Charles Gaba's blog

There's definitely some weirdness going on with some of the exchange enrollment reports.

Last night I noted that there's roughly a 17.3K gap between the number of people reported to have selected QHPs during the 2016 Open Enrollment Period according to the official ASPE report (213,883) and the number reported by the exchange itself (196,554).

Based on that discrepancy, the MA Health Connector has increased their enrollment by either a nominal 0.6% or an impressive 9.5%, depending on what you use as the starting number.

Well, this morning I've found a similar report for the Washington exchange, and this one makes even less sense to me because it not only contradicts the ASPE report, it seems to contradict the WA exchange itself.

I noted last month that the Massachusetts Health Connector had increased their effectuated QHP enrollee total by around 12,000 people in the first month of the off season, which goes against the expected net attition expected once Open Enrollment ends.

However, I also noted that MA is unusual in that most of their exchange QHPs are in the form of "ConnectorCare" plans, which are availble for enrollment year round, just like Medicaid and SHOP enrollment. As a result, this increase, while legitimate, can not be used to extrapolate anything nationally.

As everyone who's been following the ACA over the past few years knows, the October 2013 launch of HealthCare.Gov and 16 state-based marketplace websites was not one of the prouder moments in the Obama administration's history. The federal exchange (which covered 35 states at the time) was a disaster out of the gate, as well about half of the state-based websites.

Over the past three Open Enrollment Periods, of course, most of the technical headaches have been worked out of most of the sites. HealthCare.Gov operates like a dream now (update: well, relatively speaking, anyway) and major improvements have been made in most of the state exchanges as well. In 5 cases, the solution was to either scrap the original platform and start over (Maryland and Massachusetts) or to say "to hell with it", drop their own platform completely and move home to the Mothership (Oregon and Nevada in 2015; Hawaii starting this year). Washington State kept their own platform but gave up trying to handle billing for their enrollees, joining just about every other state in letting the carriers handle payments directly.

My "Grandparents" posts got a shout-out from this week's Health Wonk Review over at Health System Ed:

Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around

In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.”

Check out the other entries!

The go-to journalist in Connecticut for all things Obamacare-related is Arielle Levin Becker. Judging from her feed this AM, it sounds like she's livetweeting the monthly AccessHealthCT board meeting. Here's her key points:

CT exchange enrollment down about 9.2 percent from end of open enrollment. Also about 2% shift from subsidized to unsubsidized.

— Arielle Levin Becker (@ariellelb) April 21, 2016

CT exchange getting about 3,100 enrollments through special enrollment periods each month.

— Arielle Levin Becker (@ariellelb) April 21, 2016

Out of 116k members at end of open enrollment, 18.8k canceled covg or had it terminated; 7,983 people have signed up.

— Arielle Levin Becker (@ariellelb) April 21, 2016

During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Unlike most of the state exchanges (and HC.gov itself), MNsure has been dutifully continuing to update their data every month or so during the off season, providing an interesting glimpse into how the Special Enrollment Period (SEP) is going:

  • 11/01/15 - 1/31/16: 85,390 QHPs Cumulative since 11/01/15 (or 928/day); 33,333 MNcare; 73,173 Medicaid
  • 2/01/16 - 2/14/16: 85,690 QHPs Cumulative since 11/01/15 (+300, or 21/day); 39,887 MNcare; 90,234 Medicaid
  • 2/15/16 - 3/06/16: 86,856 QHPs Cumulative since 11/01/15 (+1,166 QHPs, or 55/day); 45,621 MNcare; 111,449 Medicaid

,,,and in the latest update:

  • 3/07/16 - 4/17/16: 90,696 QHPs Cumulative since 11/01/15 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid

Didja notice that? While the private QHP enrollment rate obviously dropped off tremendously after open enrollment closed (duh!), the SEP enrollment rate has dramatically increased since then, from 21/day in early February, to 55/day in late Feb/early March, to 91 per day over the past month. While it's still just 10% of the Open Enrollment rate, over 4x as many people are signing up for QHPs via MNsure now as were at the start of the off season.

UnitedHealthcare is operating on the ACA exchanges in 34 states this year. I assumed that they'd announce which states they were staying in or dropping out of all at once during yesterday's quarterly earnings conference call, but apparently not. Instead, the status of each state has been dribbling out one by one over the past week or two.

Zachery Tracer is doing a great job of keeping track over at Bloomberg News.

As of this writing, Tracer has the drop-out list up to 18 22 23 24 25 26 27 28 states, including:

I haven't posted anything about Louisiana's ACA Medicaid expansion since back in January, just before newly-elected Democratic Governor John Bel Edwards took office. At the time, it looked like the program wouldn't actually kick off until July, and would enroll perhaps 300,000 people.

Today brings a status update: It looks like they're gonna ramp things up a month earlier, and around 75K more Louisianans are eligible than previously thought:

La. Governor Announces Medicaid Expansion Will Begin June 1, Save State $677M Over 5 Years

About 375,000 people in Louisiana are expected to enroll in the program for low-income residents. At the same time, officials in Arkansas continue wrestling with the governor's plan to end the political impasse over expansion.

To be clear: UnitedHealthcare dropping out of almost all of the 34 states they're operating in this year is not good news by any means. So far they've only confirmed sticking around Virginia and Nevada, while confirming that they won't be available in 13 others so far: AR, CT, GA, LA, MI, MO, NE, NC, OK, PA, TN, TX, WA.

However, it's also worth keeping in mind that in many of these states, United has a pretty small presence to begin with. Case in point: Connecticut:

LT. GOVERNOR WYMAN, ACCESS HEALTH CT CEO WADLEIGH STATEMENTS ON UNITED HEALTHCARE ANNOUNCEMENT

(HARTFORD, CT) – Lieutenant Governor Nancy Wyman, Chair of the Access Health CT (AHCT) Board, and AHCT CEO Jim Wadleigh today issued the following statements on the announcement that in 2017, United Healthcare is pulling out of most state healthcare marketplaces:

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