In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks
For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.
The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.
"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.
...But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.
With the repeal of the ACA supposedly looming next year, it's worth remembering that the ACA was based in large part on a state-level program in Massachusetts, implemented by, of course...Mitt Romney. Obviously there are a lot of differences beyond simply ramping "RomneyCare" up to the national level, but at least in terms of the "3-legged stool" of the ACA exchanges (guaranteed issue, individual mandate, subsidies to help lower income enrollees), it's essentially the same.
If the law really is repealed at the federal level, some blue states where it's working pretty well would likely switch back to their own state-level versions. In addition to Massachusetts presumably just reverting back to RomneyCare again, states like California, Washington State and Connecticut seem like likely contenders.
Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.
I'm taking a break from the national panic over Trump's election to announce two subtle but important modifications to The Graph:
First: In yesterday's release of CMS's Weekly Snapshot Report from HealthCare.Gov for the first "2 weeks" of open enrollment, they explained that instead of running the weeks from Tuesday - Monday, they're going to measure them by the traditional calendar week (Sunday - Saturday). This means that the first two "weeks" are being cut off by 2 days (Nov. 1st - 12th instead of the 14th).
Since all of the official reports going forward will be measured Sunday - Saturday, I've changed the graph to match. I've also modified my official Weekly Projections accordingly. It's important to clarify that the actual projections haven't changed at all, just the cut-off date (for instance, I originally projected 1.53 million people in the first 2 weeks (14 days); instead I now have it as 1.29 million in the first "2 weeks" (12 days). The actual projection itself hasn't changed at all.
Yesterday, the Access Health CT board meeting presentation gave the 2017 QHP selection tally as (I think) 9,455 renewals plus 6,630 new additions for a total of 16,085 people, though it's a little confusingly presented.
They don't really break out the "renewal" number, so I'm not certain what the total is, but assuming the 9,455 figure is accurate, that brings it up to 16,498, or 970/day.
For comparison, last year they only averaged around 575/day (for the first 7 days anyway), so it's definitely busier (2.3x faster) so far.
Even just looking at new enrollees: The first week averaged 183/day last year; this year it was 368/day the first 8 days and 425/day the first 17 days...again, more than twice last year's rate so far.
Total effectuated QHP enrollment as of September 2016: 166,098 people...or about 5% higher than they had in March, according to the official CMS report. This is unusual; almost every other state has seen a substantial drop-off in effectuated enrollment. The only other state which constantly increases effectuations during the off-season is Massachusetts, and that's mainly because they have special "ConnectorCare" policies which are available year-round to anyone. On the other hand, according to the WA exchange report, there has been a slight net drop since March...of around 4.5% (see 2nd slide below). Not sure what to make of that. Either way, however, the point is that attrition is unusually low compared to other states.
Individuals have selected health care plans as of November 15, 2016. This enrollment reflects a period in which Covered California did not conduct media or enrollment promotion until after November 12th .
Compares to approximately 50,700 for same period 2015 (when Covered California had conducted extensive media and “bus tour” efforts to promote enrollment).
OK, so new enrollments are down about 11% from last year, but as they note, they deliberately held off on actively promoting/advertising until after the election this year.
If I'm reading this correctly, it looks like they currently have 85,250 people enrolled in effectuated exchange policies. 9,455 have actively renewed/re-enrolled into either their existing policy or a different one, plus another 5,570 brand-new enrollees who have signed up, for a total of 15,025 QHP selections for 2017.
What's confusing me is that they also say that "100,275 are currently enrolled"...which you only get by adding all 3 of those numbers together, which makes little sense to me.
With 23,883 people signing up via MNsure for private coverage as of Nov. 13, the exchange is more than one-fourth of the way to its budget target of 83,000 enrollees at the beginning of next year.
That's 1,837 per day, vs. last year's 404 per day; while things are starting to slow down, they're still enrolling people at a rate 4.5x as fast for the moment. Again, this is mainly due to MNsure's unique first-come, first-serve enrollment cap on most of their carriers.
