Charles Gaba's blog

NOTE: In light of some serious discussion with IBD's Jed Graham and a lot of thought afterwards, I've decided to run the "attrition" numbers two ways: "Current vs. April Paid" and "Current vs. April Total", for reasons I'll explain soon.

The main thrust of this article is general hand-wringing over how the state of Rhode Island plans on funding their ACA exchange after this year, although it's a bit confusing since it sounds like the problem has nothing to do with having the funding and everything to do with having permission to use it:

Enrollment starts on Nov. 15.

Not long after, the state will have to make its own big decision: how to finance the exchange.

Of the $23.4 million in federal funds budgeted for HealthSource RI this year, only $1,353,570 has been spent so far. The state anticipates — but does not yet have — federal permission to spend any of the remaining dollars after Dec. 31.

However, there's one data point that pops up smack in the middle of my current "mini-project", trying to lock down the current QHP enrollments in each state:

Yesterday I posted a whole slew of state-level QHP attrition rates, comparing the number of people currently enrolled in private exchange-based healthcare policies against the official number from back in April.

The numbers ranged from as poor as Florida losing 12% of their enrollments in just 2 months to as well as Maryland and Oregon seeing a 30%+ net increase in enrollees over the past 6 months.

Today I can add Kentucky to the latter list. She couldn't provide an exact current count, but according to the woman I spoke with at the kynect exchange (that's "Obamacare", Mitch!), the number of Kentuckians currently enrolled in private policies via kynect is "right around the same number it was at last spring, between 80-85 thousand".

Bravo, Mississippi. (sarcastic golf clap)

Why has the law been such a flop in a state that had so much to gain from it? When I traveled across Mississippi this summer, from Delta towns to the Tennessee border to the Piney Woods to the Gulf Coast, what I found was a series of cascading problems: bumbling errors and misinformation; ignorance and disorganization; a haunting racial divide; and, above all, the unyielding ideological imperative of conservative politics. This, I found, was a story about the Tea Party and its influence over a state Republican Party in transition, where a public feud between Governor Phil Bryant and the elected insurance commissioner forced the state to shut down its own insurance marketplace, even as the Obama administration in Washington refused to step into the fray. By the time the federal government offered the required coverage on its balky website, 70 percent of Mississippians confessed they knew almost nothing about it. “We would talk to people who say, ‘I don’t want anything about Obamacare. I want the Affordable Care Act,’” remembered Tineciaa Harris, one of the so-called navigators trained to help Mississippians sign up for health care. “And we’d have to explain to them that it’s the same thing.”

Read the whole thing. Nothing more for me to add.

OK, this is gonna be difficult for people to see, since the Medicaid spreadsheet is so wide (the link goes directly to the spreadsheet itself, which should help somewhat). First, scroll all the way to the right. Then scroll to the bottom. In the lower-right corner, you'll see the following:

Last week I crunched the numbers and pointed out that if the Republican Party ever successfully completes repealing the Affordable Care Act, tearing it out "root & branch" as Mitch McConnell is so fond of putting it, that 638,000 Michiganders would lose their healthcare coverage in one shot.

Today, that number has climbed 8,617 higher:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 433,469
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of October 27, 2014 
*Updated every Monday at 3 p.m.

Yup. We're up to over 646,000 Michigan residents who'd be pretty much screwed if the GOP gets its way.

In spite of their ugly technical problems, Cover Oregon was surprisingly consistent and reliable with their off-season enrollment updates, issuing them about once a week throughout the entire spring and summer. This came to a halt on September 29th, however; they didn't issue any updates at all throughout all of October. I assumed that this was because they were too busy shutting down the state exchange and moving everything over to Healthcare.Gov for the 2nd Open Enrollment period, and I'm sure they are. However, tonight I was pleasantly surprised to see that they have issued one more update after all, taking things all the way

October 28, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 416,056
Total private medical insurance enrollments through Cover Oregon: 105,055

Oregon Health Plan enrollments through Cover Oregon: 311,001

For months now, for off-season enrollments, I've been looking at 3 major numbers: The gross additions (which I settled on being around 9,000 per day); the 1st month payment rate (which I had estimated at 90% before dropping this to about 88% a few weeks ago), and the average attrition rate (that is, how many people drop their policies after the first month).

When HHS Secretary Sylvia Burwell finally revealed that 7.3 million people were enrolled in policies as of August 15th, most of my assumptions were confirmed...except that the attrition rate, which I had been assuming was around 3% per month, now seemed to be even lower, at 2%. However, I wasn't sure about this until now.

Today I added a whole slew of updated state-level current enrollment numbers, and now I have these for 10 states, comprising nearly 3.2 million of the original 8.02 million enrollees through 4/19/14, or almost 40% of the total. This strikes me as being a pretty good base to extrapolate the other 40 states (+DC) from.

I addressed Nevada's apparent attrition rate about a month and a half ago. At the time, it appeared to be a fairly ugly 7.7% per month...relative to the "high water mark" of paid enrollments they had achieved in July of around 38,000.

However, since then I've realized that given the high amount of churn during the off-season as people enter and leave the marketplace, a far more accurate measure is the number of current enrollees relative to the April tally, since that was the "8.02 Million Total / 7.06 Million Paid" figure that everyone was focusing on anyway. Doing it this way is also far more consistent, since there's a hard 4/19 number to compare against for every state instead of it being all over the map.

In the case of Nevada, I've just received word that the current number of people enrolled in exchange QHPs is exactly 32,460 as of mid-October.

Rounding out today's "Net QHP Attrition Rate" Trifecta is Indiana, which, while not as deep-red as Tennessee, a) also has a Republican administration; b) hasn't expanded Medicaid; and c) refused to set up their own exchange.

This makes it all the more of a positive surprise to see that their ACA exchange QHP attrition rate is even lower than Tennessee--in fact, it's under 1%!!

The April 19, 2014 total for Indiana was 132,423 Hoosiers. Assuming an 88% payment rate and you get about 116,500.

I just learned that the number currently enrolled as of mid-October stands at 115,800...a drop of just 0.6%.

Excellent news!! I've posted exactly one (1) Tennessee-specific blog entry since I started this site a year ago, having to do with TN's possible caving on Medicaid expansion. Aside from that, I've had bupkus outside of the official monthly HHS reports during the First Open Enrollment period (OE1)...until today.

Today I learned that the number of Tennesseans currently enrolled in QHPs (as in currently in-force policies) via the federal ACA exchange stands at 125,704.

This is significant because the official 4/19/14 total for Tennessee was 151,352 people.

Assuming 88% of the original number paid their premiums, that would be about 133,200 as of last spring, which means Tennessee has only had about a 5.7% net attrition rate over the past 6 months.