TV buzz (well, The Graph is, anyway), people have started asking me what the best comparison to use for The Surge should be. There are three examples which come to mind for obvious reasons...and while all three are indeed very similar to the current situation in many ways, they're also very different.
Massachusetts/Romneycare, 2006:The irony of having the very guy who ran against President Obama on his signature healthcare law happening to be the same guy who implemented essentially the same law in his own state as Governor in the first place aside, there were a lot of similarities between the 2006 Massachusetts healthcare law and the Affordable Care Act. This article from last fall does a good job of going over the main ways that the two are similar...and how they're different. In short:
An interesting, if somewhat disappointing update from Washington State this evening. Paid QHPs are up 3,204 from 3/06 - 3/13 to 112,225, but this still leaves WA at 63% of their February rate for March so far (granted this is better than the 54% they were at through last week).
More interestingly, the number of unpaid enrollments has dropped from 82,060 down to 71,787...a reduction of 10,273 people.
What this means is that even if all 3,200 of the paid enrollees are "conversions" (enrollees actually paying for their policies), that still leaves over 7,000 people who are apparently being, as deaconblues put it, "purged" from the list. I'm guessing that these are mostly people from last fall or early this winter who let their final payment deadline expire without paying.
Mississippi started March with 25,554 as of 3/01, so this means they went up 2,946 in about 14 days (3/01 - 3/15), or 210/day. However, this is actually a 28% drop from February's 293/day. So far, out of 15 states which have provided March data, 10 are showing daily average increases from 116% to 295%, 1 is holding steady (Rhode Island) and 4 are showing a slowdown...but the overall increase over February is 176% as of today.
Another non-official update from Minnesota; no QHP/Medicaid breakout, but based on the 28/72 ratio to date, I'll assum the 4,350 or so new additions since 3/12 break out around 1,220 / 3,130, for totals of 34,942 QHPs and 90,062 Medicaid respectively.
If I'm correct about the split, that means that like most of the other states so far, Minnesota's daily average has ramped up to 50% higher than February's in March so far.
In addition to the increased enrollment opportunities, MNsure also announced today more than 125,000 Minnesotans have enrolled in quality, affordable coverage through the state’s health insurance marketplace. MNsure aims to enroll 135,000 by the March 31 deadline.
Ka-pow! This is the other big state exchange number I've been looking for this week (after California, of course). The New York State of Health exchange hasn't put out an official press release yet, but within the past hour they quietly updated the home page of their website with the new total enrollment number: 666,397.
The overall story out of Hawaii is pretty ugly, but the QHP number is actually good news, given what a mess HI's exchange has been: QHP enrollments are up from 4,969 as of 3/08 to 5,400 as of yesterday, an increase of 431. While this isn't exactly worth cheering about, it does raise Hawaii's daily average up from 37/day in February to 46/day in March...a 24% increase.
Tom Matsuda, the interim executive director of the Hawaii Health Connector, told lawmakers at a Senate hearing Monday that the nonprofit is woefully behind its projections of individual enrollment, with only about 5,400 people fully through the process of buying coverage. While that number doesn't count those still in "a backup in the system," Matsuda said, it's far behind the projected pace of 50,000 enrollees through 2014 it would have needed to break even.
The other day I noted that I've made little progress on the Off-Exchange QHP Enrollment Project. Not only have few people volunteered to help (though I do appreciate those who have), hunting down the data itself has proven harder than bullseyeing Womp Rats.
Case in point: Aside from my success with Washington State (I don't deserve any credit--they voluntarily published their data in a press release that I stumbled across), I've contacted 24 state Insurance Commission offices so far (Alabama - Mississippi). Out of those 24, here's the responses:
Yesterday was a pretty big day here at ACASignups--not only did the site get the 2nd most traffic to date (the busiest day was Feb. 13, when the January HHS report came out), but my Twitter feed went a bit nuts as my double prediction of California hitting 1M QHPs and HHS announcing 5M QHPs nationally gained attention; I think I picked up more new Twitter followers yesterday than any day since Sarah Kliff featured The Graph back on December 26th.
Whoa. Not an official update, but Colorado already had 93K QHPs as of Thursday the 13th; they're now at over 100K as of yesterday (the 17th). that's 1,750/day for the past 4 days, or 1,033/day in March so far. It doesn't specify QHPs vs. Medicaid, but CO was already at 135K Medicaid as of 3/01, so yes, these should all be private QHPs.
For comparison, Colorado was at 536/day in February, so CO in March is nearly double the February rate.
More than 100,000 Coloradans purchased health insurance through Connect for Health Colorado. 14 days left to enroll! http://t.co/jXVrGTnHQ0
It took Ohio awhile to get on board with the Medicaid expansion train, but once it did, enrollments really started to take off; it's more than doubled since 2/20, from 23K to over 54K:
COLUMBUS, Ohio (AP) - More than 54,000 Ohioans have enrolled in Medicaid under an expansion of the taxpayer-funded program.
Gov. John Kasich's administration moved forward last fall with extending Medicaid eligibility to cover thousands more people under the federal health care law. Coverage took effect Jan. 1.
The state's monthly report on Medicaid caseloads shows that 54,031 residents have gained coverage under its extension as of February. That's about 15 percent of the roughly 366,000 people who the state projected would be newly eligible by the end of June 2015.
Now that the Arkansas legislature has finally agreed not to screw over tens of thousands of their own citizens, a few thousand more people have enrolled in their unusual "Private Medicaid Option" (their version of "Expansion", which appears to basically be effectively the same as an entry-level QHP enrollee who receives a 100% tax credit...I think). Anyway, the Private Medicaid Option is up to about 98K plus an additional 13.4K added to "regular" Medicaid; this is up from 94,000 and 11,500 a few weeks ago, for a total increase of 5,844 altogether.
DHS said Wednesday that 207,967 people have applied for the private option and that 137,809 have been found eligible. Of those, 97,934 have completed the process of enrolling in private plans and 13,410 have been determined to be better served by traditional Medicaid.
On top of today's Big News out of California (1M) and the HHS (5M) comes a smaller, but just as significant update from Nevada. They're up from 20,930 paid / 9,085 unpaid (30,015 total) to 22,533 paid / 10,520 unpaid (33,053 total), a total increase of 3,038 (although the Paid rate in NV is down slightly, from 70% to 68%...although again, none of the new enrollees start coverage until April).
The significance is this: The first week of March, Nevada was averaging 211 QHPs/day, virtually identical to February's 212/day. However, with this addition, their daily average has shot up to 323/day, a 52% increase. Even more impressive, if you only include the 2nd week of the month, that's 3,038/7 = 434/day, or more than twice the daily average. The Surge is definitely here, folks.
Update as of 3/15: 33,053 consumers have confirmed Qualified Health Plan selections through Nevada Health Link, 22,533 have paid.
Thanks to contributor deaconblues for sending me this story out of Massachusetts, which puts a bit of a downer spin on the otherwise fantastic one-two punch of hitting 1M QHPs in CA and 5M nationally. The short version? MA fired CGI, won't hit their own twice-extended deadline, and has tens of thousands of people stuck in a weird healthcare coverage holding pattern for...no one seems to know exactly how long:
Massachusetts has chosen to toss out CGICorp., the architect of the troubled Health Connector website, amid an ObamaCare enrollment crisis that threatens to spill into 2015....
As this historic open enrollment period enters its final weeks, millions of Americans are finding quality, affordable coverage thanks to the Affordable Care Act. Fernando Valdez and Denise Schroeder were part of a weekend wave of consumers signing up for new coverage and bringing enrollment nationwide to more than 5 million through the Federal and State-based Marketplaces since October 1st.
OK, talk about an 11th-hour development: The Hawaii Health Connector, which has been competing with Oregon and Massachusetts for the "worst exchange" award, may have actually turned the corner just in time for the final 2 weeks of the ACA enrollment push.
If this development doesn't turn out to be another false promise (Hawaii's exchange has had several "It's working NOW! Oh, wait..." moments since October), there could be up to 16,000+ people who get piled onto the Hawaii tally over the final two weeks of open enrollment:
The Hawaii Health Connector, in its final stretch of open enrollment, says it has fixed a substantial number of system glitches that have frustrated consumers and stifled enrollment.
Contributor Maurice H. provides a bit of Off-Exchange data from Oregon. He contacted Oregon's Health CO-OP and while they didn't provide exact numbers, they were willing to provide their on-exchange/off-exchange ratios:
Oregon’s Health CO-OP is not sharing specific enrollment numbers, but is happy to give you the percentages of on and off Exchange:
On – 42% / Off—58%
Hope that helps.
Fortunately, an article in the Oregonian by the authority on all things Cover Oregon-related, Nick Budnick, provides the other piece of the puzzle:
Policies as of March 6th / Oregon's Health CO-OP: 212
Hmmm. Well, if 212 is 42% of the co-op's total enrollments, that makes off-exchange enrollments...505 people.
OK, not exactly a huge number, but an enrollment is an enrollment...noting it...
I just posted the big announcement out of California: They broke through the 1 million mark on Friday, reaching 1,018,315 QHPs as of Saturday night. This means they've been averaging over 10,600/day in March so far.
It also means, using my projection table, that the national total, which I had predicted would cross 5 Million sometime tomorrow, should actually break the 5 million mark today.
Specifically, the national total should be running around 167% higher than February's rate (33,600/day), or around 56,300/day in March so far. 56.3K x 15 days = 844,500, added to the 4,242,325 to date, for a total of about 5.09 million. I'll assume that this is highballing a bit, so tack on an extra day or so.
Now, they may not announce it until tomorrow, but if I'm correct about this, we should actually be at somewhere around 5.09 million by the end of today (Monday, March 17th).
There we go; I originally projected California to hit 1M last Tuesday or Wednesday, but didn't realize at the time just how bad the mid-February outage had hit the exchange. It ended up taking them 2 extra days to hit the 1M mark (Friday night). Fortunately, it looks like they've bounced back nicely:
Covered California’s enrollment reached the 1-million mark late Friday. By the end of Saturday, enrollment reached 1,018,315 in the health care exchange marketplace. The figure represents the number of people applying for coverage and selecting insurance plans for themselves and their family members through the exchange.
Just as a reminder: Based on my projection model and a little big of educated guesswork on my part, I've estimated that Private Exchange QHPs should be around 4.89 Million as of today, setting things up to cross the 5 Million mark sometime on Tuesday, March 18.
If I'm correct about this, then it means:
The rate averaged around 44,000/day for the first half of the month
The rate for the second half of March will have to average at least 74,000/day in order to hit 6 Million
The rate for the second half of March will have to average at least 141,000/day in order to hit 7 million
Obviously, the 7M target is going to be extremely difficult to reach at this point.
This new addition represents my personal estimate of the number of exchange QHP enrollments which have already been completed as of today, in addition to the ones which I've actually documented and sourced. Due to this addition, I'll be updating the chart daily going forward.
For instance, as of today, March 15, I've actually documented 4.47 million QHP enrollments. However, that only includes data through 3/01 for most states plus data since 3/01 for a dozen or so state-run exhanges. Obviously there have been additional enrollments in the other 35+ states that I just haven't documented/broken out by state yet.
From today's Detroit News, strong anecdotal evidence that Michigan, at least, is already seeing a spike in enrollment activity. The article also notes something that I didn't realize: I knew that anyone enrolling between 3/16-3/31 wouldn't have their policy coverage kick in until May 1st (and I've written about thisseveral times), but I didn't realize that those who do so would have to apply for an exemption from the IRS next year:
Health insurers and advocates are expecting a surge in enrollment for insurance plans Saturday, the deadline to guarantee coverage beginning on April 1.
March Surge Factor: Even if my formula for existing March data proves accurate, that only tells me how many March enrollments there would be if the daily rate doesn't change going forward. Obviously this is not likely to be the case; by all expectations, there should be a large end-of-month spike/surge that kicks in any day now. I haven't actually filled this in yet, I'm just prepping the spreadsheet for it. I'll be adding the Surge Factor starting on Monday.
Projected Daily Average: This measures my estimate of the QHP enrollment daily average throughout March so far. This is handy for helping estimate things like...
Projected Date for 5 Million QHPs: We should currently be at around 44K/day, which means we should hit the 5 Million mark sometime on Tuesday, March 18th.
No official update, but an article in yesterday's Coloradoan.com gives the Private QHP number as 93,000 as of Thursday, up 5,234 from 87,766 as of March 8th:
WASHINGTON — At least 100,000 Coloradans are expected to sign up for private health insurance on Connect for Health Colorado by March 31, according to the head of the state’s online health exchange.
With 93,000 people enrolled as of Thursday, “we are really exceeding our expectations,” Patty Fontneau, CEO of Connect for Health Colorado, told reporters in a conference call arranged by Families USA, a health care consumer advocate.
Hmm...Last week Maryland finally reported their Paid/Unpaid numbers (54% paid); this week they didn't for whatever reason. Anyway, their total QHPs are up from 38,070 to 40,693, an increase of 2,623 since March 1st.
On the Medicaid side, they've decided to bundle together the 96K PAC transferees with the "normal" new Medicaid enrollees for whatever reason. Subtracting out the PAC number gives 97,781 through March 11th, a very impressive 37% (26,332) gain since Feb. 25th.
