Charles Gaba's blog

If you take a look at The Graph this evening, you'll notice two small additions: First, now that the confirmed QHP selections are large enough to actually be visible, I've added them as a permanent feature (it'll be jaggy due to the staggered data release schedule of the various exchanges, especially HC.gov). Second, just for the hell of it, I've decided to add a rough projection for the point I expect total QHPs to hit the 2 million point: December 8th. 

That would leave just 1 week to add a whopping 5 million people if my "7M by the 15th" projection is to also prove accurate. For comparison, last spring around 2 million people enrolled in the last 16 days of March (plus another 940K during the 15 day April "overtime" period), so it may sound insane to think that 5 million can be enrolled in just 1 week...and if it wasn't for the "autorenewal" factor, I'd agree.

However, I'm operating on the assumption that roughly 4 million current enrollees (in the 45 states which are set up for autorenewals) will simply do nothing whatsoever and automatically get renewed all in one shot on the 15th.

The last update I had for Vermont listed "over 3,000" QHP renewals in the first 5 days, but didn't include any new enrollee data.

Today I've been informed that the renewal number reached 4,415 as of 11/23, plus another 3,588 new applications. It was also specified that an "application" represents a household, not the total number of covered lives for whatever policy is eventually enrolled in.

Assuming an average of 1.8 people per household, and further assuming that roughly 50% of those who apply had also already selected a plan as of the date in question (this has been a consistent rule of thumb based on the Massachusetts data to date), that suggests that those applications represent roughly 6,400 actual people, and roughly 3,200 of them should have already selected their plans. Knocking 100 off in the interest of caution gives roughly 3,100 new enrollments on top of the 4,415 confirmed renewals, or around 7,500 total enrollments as of the 23rd.

When I last estimated QHP enrollments for Massachusetts, I assumed roughly 50% of QHP determinations had been selected and thus figured they were up to roughly 19,200 as of the 27th. Today they posted their 2nd official weekly report, and it looks like I overshot a bit (the actual number through the 28th was 18,646). The good news is that the weekly report also includes three more days (through last night). When you tack on the weekend, the grand total now sits at 21,740. Divide that into the 44,446 QHP determinations and the ratio has dropped slightly, to 48.9%.

Still an impressive showing through the holiday weekend. For the record, MA has reached about 68% of their 2014 open enrollment total in just 15 days, and is on pace to reach at least 135K by 2/15 (though I still estimate they'll reach more than double that).

Meanwhile, Medicaid additions are now up to 38,283 to date:

WASHINGTON (AP) — Like other HealthCare.gov customers, immigrants are relieved that the government's health insurance website is working fairly well this year. They're baffled, though, by what looks like an obvious lapse: There is no clear way to upload a copy of their green card, the government identification document that shows they are legal U.S. residents and therefore entitled to benefits under President Barack Obama's health care law.

President Obama’s top health  official said Monday the health care law will overcome a Supreme Court challenge that argues the administration is illegally doling out subsidies to about two-thirds of the states.

HHS is hitting the malls this weekend to make sure that Obamacare is on the minds of consumers during the busiest shopping weekend of the year.

The department on Wednesday will announce new partnerships it has made with retail stores, pharmacies and popular websites to spread the word about the current open enrollment season, which began on Nov. 15 and ends Feb. 15. On three key days after Thanksgiving — Black Friday, Small Business Saturday and Cyber Monday — as well as dates beyond, Westfield Shopping Centers, the National Community Pharmacists Association and the XO Group will provide consumers with information about how they can sign up for coverage through the exchanges.

OK, technically not all of these are due specifically to ACA Medicaid expansion, but the majority of them should be, based on past reports. Unfortunately, it's my understanding that the Colorado exchange has decided to stop including Medicaid expansion data with their reports; hopefully this isn't the case, but assuming it is, this is the best I can do for now.

According to the CO Dept. of Healthcare Policy, as of October, the combined Medicaid/CHIP enrollment was 1,172,793:

In October 2014, there were 1,120,120 Coloradans enrolled in Medicaid and 52,673 Coloradans enrolled in CHP+.

Back in December 2013 (just prior to the expansion provision), Colorado had 862,549 people in these programs, a difference of 310,244. 

I'm estimating that perhaps 40,000 of these are "woodworkers", the other 270K or so strict expansion.

According to KFF.org, roughly 332,000 Coloradans are eligible for the expansion program.

According to the state administration, there are roughly 477,000 Michiganders who qualify for Medicaid expansion under the Affordable Care Act. Well, guess what?

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 469,698
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of November 24, 2014 
*Updated every Monday at 3 p.m.

Now, obviously that 477K eligibility figure could be off (I had previously heard estimates as high as 500,000). The point is, the Medicaid expansion well in Michigan, along with many other states, is already running dry less than a year into the program (and in Michigan's case, less than 8 months in).

UPDATE: Hmmmm...ok, that's a first: According to today's update, the number enrolled in the Healthy Michigan program has actually dropped by around 8,500 people over the past week:

Healthy Michigan Plan Enrollment Statistics

Last night I noted that both Alaska and Wyoming are strongly considering jumping in the ACA Medicaid expansion pool. If both go through, the number of states which have expanded the program would rise to 31 out of 51 (if you include DC). Tennessee is also considering an Arkansas-style "private Medicaid option".

I also mentioned in passing that one of the "existing" expansion states was Pennsylvania. I knew they were also talking about a "private option" program, but I wasn't sure what the status of the program was. I didn't think it was a done deal yet, but the Kaiser Family Foundation has already struck PA off of their "Medicaid Gap" list, so I'm including them in the tally.

Well, this morning, not one but two site supporters have confirmed that not only is PA definitely moving forward with that program, it might actually end up being "full" expansion instead of the "private option" after all...along with some other useful tidbits I didn't know about:

OK, I wasn't quite sure how to deal with the Medicaid Graph this year. On the one hand, there isn't any deadline or "open enrollment" period for enrolling in Medicaid/CHIP; it's year-round. On the other hand, there simply wasn't room to just keep the 2014 Graph running continuously, at least without making the relative scale between the QHP and Medicaid graphs completely out of whack.

In addition, as I noted when the September CMS Medicaid/CHIP report came out, my own estimate seemed to be running around 4.5% too high compared to the official government figures (they had 9.1 million + 950K from prior to 2014 as of 9/30 (around 10.05 million); I had it down as around 10.5 million, or 450K higher.

Therefore, I'm resolving both issues by picking up the 2015 graph right where the 2014 graph left off...but I've also knocked a couple hundred thousand off in order to at least partially account for the discrepancy. As a result, if you try putting the two side by side, there will be a mis-match of a few hundred thousand, but I can live with that.

In any event, here's what it looks like at the moment:

Alaska:

On the campaign trail, Bill Walker made expanding the state’s Medicaid program under the Affordable Care Act one of his top priorities. He said he could make the decision without input from the state legislature:

“It’s up to the Governor to accept that.”

But when Walker takes office next month, will it really be so easy to expand a program that has been a tough sell in other conservative states?

Medicaid expansion would allow around 40,000 low income Alaskans– mostly childless adults, to receive health benefits. The federal government will pay 100 percent of the program until the end of 2016. After that, the state’s share will slowly increase to 10 percent by 2020. Walker has said the decision is a no-brainer, at least while the federal government is providing full funding.

Wyoming:

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.

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