Charles Gaba's blog

Connect for Health Colorado just issued their official monthly enrollment update:

Connect for Health Colorado® and Colorado Medicaid Report Enrollment Gains of More Than 169,000

January 5, 2016

DENVER — Between Nov.1 and Dec. 31, more than 169,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.

“We are very happy with the enrollment growth during the first two months of this open enrollment period,” said Connect for Health Colorado® CEO Kevin Patterson. “But I want to urge everyone who does not have health insurance provided through their employer to act now to provide financial security for their families and to avoid a penalty of nearly $695 or more. The final deadline for 2016 coverage –Jan. 31 – is fast approaching.”

Rhode Island, which already had one of the later deadlines in the first place, just bumped it out even later...all the way out through December 29th. However, having such a small population, Rhode Island's latest update still doesn't move the needle that much:

INDIVIDUAL AND FAMILY ENROLLMENT As of January 2, 2016:

  • 34,627 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
  • Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan.
  • 4,462 of the 34,627 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
  • 27,124 of the 34,627 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.

SHOP ENROLLMENT As of January 2, 2016:

According to Dan Mangan of CNBC, a new report has been released about the impact of the ACA on full-time workers' hours. The conclusion can be summed up thusly:

A new study further undercuts a major claim by critics of the Affordable Care Act, who contended that the law would encourage companies to slash full-time workers' hours and shift them into part-time work in order to avoid having to offer them health insurance.

The study "found little evidence that the ACA had caused increases in part-time employment as of 2015," according to a summary of its findings published in the journal Health Affairs on Tuesday.

In 2014 and 2015, the Washington State ACA exchange was one of a handful of exchanges which also handled the billing for QHP enrollees...and in their case, ran into a lot of technical problems in doing so. This year, they've given up on trying to handle the payments themselves, offloading them to the actual insurance carriers as most other states do. I have no idea how much impact this change has had as opposed to improved outreach, the individual mandate penalty increase and so on, but whatever the reasons, WA's numbers are dramatically improved this year:

The Washington Health Benefit Exchange today announced that nearly 174,000 residents have signed up for or renewed their health coverage as 2016 open enrollment enters its final month. The deadline to select a Qualified Health Plan through wahealthplanfinder.org is Jan. 31 for coverage effective March 1. Customers who select a plan by Jan. 23 will have their coverage start Feb. 1.

I've been getting a little worried about the Minnesota exchange of late. Their first two years were pretty rough, and their most recent update prior to today had them at only 26.5K QHPs as of 12/13. Of course, that didn't include the critical final few days before the January enrollment deadline...nor did it include the extended deadline for Minnesota, which was pushed all the way out to 12/28.

Well, it looks like my concerns were unfounded, and the extension definitely did the trick, because MNsure just announced that as of 12/28/15, they had enrolled 67,680 people in private policies:

Nearly 68,000 Minnesotans Enroll in Private Plan Coverage for 2016 through MNsure

Eighty percent of goal reached with one month of open enrollment remaining

January 04, 2016

Abby Goodnough had an interesting story in the NY Times yesterday about the fact that for some people, simply paying the Affordable Care Act's "Shared Responsibility" tax (otherwise known as the Individual Mandate penalty) may actually be more affordable than actually signing up for an ACA-compliant healthcare policy.

I've written about this before, of course. It is absolutely true that for some people (the Kaiser Family Foundation estimates roughly 7.1 million people), their mandate tax (whether a flat $695/person or 2.5% of their household income, whichever is greater) is indeed less than the annual premiums for the lowest-cost policy available in their area (even after taking federal tax credits (APTC) into account). By KFF's estimates, the mandate tax would cost more than the least-expensive policy for only around 3.9 million currently-uninsured Americans (although the actual number of uninsured who could potentially enroll in exchange policies, whether with APTC or at full price, seems to be closer to 15 million according to the very same KFF study from which they stated the 11 million figure...I'm not sure what accounts for the 4 million difference, but that's actually besides the point here).

Now, as I noted in my own analysis of the potential impact of the mandate tax on "Young Invincibles", I noted that given a choice between paying $X for nothing and $X + (some variable amount) for a ACA-compliant healthcare policy, my guess is that most people are likely to still go ahead and sign up as long as the cost is less than perhaps twice as much, even if the plan itself seems somewhat skimpy.

In other words, if the choice is between a $700 penalty for bupkis and, say, $1,000 for a Bronze plan (43% more), most people will probably go ahead and spring the extra $300...but they if the least-expensive plan is more than twice the penalty (say, $1,500) they're much more likely to say "screw that!" and just pay the tax. Again, I'm not basing this on any hard analysis, it's just my gut instinct; I could be wrong about this.

Here's the first example from the NY Times story:

According to a recent Kaiser Family Foundation study, as of last spring there were still around 32.3 million uninsured people in America, broken down roughly as follows:

Three portions of the total are eligible to enroll in private policies through the ACA exchanges: "Tax Credit Eligible", "Ineligible for Financial Assistance due to ESI Offer" and "Ineligible for Financial Assistance due to Income" (22%, 15% and 12% respectively). It's important to remember that "Ineligible for Financial Assistance" means that they can enroll through the ACA exchanges, they just have to pay full price if they do so. Many of these folks will simply enroll off-exchange, directly through the insurance carriers, but there's nothing preventing them from going through the exchange instead.

One other small Medicaid expansion entry: Alaska, which just formally launched the expansion program on September 1st, has enrolled about 7,700 residents to date. While that's a pretty tiny number, Alaska only has about 740,000 residents total, of which only 42,000 are even eligible for ACA expansion anyway:

JUNEAU, Alaska (AP) — About 7,700 people have enrolled in Medicaid since the state expanded the program on Sept. 1 to cover more lower-income Alaskans, a state health department official said.

The agency appears on track with projections that a total of about 20,100 newly eligible people would enroll in Medicaid during the first year of expansion, Chris Ashenbrenner, Medicaid program coordinator for the health department, said Tuesday.

A study commissioned by the department estimated that about 42,000 people would be eligible for Medicaid under expansion but only about 20,100 would enroll the first year.

 

I somehow managed to completely miss the September Medicaid report released last month, but it turned out to be a virtual non-issue; there was a net increase of just 2,599 people enrolled in Medicaid nationally from the end of August through the end of September 2015.

In October, however, things picked up; while not nearly the half-million-plus-per-month that we saw during 2014 and the first half of this year as the bulk of ACA Medicaid expansion went into effect in most states, the total number of people enrolled in the program did still increase by a respectable 187,958 people month over month.

This has resulted in a net enrollment increase of over 13.5 million people since the ACA expansion program went into effect two years ago, and a grand total of 71.8 million enrolled in the program nationally.

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