From October 1, 2013, through March 8, 2014, there have been more than a million unique visitors to the Maryland Health Connection website. 186,268 Marylanders have created identity- verified accounts. Through March 8, 40,693 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
As of March 11, 193,670 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
UPDATE: CNBC Reports that 2 additional states (well, one state, Minnesota, as well as DC, anyway) have released their paid/unpaid data; the chart has been updated below, which changes...nothing really; Minnesota is at 90% while DC is at 75%, and Vermont's paid rate has apparently fallen from 85 to 59%...between the three they seem to have cancelled each other out.
I've written about the "But How Many Have PAID???" issue many times before, but going into the final stretch, I wanted to explain my reasoning as clearly as possible.
The following chart only includes states which have broken out Paid vs. Unpaid Enrollments. If you only use these 9 states as a guideline, it looks like the paid rate is around 80%:
Connecticut continues to Do It Right®. Not only have they broken their own combined goal by 60%, they're also now 37% past their fair share of the CBO's original 7 million QHP figure. The exchange's CEO is quoted in the article as saying that CT doesn't expect to see much of a "March surge", but that isn't too concerning to me--they're already doing fantastic, so any enrollment rate increase wouldn't be as dramatic by comparison anyway.
Oh, yeah--and 92% of all of their enrollees to date are paid up, even more impressive considering that this should include people whose policies don't even start until April.
In Connecticut, 160,580 people have enrolled in coverage through Access Health CT, surpassing the exchange's self-imposed goal of 100,000 people. Counihan said roughly 62,000 of those who enrolled signed up for one of three private health plans represented on the exchange. Most of the remainder signed up for some form of Medicaid.
Considering that their exchange website is still a complete mess, Oregon is actually doing a pretty good job of processing enrollments (not sure how many of these are newly added or reducing the backlog of older ones, not that it matters). Private QHPs are up almost 2,800 over last week, and Medicaid enrollees are up over 8,700.
In fact, so far, Oregon's March QHP enrollment rate (526/day) is actually nearly triple what it was in February (179/day). If every state were to pull this off, the total would actually surpass 7 million after all, though that doesn't seem likely at the moment.
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon
Total: 145,941 Private insurance: 45,119
Oregon Health Plan: 100,822
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.
(Sigh) Don't get me wrong, I'm glad Minnesota is staying on the ball with their updates but really, this is like 8 in the past 9 days or something...anyway, this one includes specific numbers for both categories, no messing with private/public ratios: 33,722 QHPs, 86,932 Medicaid.
Today, MNsure announced more than 120,000 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s health insurance marketplace. With an original goal of enrolling 135,000 Minnesotans, MNsure is on pace to meet or exceed that goal when open enrollment ends on March 31.
“We are averaging about 1,000 new enrollees every day,” said interim CEO Scott Leitz. “We anticipate we will continue, or improve this pace, keeping us on track to meet our original goal of enrolling 135,000 Minnesotans during this open enrollment period.”
The goal of enrolling 135,000 Minnesotans during the 2014 open enrollment period was discussed at the MNsure Board of Directors meeting on October 16, 2013.
Their last update had them at 57,090 QHPs and 223,378 Medicaid/CHIP, 280,468 total, so this is an increase of at least 19,532.
KY has recently shifted towards roughly a 17.5% QHPs / 82.5% Medicaid split. I'll assume a 15/85 with the newest batch for now, which brings the totals to 2,932 QHP / 16,600 Medicaid, for totals of over 60,000 and 240,000 respectively.
In addition, California's NEW Medicaid enrollee numbers continue to skyrocket, up from 877K (exchange) / 652K (bulk transfers/other) at the end of January to a whopping 1.136 Million + 968,500 = 2,104,500 total (!)
The wording of the 1.136M Medicaid number specifies that this is a combination of NEW enrollees as well as "ongoing caseload activity", which sounds to me like people who enrolled a few months earlier but are still having paperwork issues. Either way, it sounds clear to me that these are not "renewals (aka rederminations)".
A beautiful find by new contributor Uncle Toby: Highmark Inc., a major insurer which serves Pennsylvania, West Virginia and Delaware, just did exactly what I've been wanting every insurer to do: They officially announced not just their off-exchange enrollments, but specified the exact date that these run through and the fact that they're all 100% ACA compliant.
As a bonus, they've included specific state-by-state breakdowns as well as a comparison against their on-exchange enrollments. 32% of PA's, 27% of WV's and 29% of Delaware's QHP enrollees to date have been off-exchange. This proves exactly what I've been saying: There are absolutely several million (at a minimum) direct QHPs out there which simply haven't been documented publicly yet.
A couple of days ago, Avalere Health, with whom I've alternately butted heads with and agreed with on all things Medicaid-related, has issued their QHP projection: They're calling for around 5.4 million total. In order to hit that number, the March average would be around 38,600/day.
Avalere is basing their projection primarily on the Medicare Part D enrollment pattern back in 2006. They could very well be correct, but there's also some key differences between that situation and this one (the most obvious one: Medicare enrollments were presumably mainly limited to those over 65, whereas it's the "Young Invincibles" that are the primary target at the moment). However, I'm not going to pooh-pooh their projection either, as there are many similarities between the two as well: Both were/are large, national government healthcare enrollment programs, with a 6-month limited enrollment period, a financial penalty for not enrolling by the deadline and so on.
After a couple of weeks where the paid QHPs seemed to only be drawing from the existing unpaid enrollments (a sign of new additions drying up), WA seems to be back in gear with 2,740 more paid QHPs, 4,019 more unpaid QHPs and 16,247 new Medicaid/CHIP additions, all since February 27th.
Qualified Health Plans: 109,021
Medicaid Newly Eligible Adults: 222,607
Medicaid Previously Eligible but not Enrolled: 115,159
Qualified Health Plan Applicants – Need to Pay: 82,060
*Note: These numbers reflect enrollments and applications through March 6.
Looks like the 30/70 QHP/Medicaid split that I've been assuming for Minnesota has shifted somewhat; as a result, I actually have to lower the QHP number by a bit compared with the 3-4 mini updates from last week. MN QHPs now stand at 33,362; new Medicaid/CHIP enrollees are at 85,267 as of March 11.
In addition, SHOP (Sm. Biz) enrollees are up a bit from 1,042 to (660 employees x1.8 per household) = 1,188 total individuals covered.
DC itself has an unusual situation: Due to the quirky ACA rule that has Congressional Staffers (some 10,000 of them) enroll via the Small Business SHOP exchange instead of the individual exchange (or that of their home state), DC's SHOP exchange actually has twice as many enrollees as individual QHPs. Anyway, QHPs have gone up 267 in the first week or so of March, while SHOP enrollees have gone up 104. Meanwhile, new Medicaid enrollees are up 506.
As of March 9, 2014, 30,642 people have enrolled through DC Health Link in private health plans or Medicaid:
6,516 people enrolled in private health plans through the DC Health Link individual and family marketplace; 11,383 people gained Medicaid coverage through DC Health Link; and 12,743 people enrolled through the DC Health Link small business marketplace.
