Charles Gaba's blog

The official CMS November 2015 Medicaid/CHIP Enrollment Report has been released, and the net enrollment increase due to the ACA continues to quietly increase, passing the 14 million mark (or, arguably, hitting 15 million, depending on your POV):

  • Nearly 71 million individuals were enrolled in Medicaid and CHIP in November 2015. 7 This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.

This number is about 900K lower than October's report (71.8 million) due to a reporting correction in California:

There was a quick "Final Countdown" conference call with the CMS team this afternoon, pushing the upcoming final Open Enrollment deadline this Sunday at midnight.

There wasn't a ton of notable news; most of it was reiterating the numbers put out yesterday, giving a shout-out to certain states and specific cities which are substantially outperforming last year so far (14 states are 20% ahead of where they were last year at this time, and several southern cities were recognized specifically:

  • States which are 20% ahead of last year: OR, NV, IA, UT, SD, LA, NE, ND, TN, OK, AL, ME, WI, NJ
  • Southern cities outerperforming last year: Houston, Dallas, San Antonio, Austin, Nashvillle, New Orleans, Atlanta and Miami

They also noted that yes, traffic is finally starting to ramp up in the final days: A 50% increase in HealthCare.Gov traffic, twice as many phone calls came in by this morning as all of yesterday, etc.

Maryland already exceeded my (and their) OE3 target of 150K QHPs a few weeks ago, so anything more is just gravy, but every bit helps counter the shortages I'm seeing in other states. Last week they reported 155,701 QHP selections as of 1/20/16.

Just now, they confirmed the latest numbers ahead of Sunday's final deadline:

As of 1/26, 156,695 QHP / 304,667 Medicaid / 25,784 Dental.

I've never really tracked dental plans, and I'll be writing about the latest Medicaid numbers later, but that's 156,695 QHPs as of 1/26, or 994 more in the past 6 days, or 166 per day.

This is actually a slowdown from MD's average from 12/28 - 1/20, when they reported a net gain of 5,408 over 23 days (235 per day). On the other hand, given how much Maryland has been kicking butt this year, perhaps they're just running out of people to, you know, enroll.

Anyway, MD is on track to add at least another 1,000, potentially up to 3,000 more for a final number close to 160K.

As noted yesterday, after seeing the writing on the wall for several weeks now and lowering my final 2016 Open Enrollment Period projection by around a million already (from 14.7 million down to a range of 13.6 - 14.0 million), I've gone ahead and lowered it once again to a range of 12.4 - 12.9 million. It's still possible that the final weekend will see a shocking vertical spike, of course, but it would have to shoot up something like 10-12x last week's daily average in order to hit the 14 million range (as opposed to last year's 3-4x increase in the final week.).

So...what went wrong? Well, from the HHS Dept's POV, nothing...or at least nothing that they didn't already project last October. They had already openly stated that they didn't expect any dramatic exchange enrollment increases this year, giving a wide open enrollment range of 11.0 - 14.1 million QHP selections...which has a mid-range of 12.6 million.

The proper question here is how I managed to get it wrong, overestimating by what could be up to 2 million people, Obviously I can't be expected to nail every number, but that would be the least-accurate projection I've had to date.

I'll run a full post-mortem after the final numbers come in next week, of course (it may take even longer for a few of the state exchange numbers to roll in), but there are three four major factors I wanted to address right now (and no, none of these have anything to do with how affordable the policies are, whether the networks are too narrow or the deductibles too high, etc etc; those all contribute, of course, but are also a completely separate discussion):

Your Health Idaho has only issued one official enrollment data press release to date, back on 12/18, when they reported "over 93,000" private policy selections.

There was one additional update via the HHS Dept's ASPE report, which reported exactly 96,662 QHPs as of 12/26/15, which seems about right given that it included 8 extra days.

Since then, there's been nothing out of Idaho...until today, when they reported:

BOISE, Idaho – The deadline to get health insurance coverage through Your Health Idaho is just days away. If you want health insurance for 2016 you must enroll by January 31. Already, more than 95,000 Idahoans have selected health insurance plans through the state’s health insurance exchange.

I may have seriously lowered my final projection earlier today, but Washington State is still cranking along. Just a few days ago they reported having enrolled 180,000 people in private policies (thru 1/21). Today they report:

Through the first 12 weeks of open enrollment, more than 188,000 residents have selected a Qualified Health Plan for coverage in 2016. Those sign-ups represent a 30 percent increase in plans selected over the first 12 weeks of open enrollment last year.

I presume "the first 12 weeks" means as of 1/23, which would mean another 8,000 people in just 2 days, which is excellent if true (WA was one of 3 states to have a later February coverage deadline...of 1/23).

In any event, this brings WA up to 188,000 people, or 89.5% of my 210K target for the state.

That leaves just 1 week to enroll at least 22,000 people, or 3,142 per day, which actually seems doable after all.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

Note that whle the enrollment numbers for most states below are current through January 23rd, most of the state-based exchanges are either slightly more current or up to a month behind.

With that caveat out of the way:

Just a few hours ago, I said:

If, however, last week was a bust, then it doesn't bode well for the final week either:

  • 200K Week 12 x 1.33 = 266K nationally = around 12.0 million cumulatively
  • Assume 3x 266K for the final week = around 800K more = perhaps 12.8 million total

CMS just released the Week 12 Snapshot report:


Hmmm...what about the purge factor? Last week it lopped the grand total down by 60%, from around 400K to just 154K, so perhaps something similar happened this week?

A few hours from now, CMS should be releasing the HealthCare.Gov Week 12 Snapshot report. As noted last week, the "pre-purge" factor has completely messed up my projection model this year, since the numbers for weeks 1-10 could have been lopped down by several hundred thousand people (nearly 250K of which were confirmed to have happened in Week 11 alone). While the purge numbers for the previous 10 weeks were likely much smaller, it still screws up my methodology.

As a result, my original projection for this week of around 400,000 QHP selections has an important caveat: It depends greatly on how whether that number includes the purged/cancelled enrollments or not:

A few minutes ago I noted that Michigan Governor Rick Snyder, currently in the hot seat for poisoning nearly 100,000 of his residents, has formally requested full Medicaid coverage for every Flint resident under the age of 21 (around 30,000 people, as far as I can tell). While my post was sarcastic, the need is real, and while it's revolting that Snyder would try to get the federal government to literally pay for his administration's crime, the move itself makes sense.

Here's a related development which makes sense as well (thanks to Rachel Karas for the link): A letter from U.S. Senator Gary Peters and U.S. Rep. Dan Kildee to HHS Secretary Sylvia Burwell (emphasis added):

January 22, 2016

Dear Secretary Burwell: