Charles Gaba's blog

Still waiting for clarification of the distinction between private enrollments and Medicaid/CHIP expansion on the new additions, but assuming they're a similar ratio to the prior enrollments, it should be roughly 38,500 private and 14,500 Medicaid/CHIP. If that ratio is close, this means that New York has essentially reached their March 31st private enrollment projection of 218,000 (give or take a few thousand).

Bonus: It was also revealed during NY State Senate testimony today that a whopping 40% [Ed: 30%, thanks to DwightKSchrute for the correction] of enrollees are under 35, and another 16% are between 34-44. This should go a long way towards quieting the ""young invincibles" aren't signing up!" ACA attack point.

A regular site visitor has sent me some in-depth information about the public healthcare program situation in Minnesota, which is evidently quite a bit more complicated than most other states. I've put together this information into what I hope is a cohesive whole, with my response below. Anyone who's more familiar with the Minnesota situation can feel free to correct or clarify any of this if you'd like.

Regarding your blog post entitled Minnesota Update: Nominal private increase; Medicaid up 10% In it, you quote the Minnesota StarTribune, which states, in part, that:

"Of those nearly 72,000 enrollees, slightly more than 26,000 signed up for private insurance while the rest are on public plans."

Several thousand more than 26,000 should be counted as exchange sign-ups rather than Medicaid signups. Minnesota has a sort of in-between basic health plan called MinnesotaCare. It covers people between 133% and 200% (I think?) of poverty. It is not Medicaid (which is called Medical Assistance in Minnesota) and therefore not part of the ACA Medicaid expansion, but it is a public plan. So, when the StarTribune refers to "public plans," they are lumping Medicaid and MinnesotaCare together. The state has cleared this up before in reporting on Minnesota's enrollment numbers in the New York Times. MinnPost reported on this correction back in November.

As a follow-up to Friday's news that Idaho has hit around 20,000 private enrollments comes this story about the status of those enrollments from the actual insurance companies' perspective. While the major thrust of the article is the unusually long payment deadline extensions that have become necessary due to the technical and paperwork confusion caused by the Federal HC.gov exchange, as contributor Witgren notes, there's two important points which are quite telling.

First, in Idaho, at least, it appears that at least 75% of those 20K people have made their first payment. While you can certainly spin this as being "25% are deadbeats" if you want to, this certainly goes a long way towards disproving that the "OMG!! NOBODY IS ACTUALLY PAYING!!!" meme that the ACA opposition has been shouting about.

Secondly, it appears that, according to the insurance companies themselves, having a large percentage of new policy purchasers not make their payment until the last possible moment is standard for the industry as a whole, and has been for a very long time.

Right after last night's South Dakota update we have their sister state to the North. ND was at just 265 private enrollments as of 11/30, so this represents a four-fold increase as of January 7. I've subtracted 800 from the "unspecified" pool at the bottom of the spreadsheet to compensate.

Meanwhile, their Medicaid expansion has gone from 1,001 up to around 1,700.

As of the first week of January, when coverage started through plans under the Affordable Care Act, 977 members had signed up with Blue Cross Blue Shield of North Dakota, the state’s dominant insurer.

The Sanford Health Plan enrolled 92 in North Dakota through the new marketplace exchange.

By contrast, enrollment in North Dakota under expanded Medicaid eligibility stands at about 1,700 in the first week of January....

In North Dakota, estimates of new Medicaid enrollees under the expanded eligibility have ranged from an increase of 20,000 to 32,000.

A 42% increase from South Dakota since 12/23 is pretty good by itself. However, this number only covers 2 of the 3 insurance companies participating in the exchange. I have no idea what sort of market share the 3rd company has in SD, so I can't speculate as to how many more enrollments they have to add to the total.

I've also subtracted a the corresponding 1,000 difference from the "unspecified" Federal pool at the bottom of the spreadsheet to compensate.

As of Jan. 1, about 3,550 people in South Dakota had signed up through the federal marketplace website from Avera and Sanford, with about 2,700 from Avera and about 850 from Sanford. DakotaCare figures weren’t available.

Just some minor adjustments here; I had CT down as 40,895 private enrollments; I have to drop this by 895. However, the Medicaid number needs to be bumped up by about 1,552.

So far, about 40,000 Connecticut residents have enrolled in private insurance plans under the Affordable Care Act. Access Health CT CEO Kevin Counihan said that number rapidly growing...

Overall, about 76,000 residents have signed up for health insurance in Connecticut, either through private health plans, or the state's low-income Medicaid program.

Who would have thought that it would be Idaho, of all states, that would mark the first significant milestone since hitting the 2.1 million mark a around Christmas? In any event, the spokeswoman for Your Health Idaho announced that ID has shot up from just 1,730 private enrollments at the end of November to a whopping 20,000 people "in time for January 1st". Since the final January deadline for Federal exchange states was Christmas Eve, I assume this means that an additional 18,270 people enrolled from 12/01 - 12/24, increasing Idaho's total 11-fold.

Of course, most of those 18K new people will probably have to be taken out of the HHS's non-specific "1 million" enrollments which haven't been officially broken out by state, but even after doing so, the total number of private enrollments now still sits at just over the 2.2 million mark.

At the same time, since Idaho's CBO projection for 3/31/14 was only 40,000 people to begin with, this means that just like that, they've jumped up to 50% of their target.

Maryland added another 2,093 people to the private exhange rolls from 12/28 - 01/04, a 11% increase. The Medicaid situation is a bit more confusing: Actual enrollments increased from 19,578 to 26,500 (a 35% increase), but the prior week's tally had it at 43,065. It turns out that about 20,000 or so of the Medicaid applications need to be double-checked for duplicates, so they can't be counted yet, making it look like a huge drop by comparison. Sorry about that, folks.

As of Jan. 4, just over 20,350 people had enrolled in private insurance plans on the Maryland health exchange, up 2,100 from the week before, according to a weekly report by exchange officials. The pace of enrollment slowed from recent weeks.

...About 26,500 people had enrolled through the exchange in Medicaid, the federal-state health program for the poor, according to the latest numbers, up some 7,000 from the previous week. Tens of thousands more have been found eligible, but officials say many might be duplicate applications.

Well, that just figures. Right after I post a screed whining about the lack of big numbers since New Year's--in which I specifically call out the DC Health Link for not releasing any data since mid-November--what happens? Whammo: Private enrollments have skyrocketed from 1,115 on Nov. 15 to 15,613, a whopping 14x increase. They also released the first Medicaid expansion figure at all, since neither the HHS nor anyone else has had a number for that since the exchanges lauched on October 1st: 4,677 people.

Amusingly, it looks like the majority of enrollments (up to 10,000 of the 12,000 small business enrollments) were from Congressional staffers who were, ironically, required to do so due to a clause insisted upon by Congressional Republicans.

The top line talking point: More than 20,000 people have secured medical coverage.

But nearly 60 percent, or 11,967, enrolled through the small business side of the exchange, which is designed for companies with fewer than 50 workers but also — via the Republican amendment and Obama administration rules — Congress.

After the massive spike in enrollments seen in mid- to late December, regular site visitors might be a bit disappointed at the relative dearth of increases since New Year's. There have actually been quite a few updates, including several impressive percentage increases, but the actual numbers involved have been relatively small compared to the massive jumps seen just a few weeks ago. In short, you're probably wondering why the total number of private enrollments which shot up to 2.1 million in late December only seems to have gone up about 80,000 more since then.

There are three reasons for this:

First, obviously there was a tremendous sense of urgency for people to enroll in time for January 1st coverage. A drop-off after Christmas has long been expected, although this has been a bit fuzzy as the actual enrollment deadline bounced around, from 12/15 to 12/23, then 12/24 (for most states), then 12/27 or 12/31 for a handful, and finally as late as 01/06/14 for Oregon.

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