Eureka! I just received an explanation from the New York Dept. of Health of the mysterious 40,000 QHP enrollment discrepancy between the February HHS report and the New York State of Health press releases--apparently the additional 40K are newly-added enrollees in NY's Child Health Plusprogram, which is privately operated (and thus not included under Medicaid/CHIP) but is also technically not an official "Qualified Health Plan" by the technical definition.
According to the NY DOH, the higher NYSoH enrollee numbers include both the technical QHPs as well as enrollment in the state's CHild Health Plus program. This program covers kids up to 19 years old, with subsidies given for families up to 400% of the FPL. Therefore, children who fit this criteria get enrolled in Child Health Plus instead of actual QHPs.
They've specifically confirmed that "over 40,000 additional children have been enrolled in Child Health Plus through the Marketplace."
Contributor Steve Ciccarelli brought the following footnote ("Appendix D") from the February HHS report to my attention, which kind-of, sort-of explains the 40,000 QHP enrollment discrepancy between HHS (which gives the 3/01 total as 244,618) and the NY State of Health Exchange, which had the total as appx. 285K as of 3/01:
It is important to note that the SBM enrollment-related data that are reported in this issue brief represent state data that have been reported to CMS through March 7, 2014, and may differ from comparable data that have previously been publicly reported on SBM websites or in media reports because that data may be based on different time periods or metric definitions from those used in this report.
I've already corrected for the "different time periods" in order to get the 285K number from the NY exchange for March 1st. The 40,000 difference between them and HHS appears to fall into the "different metric definitions".
Here's all 50 states, sorted by their achievement of sensible "% of 7M" QHP enrollment goals (as opposed to the CMS's state-by-state projections, which never made much sense).
Two caveats: First, most of the state-based exchanges (blue rows) have an unfair advantage, as their numbers include some post-3/01 data. However, this should still give a good general sense of how the states are doing going into the home stretch. Second, all QHP numbers shown include unpaid enrollments, even for states which have broken them out; this seemed more consistent to me (and yes, I realize the contradiction in going for consistency on that front while still including post-February data on some states, but what the heck).
Anyway, as you can see, the state exchanges are definitiely in the lead:
--Vermont is crushing everyone else, with more than 300% of their fair share of the 7 million figure enrolled
--Washington, Connecticut, DC, Rhode Island and California, all state-based exchanges are all also above their "7M CBO" projections
--4 more states are also overperforming (that is, above the 89% mark; the enrollment period is 89% of the way through as of today): Idaho, New York, Maine and Michigan
--Interestingly, even though the Massachusetts and Oregon exchange websites are still complete messes, both states are actually "peforming" quite well now in terms of actual enrollments based on their reasonable percentage of the total uninsured nationally. In both cases, the states wisely made the decision to pour a ton of resources into manually processing enrollments instead of focusing purely on fixing the websites. While neither should be cheering, this tactic does seem to be acting as a pretty effective workaround.
--Meanwhile, the other 3 troubled websites, Hawaii, Nevada and Maryland, are indeed in the lower half of the list...but amazingly, Hawaii (with arguably the worst-running exchange) is above the other two, based purely on their extremely low uninsured population to begin with.
--Finally, bringing up the rear are mostly the usual suspects: Wyoming, Iowa, South Dakota, Louisiana, Texas, West Virginia, Oklahoma and Alaska. The only surprise (to me) here is to see New Mexico coming in dead last; as far as I know, NM's political climate should be fairly ACA-friendly, but so be it.
The February HHS Report included some especially confusing numbers out of the two largest state-run exchanges, California and New York, as both seemed shockingly low given how successful they both seemed to be doing in the first half of the month.
In the case of California, they were kicking serious ass in the first half of February, averaging around 7,200 QHP enrollments per day. Unfortunately, a few days later the CoveredCA exchange was hit with a very nasty technical problem which brought things to a standstill for not the 3 days that I thought, but 5 days. Result? The daily average dropped from 7,200/day in the first half to only 2,800/day for the second half of the month:
Enrollment in Obamacare coverage slowed last month in California, hurt by a recent website outage.
New federal data show 868,936 Californians signed up for health insurance in the state's exchange through March 1.
OK, now that I've resolved the 290K discrepancy from the HHS report (short answer: they corrected the report sometime yesterday, but the total hasn't changed), and have confirmed that someone from HHS/CMS is checking on the 40K New York QHP discrepancy, I've finally been able to update both The Spreadsheets (QHP and Medicaid) and The Graph with the latest data. Here's where things stand as of the morning of March 12th:
PRIVATE QHP ENROLLMENTS:
Exchange-based, Paid or Unpaid for Legitimate Reasons Only: 3.91 Million
Exchange-based, Including Unpaid Enrollments: 4.45 Million (this is the figure used to measure against the CBO 6M/7M projections)
I ran into a similar issue a month ago, and thought I had straightened it out, but there's a major disconnect between the official HHS numbers for New York and the NY State of Health press release data.
According to HHS, New York only enrolled 33,328 people in February:
Colorado's offiicial metrics press release from last week only runs through March 1st, but contributor deaconblues found an interesting county-by-county breakdown which runs through the 8th. No Medicaid data, but the QHP number is up to 87,766, a 2,885 increase over a week earlier.
Y'know, no one wants up-to-date data more than me, but did Rhode Island really have to release their latest state enrollment data TODAY, while I'm still in the middle of compiling/updating the HHS report???
Anyway, They're up to 16,345 paid + 3,345 unpaid QHPs, and 48,602 new Medicaid enrollments, plus some SHOP updates. Yeesh.
Enrollment data (Oct. 1, 2013 through March 8, 2014)
Total HealthSource RI enrollments (including those who have not yet paid): 19,690
Paid enrollments: 16,345
Medicaid enrollments (per EOHHS): 48,602
Small employer applications initiated: 1,132
Small employer enrollment: 133 (these 133 employers represent 491 covered employees and 795 covered lives)
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.
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!
For the most part this is just a standard update for Connecticut, which continues to be one of the most successful ACA exchanges with little drama; private QHPs are up another 2,065 from 58,469 on March 5th to 60,534 as of yesterday, while new Medicaid enrollments have gone up from 82,764 to 92,027, an increase of 9,263. Connecticut recently gave a "Paid QHP" percentage as 91%; assuming this still holds, I have them at 55K paid / 5,534 unpaid.
However, in a nice surprise, the latest update also separates the Medicaid numbers out into "strict expansion" (69,692) and "woodworkers" (22,335). This makes CT among only a handful of states to pinpoint the Medicaid enrollees in this way; hopefully the other expansion states will follow.
According to Access Health CT, 60,534 people have signed up for plans with Anthem, Healthy CT, and ConnectiCare. The rest, or 92,027 individuals, have signed up for Medicaid plans that are funded by the federal government.
Nevada just updated their QHP enrollments for the first week of March: 20,930 paid (up from 19,840 on 3/01) and 9,085 unpaid (up from 8,695 on 3/01). The combined tally is an increase of 1,480, from 28,535 to 30,015.
Update as of 3/8: 30,015 individuals have confirmed Qualified Health Plan selections with Nevada Health Link, 20,930 have paid.
There's a lot of buzz today about a new Gallup poll which states that the total uninsured rate has fall by about 1.2% since the end of last year:
The percentage of Americans without health insurance continues to fall, measuring 15.9% so far in 2014 compared with 17.1% in the fourth quarter of 2013.
These data are based on more than 28,000 interviews with Americans from Jan. 2-Feb. 28, 2014, as part of the Gallup-Healthways Well-Being Index. With only a few weeks remaining in the first quarter, the uninsured rate is on track to be the lowest quarterly level that Gallup and Healthways have measured since 2008.
And another "mini-update" out of Minnesota...up another 2,000 total in 3 days to 115,001+. Still assuming a 30/70 QHP/Medicaid split until they release detailed numbers, based on existing data, which brings MN up to 34,600 QHPs / 80,401 Medicaid.
ST. PAUL, Minn. — MNsure announced today an addition to their television campaign that highlights the March 31 deadline to enroll in a qualified health plan. More than 115,000 Minnesotans have enrolled through MNsure to find comprehensive, affordable coverage, and with only 21 days left of the open enrollment period, MNsure is reminding Minnesotans to take action so they do not incur a penalty.
While it's great to see an official press release instead of just the number on the website, and it's also great to see that the new number is 32,000 higher than 5 days ago, it's rather irritating and strange that nowhere in the press release do they break out the QHP/Medicaid numbers.
ALBANY (March 10, 2014) – NY State of Health (NYSOH), the State’s official health plan marketplace, reported that as of 9 a.m. today, 908,595 New Yorkers have completed their applications and 590,639 have enrolled for coverage since the launch of the Marketplace on October 1, 2013. More than 70 percent of those who have enrolled to date were uninsured at the time of application. Over the last week alone, enrollment has increased by more than 55,000.
I discussed the "Paid/Unpaid" issue in the California update a few moments ago, but the topic needed a separate entry as well. According to the San Jose Mercury News, CA-exchange-based QHP enrollees who enrolled by January 31st are up to an 85% payment rate, from 80% as of 2/19:
The numbers of nonpayers varied only slightly among the largest insurers on the exchange: Kaiser Permanente reported that 13 percent of its enrollees didn't pay. Anthem Blue Cross of California, Blue Shield and Health Net said it was closer to 15 percent.
Federal officials say they've noticed the same trend nationwide.
As I've pointed out repeatedly, it's not enough to know how many haven't paid, it's also important to know when the unpaid policies actually start as well as why they haven't paid yet.
This article is both very helpful but also has 2 frustrating data points missing. The key numbers: While CA was averaging around 7,200 QHP enrollments per day in the first half of February, that rate is apparently up to 8,000/day now. This is excellent, but I don't know whether that 8K/day rate is only for the past week or if it includes the full 2nd half of February (I would guess that it's risen steadily since then.
On the other hand, CoveredCA also suffered from a 3-day outage, which could skew the daily average...they had 3 days of no enrollments, followed, presumably, by the 22K people who tried on those days possibly joining another 22K over the subsequent week or so. Either way, it's looking pretty good, though California will have to end up averaging around 20,000/day in March to do their part in hitting 7M total by 3/31, or 13,000/day to hit 6M.
The other big news here (the main point of the article) is that payment rate for enrollees through 1/31 has gone up from 80% as of 2/19 to 85% as of a couple of days ago:
Greetings, all...just a few little site enhancements that I've added going into the Home Stretch:
As you may have noticed, I've started adding simple State Icon graphics to the entries. The site is pretty bland...nothing but dry text...so I decided to spruce it up a bit. In keeping with my Dour, Strictly Business style, however, the icons are still gray :)
For a long time I've kept the commenting system on a very short leash, to avoid spammers and wingnuts from pissing all over the threads. As such, I've limited commenting to only those who contribute either a donation or new data points. I've decided to experiment by replacing the comment system (which hasn't really had that much activity so far) with the more open-ended Disqus system; people will still have to log in with an account, but at least it should be attached to something solid (Disqus, Facebook, Twitter or Google+). We'll see how it goes...if the comments go to hell, I'll reverse myself and go back to the previous version (existing comments are all still there, though they don't appear on the Disqus system).
I know this is really cheesy, but I couldn't help myself: I've added a QHP Enrollment Deadline Countdown Clock on the home page. I've also posted my official QHP Projections for February (902,000) and Cumulative through 3/01 (4,202,000). (OK, never mind...the countdown clock was messing up the layout on smartphones, and it was pretty cheesy-looking. Plus, as someone pointed out, there's at least 2 states (Oregon & Massachusetts) for whom 3/31 may not end up being the deadline anyway...
Whoops...looks like I may have misread the previous Cover Arizona report. It had stated the total added to Medicaid due to Prop 204 restoration + Expansion as being 134,674, but they didn't specify the starting date for that figure; this time they're more specific, giving the total as 91,115 since October, which is the relevant date. Correcting now...sorry about the mix-up.
As of March 1st, AHCCCS reported that there had been 85,309 Arizonans added to AHCCCS under the Prop 204 restoration category (adults between 0-100 FLP) and 5,806 added to the expansion category (100 -133 FPL) since October. In total, that adds up to more than 91,000 Arizonans who have been added to AHCCCS since October due to the restoration/expansion.
I've had quite a few updates first announced via Twitter, but this is the first one I've received via Facebook: Kynect Kentucky just announced 275,000 total enrollments, an increase of 10,086 since 2/27. The announcement was apparently made on Thursday the 6th, so presumably they hit the 275K point by the end of the Wednesday the 5th. Assuming the same 20.4% QHP / 80.6% Medicaid ratio that they've had until now, that brings KY up to 56,000 Private QHPs and 219,000 new Medicaid enrollments.
kynect Enrollments Top 275,000!
Staff at the Kentucky Health Benefit Exchange paused on Thursday to celebrate this enrollment milestone, and prepared for a different kind of "March Madness," as Kentuckians rush to find affordable health care coverage through kynect before the March 31 deadline, when the 2014 open enrollment period comes to a close.
UPDATE: Hold the phone! Kynect just replied to me personally on Facebook, clarifying both the even more-recent total through yesterday as well as the exact QHP / Medicaid numbers!!
Several new numbers out of Arkansas. QHPs were at 21,763 at the beginning of February; I'll assume "late February" means around the 26th(?), so that's 4,237 in around 25 days.
