Long-time followers of this site know that I attempt to track every person who gets enrolled in healthcare coverage through the Affordable Care Act, whether it's via individual/family exchanges, Medicaid expansion, off-exchange QHP enrollments...or the SHOP (Small Business) exchanges. They'll also recall that last year, due to the massive technical problems which most of the exchange websites faced, only a handful of SHOP exchanges were even usable, much less actually signing people up. The exchanges were, for the most part, so busy scrambling to get the individual enrollment side working properly that they pretty much put the SHOP exchanges on the back burner. Only about a half-dozen states had theirs running at all, and the total enrollment topped out at only around 83,000 people nationally.
A couple of weeks ago, Gallup released a massive Health Insurance Survey which noted that the uninsured rate nationally fell from 17.3% to 13.8%. On the one hand, yay Obamacare! On the other hand, this drop in the uninsured was far less impressive-sounding than earlier surveys put out by the Urban Institute, Commonwealth Fund, RAND Corporation...and even Gallup itself.
There was an obvious reason for this, however:
In other words, they surveyed a mountain of people, but the polling was spread out over the full course of each year. These are full-year averages. There's nothing wrong with this, and 10 years from now it will be more practical to look at historical data from a year-to-year perspective. At the moment, however, things are changing very rapidly as enrollments/expansion/policy implementation goes into effect, and a month-to-month or quarter-to-quarter perspective is far more telling.
Today is his birthday. In honor of Chris, I'd like to ask visitors to consider making a donation to him today. Just visit Eclectablog, scroll all the way down and look for this PayPal area in the lower-right corner:
P.S. I'll have plenty to say about today's King v. Burwell developments this afternoon or tomorrow, I'm sure, but for the moment there's not much more I can add. I'm neither a lawyer nor a Constitutional scholar; others are far more knowledgable about the particulars of the Supreme Court as well as the personalities/idiosyncracies of the individual Justices.
The first reason why he is wrong is that the June numbers are preliminary numbers. Those numbers are not set in stone. The second reason is if the subsidies are upheld, any uncertainty costs that appear on the 2016 Exchange gets eaten by the subsidy. For the subset of people who are buying on Exchange without financial assistance and all people buying off Exchange, they could pay slightly higher rates but on-Exchange subsidized buyers are protected by the subsidy structure.
Back in December, I noted that Michigan's implementation of the ACA's Medicaid expansion provision had achieved an impressive 99.4% of it's theoretical maximum enrollment. Official state administration estimates pegged the number of Michiganders eligible for the program at around 477,000, and as of 12/08/14, enrollment had hit 474K.
Other estimates had Michigan's eligible population as being higher--perhaps 500,000, so I didn't think too much of it at the time. Besides, population shifts, changes in the economy and so forth could mean that an estimate from last spring had shifted up or down a bit.
Even so, as the official enrollment total broke 500K, then 510K, then 530K, I noted each increase, with increasing curiosity about the discrepancy.
Ever since I first wrote about the Halbig v. Sebelius case (later Halbig v. Burwell, then shifted over to King v. Burwell shortly thereafter), the one question I've never been able to get a straight answer on is whether Oregon, Nevada and/or New Mexico would be legally defined as "exchanges established by the state" in the even that the Supreme Court does end up ruling in favor of the King plaintiffs.
Ironically, three states that experienced monumental failures when they initially tried to create exchanges might hold the closest thing to a golden ticket.
This is about as minor of an update as I can post; the actual hard enrollment number is slightly lower than the 160K figure that I already had, but it's still good to have specific data, plus it's broken out into more detail. Plus, the SHOP data is here as well (such as it is):
Open Enrollment Numbers (All Numbers Effective as of February 15, 2015)
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:
