A few weeks back I posted a wildly speculative look at what the rest of 2015 might look like (assuming, that is, that the Supreme Court doesn't blow all of my enrollment models out of the water this June with a horrible King v. Burwell ruling).
At the time, I made a pretty ambitious assumption about how many people might enroll during the special 2015 Tax Filing Season enrollment period...I figured a good 1.8 million might do so.
Since then, I've thought it over and decided to be more cautious--I honestly have no clue how many people will follow through and enroll during this period (all I know for sure is that the total number eligible to enroll is somewhere between 0 and 6 million nationally). In the interest of caution, I'm lopping this down to just 1 million even today (it could be higher or lower, of course).
My other assumptions remain the same: An 88% payment rate (for the 1st month) and a roughly 2% net monthly attrition rate, plus about 9K/day enrolling during the "truly" off-season (ie, no special enrollment periods, major life events only).
Since the 2015 Open Enrollment Period began, in addition to the weekly HC.gov "snapshot" reports which gave state-by-state breakouts of exchange-based private policy enrollments, the Oregon Insurance Division has also been tracking and reporting the number at their site...along with off-exchange (direct) QHP policies. As the only state reporting the off-exchange data on a regular basis, OR has become the only hard source I have for this number (other states like Washington, Florida and Louisiana report off-exchange data as well, but only on a quarterly or annual basis).
Their exchange-based data has always lagged slightly behind the HC.gov number, partly because the thru-dates don't match up and partly because at least one of the insurance companies in Oregon only reports paid enrollments instead of plans selected. Still, with the final week or two of HC.gov data missing at the moment, this is a handy estimate of how things played out in the final "overtime" enrollment week:
Members enrolled, Nov. 15-Feb. 22
On Healthcare.gov 113,219
Outside of Healthcare.gov 102,232
Total 215,451
Last July, I came up with a rather idiotic-sounding "solution" to the "problem" caused by the infamous King v. Burwell court case:
So, the question becomes, just how much of the "establishment" has to be done by the state, and how much is allowed for by the Feds? For that matter, if "the state" contracts out the actual site development work to a private corporation, that's technically not being done by "the state" or "the Feds"...it's being done by a private company which is simply paid for their services by one or the other (ie, the Oracle debacle in Oregon; CGI Federal at the Federal level; Deloitte or Accenture in other states, etc).
In other words, what do "established by" and "facilitates participation" actually mean?
Depending on the answer to those and related questions, there could be an incredibly stupid-sounding solution.
I'm referring to domain names.
Yes, that's right: For just $9.95 apiece (or less, if you shop around), the United States Federal Government could simply ask the health departments of the 36 states in question to snap up a domain name along the lines of:
Caveat: This may have changed significantly in the past year or so, and just because someone identifies with one party or the other (or neither) doesn't tell us their actual voting record or frequency)
Then, let's sort the states by their red/blue lean, making some adjustments for states which don't seem to match up in practice with their "on paper" party lean (for instance, Viriginia has been trending blue recently, while Ohio, Wisconsin, West Virginia and Florida, which officially have more self-identified Democrats than Republicans, sure as hell seem to be on the red side in recent years (the same could be said of Michigan, but there's too strong a Dem advantage there to ignore).
As for other states like Florida, Texas and Louisiana, consider the following attack ad, modelled on Mark Totten's press release above:
"Tens of thousands of Louisianans will have to pay hundreds of dollars in higher taxes...all because Bobby Jindal is too petty to shell out $10 bucks for a domain name!!"
The Republicans in two dozen states thought they were playing smart politics (with people's lives, but screw them, right?) when they denied Medicaid expansion, but this has since blown up in their faces, and has now become a potent issue for Democrats in several GOP-held states. I think I know why they thought this...and why it didn't work out the way they figured.
As far as I can tell, the Republican mindset was this: Poor people don't vote. Therefore, screwing over poor people = brownie points from the GOP base without any potential downside.
This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).
The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.
As I noted earlier, I've been expecting final #OE2 numbers from at least two states, Massachusetts & Minnesota. MA has just come through with an extremely detailed report.
In addition, they've given me a partial answer to my earlier question: Yes, they do plan on releasing off-season enrollment data at least monthly (via their board meetings), and possibly weekly (I'm guessing daily would be too much to ask during the off-season). So, I can count on off-season data from at least 1 state...49+DC to go...
They also said that they don't know about a Tax Season Special Enrollment Period yet, and did not have any SHOP data or Medicaid expansion-vs-woodworker data yet.
Finally, one interesting MA-specific quirk: "ConnectorCare" enrollees...which are QHP enrollees but are heavily subsidized by the state as well (I think this is sort of like Arkansas' Medicaid "private option"?)...can be enrolled in year-round. This could be significant during the off-season, espeically since this makes up 64% of the total QHP number to date.
With that, in the end, Massachusetts final official numbers are:
UPDATE: I've confirmed that Maryland and Massachusetts do both plan on continuing to issue at least monthly reports during the off season (I'd prefer weekly but I'll take what I can get).
As of today (February 27th), the 2015 Open Enrollment Period has ended in 47 states (KY, MD, NY & WA states are still allowing "In Line by Midnight" extensions through tomorrow night or all the way out until April, and CO, CT, DC & HI have taken a sort of "case by case basis" approach with no specific hard deadline).
I'm expecting final official #OE2 enrollment reports from Massachusetts and Minnesota later today, but otherwise have to catch up on a bunch of my actual day job work. Here's three quick things to note:
MARYLAND: The Maryland Health Connection has released a big slideshow PDF with a mountain of demographic info. The only gripe I have is that it only runs through 2/15, so doesn't include the extra folks who signed up during the #ACAOvertime period. Data nerds, rejoice!!