On the Medicaid side, Arkansas' unusual "private option" system (in place of the standard Medicaid expansion) is a bit confusing as usual; technically the 94,000 people referred to are enrolled in "private" QHPs, but their bill is being footed 100% by Medicaid money, which is the more important factor here. The other 11,500 referenced were placed in "Medicare" although I'm pretty sure that's a typo and that it's supposed to read "Medicaid" (as in, "normal" Medicaid). It doesn't really matter, though; either way, both of these groups end up on the Medicaid side of the aisle, bringing Arkansas' total up from 79,000 to 105,500 new, ACA-enabled Medicaid recipients.
Already, as of late February, Wilson said 26,000 people had enrolled in the Health Insurance Marketplace and "had been transmitted to the (health) insurance carriers."
Connecticut's exchange PR person gave a new combined QHP/Medicaid tally of 141,233. The story was posted on the 7th but was actually updated on the 6th, so I'm assuming the number was as of the 5th. The previous number was around 58K Private QHPs and 82,100 Medicaid; using the same 41/59 ratio should bring these to 58,469 / 82,764.
Kathleen Tallarita, government and public affairs outreach manager for Access Health CT, said 141,233 residents statewide have signed up for health insurance through Access Health CT, created as the state's response to the federal Affordable Care Act. That surpasses the agency's goal of 100,000 new sign-ups in the first year.
Two reasons have been offered for why McKinsey might be wrong. For starters, Charles Gaba asks why, if McKinsey is correct, these numbers are so different from the numbers in New York, which collects data on prior insurance status and has found that a majority of purchasers are the previously uninsured.
I believe this is my first Missouri-specific QHP update: Their private enrollments went up from 54,147 as of February 1st to "about 68,000" by February 20, an increase of 13,853. Like the average of the other 17 states I have post-2/1 data for, Missouri's February enrollment rate appears to be very close to what it was in January, so I'm still confident of my appx. 902,000 February HHS report projection.
As of Feb. 20, about 68,000 Missouri residents had enrolled in private health plans through the online insurance marketplace, most of whom received federal subsidies to help offset the cost of premiums, said Ryan Barker, vice president for health policy at the Missouri Foundation for Health, a nonprofit group that's promoting the insurance marketplace.
Well, Oregon's website may still be a complete disaster, but their manual enrollment process seems to be chugging along fairly well. Private QHPs are up 3,500 from 38,806 a week earlier, while Medicaid enrollments are up another 7,100 from 84,991.
Note that they've finally stopped including the "Fast Track" Medicaid numbers, presumably because they've already enrolled everyone they could find via that route:
March 7, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon
Total: 134,412 Private insurance: 42,325
Oregon Health Plan: 92,087
Update: Something else very interesting about Oregon's situation. Take a look at their QHP enrollment history:
02/01: 33,808 (15,471 in 35 days, or 442 per day)
02/28: 38,806 (4,998 in 27 days, or just 185 per day...a 58% drop per day, ouch!)
However, today they announced the number, as of (I presume) yesterday, the 6th, as:
Back in January, I found my first solid data on off-exchange enrollments via a Co-Op operating in Iowa and Nebraska called CoOportunity. They helpfully provided their data through January 24, which totalled 10,166 off-exchange enrollments in Iowa and antoher 17,779 in Nebraska.
Last week, they provided an update to these figures. When you add off-exchange individual/family policies to small & large group policies (which are "off-exchange" by definition, since the HC.gov SHOP system isn't operational yet...you get redirected to the individual companies/co-ops), Iowa is up to 12,293 and Nebraska is up to 19,959, as of February 24.
Last month there was news out of Massachusetts of some sort of extension being granted to "bring the state’s health care system in line" with ACA regulations. At the time I didn't pay much attention to it, thinking that it only related to administrative procedures or somesuch.
However, it turns out that there's actually 154,000 people who are currently enrolled in a sort of healthcare batter's box, being placed on hold until MA's screwed-up exchange is able to absorb them into the system via proper ACA-compliant QHPs (or Medicaid/CHIP...not sure about that yet):
Unable to immediately enroll applicants in new, private plans under the Affordable Care Act, state officials extended existing state coverage for about 124,000 individuals, and granted temporary state coverage to about 30,000 new applicants. Those individuals were supposed to move onto new plans by March. 31; the federal waiver gives officials another three months to do that.
So why am I bringing this up today, 3 weeks after that story broke? Because a contributor called my attention to this story out of Oregon:
Maryland's private QHPs went up 2,434 in the last week of February. More noteworthy, Maryland's exchange seems to be getting a lot of pressure to explain their "paid/unpaid" data; this is the most extensive explanation I've seen from any state about the subject (except for one Vermont report last month). They're up to 38,070 total, of which 20,439 are paid up.
Medicaid numbers are the same, since they're still through 2/25.
Through March 1, 38,070 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
On the one hand, it's nice to see Minnesota post 3 enrollment updates in a single week. On the other hand, for some reason they didn't include the exact number or the QHP/Medicaid breakdown this time. Not sure why...it's already known that their private QHPs have been making up around 30% of the total until now, and the exact tally through 3/1 will be out next week sometime anyway; no point in trying to mask low numbers. Strange.
Anyway, I'm still assuming a 30/70 split, which would be another 300 QHPs and 700 Medicaid/CHIP on the pile, for a total of 34,000 / 79,001.
ST. PAUL, Minn. — Today, MNsure announced more than 113,000 Minnesotans have enrolled in comprehensive, affordable health insurance coverage through the state’s new health insurance marketplace.
Hawaii's private QHP exchange may still be a mess, but there's great news out of the Medicaid side: Over 48,000 new enrollees since October 1st. The article specifies that these are a combination of "strict expansion" and "woodworkers", though it doesn't break the total out between those two, which would have been nice to have, but so be it. Based on existing data, I'll assume roughly 25% woodworkers to 75% strict expansion for now, or 12K / 36K.
Hawaii has seen a spike in Medicaid enrollment since eligibility was expanded under the federal Affordable Care Act, with more than 48,000 new enrollees since October.
“The expansion (to 138 percent of the federal poverty level) meant Hawaii was expecting about 48,000 additional beneficiaries because of the mandate that you have to have insurance,” said Kayla Rosenfeld, spokeswoman for the Hawaii Department of Human Services, who noted that enrollment has exceeded that benchmark to date. Increasing enrollment is also due to greater awareness rallying Medicaid-eligible individuals “out of the woodwork.”
The good news is that North Dakota's Medicaid tally has gone up from 1,700 as of early January to over 4,000 at the beginning of February. The bad news is that due to an oversight on my part, this is actually a drop from what I had entered in that field (a confusingly-worded article in January led me to confuse enrollees with the potential pool, which was considerably higher). Anyway, ND Medicaid stood at 4,071 as of a month ago.
As of Feb. 1, 4,057 people in North Dakota had selected an insurance plan through the marketplace. That’s up from 2,624 who chose a plan in the final three months of 2013. Another 4,071 here have been determined to be eligible for Medicaid or the Children’s Health Insurance Program.
Another non-exact update; in a press release issued today, MNsure gives the combined total of QHPs & Medicaid enrollees as "more than 112,000", up around 3,000 from a few days back. As I did then, assuming the same 30/70 split that MN has had up until now, this means an increase of around 900 QHPs and 2,100 Medicaid enrollees.
As always, these figures will be adjusted as necessary when the formal data is released by MNsure.
To date, more than 112,000 Minnesotans have selected health insurance plans on the MNsure online marketplace. Under the Affordable Care Act, consumers must enroll in health insurance coverage by April 1, 2014, or face a penalty.
Iowa's Medicaid total just got a nice shot in the arm. It seems that 55,034 Iowans who were previously enrolled in IowaCare have been bulk-transferred over ot Medicaid proper, on top of over 13,000 additional new enrollees. All of these people are specifically listed as being due to ACA Medicaid expansion, they are not woodworkers.
While the total above is 67,893, another article from the next day lists the exchange-based enrollments as "more than 13,000", so I've bumped it up by another 142.
More than 50,000 former IowaCare members automatically were enrolled in the new system, giving them access to more services and a choice in who provides their health care, including – in many cases – local options, McCoy said.
Including those who have signed up since, the Iowa Health and Wellness Plan through mid-February boasted a total enrollment of 67,893 – 55,034 in the wellness plan and 12,859 via the marketplace choice, according to McCoy.
This is an interesting example of the fundamental philosophical difference between those who support the ACA and those who oppose it (well, those who oppose it from the Right, anyway; some people oppose it from the Left because they'd prefer Single Payer, Public Option, etc.).
It seems that Illinois has seen Medicaid enrollments shoot up quite a bit more than expected since ACA Expansion officially went into effect on January 1st. This appears to be primarily due to the "woodworker effect", which the article, as a bonus, breaks out specifically: 200K Strict Expansion + 115,000 Woodworkers:
Illinois has added 315,000 people to Medicaid since Jan. 1. Here’s a breakdown:
Two nice finds about Connecticut from contributor deaconblues today. The first article (about CT shopping their successful exchange website package around to other states) gives the QHP enrollment through 3/01 as roughly 58,000; this is up from 53,673 eleven days earlier, an increase of 4,327.
The second article gives the total enrollments as of 2/24 as around 128,000, which suggests around 80,000 Medicaid enrollments, but a little simple math to account for the 5-day difference in the two figures gives the actual Medicaid portion of that as being around 2,100 higher, or 82,100 total. This is an increase of 9,120 people in 6 days.
As of March 1, some 58,000 state residents had signed up for private health insurance through Access Health CT, nearly twice the goal of 33,000 established by federal officials for the entire open enrollment period, which runs through the end of the month, according to Kevin J. Counihan, chief executive of the Connecticut exchange.
At a press conference today, the Secretary of the DHSS announced that Delaware's private QHP enrollments went up 38% in February while Medicaid expansion went up 55%, to 6,994 and 2,168 respectively. Not much in sheer numbers but a nice bump for a small state. This brings Delaware up to 58% of their reasonable 1st year QHP goal of 12,000.
Sec Landgraf says 6,994 Delawareans have enrolled in the marketplace through Feb. 28, up 38% from last month's report. #choosehealthDE
Yesterday the Obama administration announced several new modifications to ACA implementation. The one that's getting the most attention is a 2-year extension on non-compliant, pre-ACA healthcare plans. After getting criticized for "lying" about his "if you like your plan you can keep it" statement last fall, Pres. Obama gave individual states the option of extending existing plans by 1 year if they wanted; this just extends that period further, out to pretty much the end of Obama's term of office:
Americans with health coverage that predates Obamacare can stay on their plans for two more years, insurers will have an extra month to enroll customers next winter and states will get more time to decide whether to manage the law themselves, officials said. Also, a program aimed at covering financial losses for insurers will be adjusted to help ensure it doesn’t cost taxpayers, the Obama administration said.
Another nice find by contributor Denver11. Family Health Hawaii is a new insurance company that is apparently not on the Hawaii exchange, meaning that any enrollments they sign are off-exchange by definition. The article doesn't give a specific number of ACA-compliant plans, leaving it an amorphous "most" out of 3,400. I'm figuring 60%, which would be 2,040 employees. Using my standard (and very conservative) 1.8x people-per-household (per employee) ratio, that comes to around 3,672 total individuals covered.
If I'm not missing something, this brand-new startup company has single-handedly enrolled 80% as many Hawaii residents as the state exchange has. Not sure if this says more about the company or the exchange.
He [Family Health Hawaii CEO JP Schmidt] estimated that around 3,400 employees are enrolled to date, with the goal of enrolling 50,000 employees by the insurer’s five-year mark in 2018. And while the insurer offers some grandmothered 2013 plans, most seem to be opting for the new Affordable Care Act 2014 plans, he noticed.
Nice find by contributor deaconblues; Arizona's Medicaid tally was at around 98,000 on January 10, so this represents a 37% increase to 134,674 total. The "coverage restored" note is a bit confusing, but it sounds like this includes a mixture of "woodworkers" and "baseline churn" while the 3,042 number appears to be part of "pure expansion". However, note that I'm still only counting 20% of the grand total (of which this is just a portion) as "woodworkers" and 50% as "expansion".
If any Arizona Medicaid expert wants to help sort this out, feel free to contact me.
As of February, nearly 64,000 adults eligible for AHCCCS under Arizona voter mandate Prop 204 had their AHCCCS coverage restored. (In total, there are 131,632 Arizonans enrolled in this eligibility category.)
An additional 3,042 adults who were without health insurance were able to access health insurance in the “expansion” eligibility category (those earning between 100-133 percent FPL.)
There hasn't been any sort of press release yet, but the total enrollment figure on the home page of the New York health exchange shot up over 11% today, from 501,205 up to 557,840, a jump of over 56,000 people.
I don't have the Private QHP/Medicaid breakdown yet, but the ratio has quickly shifted from 60 private/40 public through early February to a 23/77 split in favor of Medicaid a couple of weeks ago. I'm going to error on the side of caution and assume that this trend has continued, so I'm going with a 20/80 split for the new additions until the actual numbers are released. I'll be more than happy to be overly cautious on this if the breakout is more favorable to private QHPs, however.
In any event, a 20/80 split would mean the 56,635 additional enrollees break out as 11,327 Private QHPs and 45,308 Medicaid/CHIP, for totals of 288,008 & 269,832 respectively.
For months now, I've been pointing out that while the CBO's original 7 million overall Private QHP projection seemed reasonable at the time, the CMS's state-by-state projections to achieve that 7 million goal never made any sense, and in some cases were flat-out ludicrious. States like New York and Kentucky were assigned the same enrollment target even though NY's population is 4.5x the size of KY's, and so on.
Even within individual states this made no sense--Vermont was expected to have 57,000 people enroll in QHPs even though they only have around 47,000 uninsured residents. Sure, there'll be some overlap due to the "5 million policies cancelled!!" debacle (ie, people switching from a non-ACA compliant plan to a compliant one, including my own family), but it still made little sense, and in fact the odds are very high that someone simply copied & pasted Utah's projection numbers onto Vermont, right below it.
I know Hawaii has a small population to begin with, and a very small number of uninsured residents out of those, but this is still a bit underwhelming: Private QHPs are up less than 200 from 2/22 to 3/01, to 4,661.
Total since October 1, 2013
20,018 Applications completed in the Individual Marketplace
4,661 Enrollments in the Individual Marketplace
Using my new (upcoming) "potential pool" methodology, after removing undocumented immigrants and assuming that 60% of QHP enrollees were previously uninsured, Hawaii is now at:
2,797 out of 35,000 potential QHP enrollees (8%)
14,746 out of 58,000 potential Medicaid/CHIP enrollees (25.4%)
Colorado continues to be one of the more smoothly-running state exchanges, adding 5,102 Private QHPs and 7,341 new Medicaid enrollees in the 2nd half of February. These represent a 6.4% and 5.7% increase respectively. Unfortunately, their daily QHP rate for February, which had looked to be slightly higher than January, was actually down about 8% per day. As always, in CO, the Medicaid number listed only includes actual ACA expansion (woodworkers are included separately in the CMS reports; there are no renewals or churn the number below).
Here's a bonus data tidbit that's also a precursor to a new feature that I'm adding later this week: Out of the total uninsured in the state, Colorado has a potential QHP pool of around
325,000 residents, and a potential Medicaid pool of around 332,000 people, once you remove undocumented immigrants.
Assuming 60% of QHP enrollees were previously uninsured, this means Colorado has enrolled:
In an unofficial update, MNsure's CEO has confirmed the total number of exchange-based enrollments as "more than 109,000" total through March 2nd (the PR was issued on the 3rd). In the previous update (thru 2/24) had QHPs at 31,522 and Medicaid at 73,271 new enrollees (104,793 total), so the combined total has gone up at least 4,208. Assuming the current 30/70 split between private QHPs and Medicaid holds true, this brings Minnesota up to 32,784 and 76,217 respectively.
“Since October 1, more than 109,000 Minnesotans have secured affordable health insurance coverage through MNsure,” said MNsure’s interim Chief Executive Officer Scott Leitz
Small update out of Nevada: Between 2/22 and 3/01,paid QHPs went up 698 from 19,142 to 19,840 while unpaid QHPs increased from 7,893 to 8,695, for a total increase of 1,500 even. Nevada's Paid percentage remains at around 70%.
Update as of 3/1: 28,535 Nevadans have confirmed Qualified Health Plan selections with Nevada Health Link, 19,840 have paid.
Hmmm...I'm hoping that either this weeks or last weeks press release from the Washington exchange contains a clerical error, because if both are accurate, it means that private QHP enrollments in Washington State all but dried up in the last week of February. They're showing an increase of paid enrollments from 101,857 (as of 2/20) to 106,281 (as of 2/27), which isn't bad (about 4,400 more)...but a decrease of unpaid enrollments from 82,249 to 78,041. This means that the total number of enrollees only went up by 216 during that week; the rest were all conversions of unpaid to paid. The good news is that this improves WA's paid percentage from 55% to 58%.
Meanwhile, WA's Medicaid expansion increased at a more reasonable rate, from 202,168 expansion-only + 102,238 woodworkers (304,406 total) to 212,633 expansion + 108,886 woodworkers (321,519 total), or by about 17,000 people.
Another way of looking at it: According to the Kaiser Family Foundation, prior to the ACA, WA had a total of around 959,000 uninsured residents, of which around 449,000 are supposedly eligible for Medicaid.
*(when each is corrected for certain factors...read for explanation)
A month ago, Avalere Health released an analysis of the Medicaid/CHIP data released by the HHS and CMS for the first 3 months of the ACA enrollment period, October through December. At the time, they estimated that the number of new Medicaid/CHIP enrollments due to ACA expansion as being somewhere between 1.1 million - 1.8 million. I questioned some of their methodology (counting households instead of individuals for some states, not clarifying whether the figures included "woodworkers" or not, not accounting for seasonal variations in enrollment patterns, and not including any January data at all). They acknowledged some of these points, but also pointed out a few valid flaws in my own methodology (primarily forgetting to correct for "baseline churn").
Originally, our respective Medicaid tallies at the time came in at:
For months I've been talking about the "holy grail" of missing ACA data: Direct, or Off-Exchange enrollments: People buying ACA-compliant health insurance policies directly via the insurance companies without bothering to do so via the Federal or State exchanges. I've documented nearly a half-million of these already from just a handful of companies (and 1 state, Washington), and over the weekend launched a new effort to try and crowdsource the missing data.
Until I have that information, however, the question is just how many of these are there out there? I know that around 4.2 million have enrolled via the exchanges, and I already know of at least 456,000 off-exchange enrollments, or around 4.7 million total. Even if every single exchange-based enrollee already had insurance (and that's absolutely not the case), there should still be several million people out there who have either switched from one private plan to another (directly) or enrolled in a policy for the first time (directly).
Oregon continues to slowly drag their still-crippled exchange along, adding another 2,859 private QHPs and 22,564 Medicaid/CHIP enrollees (17,474 + 5,090 via the "Fast Track" program) over the past few weeks.
March 1, 2014 Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon and Oregon Health Authority
Private insurance: 38,806
Oregon Health Plan: 84,991
Oregon Health Authority “Fast Track”
Oregon Health Plan: 128,434
Since October, dozens of you have been assisting with the ACA Signups project by providing press releases, reports and news items containing data about exchange-based enrollments in both private and publicly-funded healthcare plans. Once in awhile, you've also provided stories about interesting related topics, and I'm eternally grateful for all of it. Now I'm going to ask for help in tackling the Holy Grail of ACA enrollment data.
Using my new projection model, which accurately called both the announcement (a week or more earlier) of both the "close to 4 million" announcement on 2/20 and 4 million even on 2/25, I'm confident enough to make my official call for the actual February HHS Enrollment Report, which probably will be released on or around March 13, give or take:
902,000 Total Exchange-Based Private QHP Enrollments between 2/02/14 - 3/01/14
4,202,000 Total Exchange-Based Private QHP Enrollments between 10/1/13 - 3/01/14
You'll notice that I'm being very careful about how I word this, for several reasons.