I've been shouting from the rooftops about OFF-exchange QHPs for months now (I first added a column for them on January 3rd and had my first significant data update on January 31st), and until recently few in the news media seemed to catch on to the significance of these.

Until a few weeks ago, I had only officially documented about 560,000 off-exchange QHPs, but guestimated that there were easily 4 million or more out there (I had mused off-handedly back in mid-February that the total could potentially be 7.7 million, but decided to backtrack to "4M or more" out of caution).

Nothing major, just another 4,000 people added to NM's Medicaid tally:

An estimated 107,000 New Mexicans have enrolled in Medicaid since the state expanded the qualifications in October to include low-income adults, state Human Services Department spokesman Matt Kennicott said Monday.

...A total of 26,412 New Mexicans had enrolled in health plans through the state insurance exchange by the March 31 enrollment deadline, the state office of the Superintendent of Insurance said in a news release issued recently.

...An additional 10,000 applications had been submitted by the deadline but remained unprocessed, the statement said.

That's right. Thanks to high winds and a mid-April snowfall, I have no electricity today. Expect updates to be few and far between.

--posted from my iPhone

I've been debating whether to post about this since frankly, I'm not entirely sure that I have all the details straight about how this works. If anyone more familiar with this process wants to correct or clarify my description in the comments, please feel free to do so.

OK, so there's all sorts of hand wringing over how much premium rates will increase for 2015 based on the 2014 risk pool. The CBO issued a report yesterday which projects that in spite of all the fretting, the overall average increase will only be a few percent, which is good news if true (although this will no doubt vary from state to state).

However, I recently learned a couple of very interesting things about how the ACA works when it comes to pricing oversight and the "risk corridor" program.

Think Progress has a nice explanation of "risk corridors" (which the GOP hypocritically and wrongly refers to as an "insurance company bailout"):

There are many ways of getting a society to “do the right thing”. Many years ago, as I was driving into San Francisco across the Bay Bridge, traffic was at a crawl – except for two lanes labeled Car Pool. Those cars whizzed by and their drivers didn’t even have to stop to pay the road toll. Life can be so unfair to a lonely guy in a BMW or Porsche.

Above the highway was a billboard advertising, in large letters, the Car Pool Switchboard; its sole function was to hook up people regularly commuting from one place to another at roughly the same time. Saving a few dimes by sharing gas expenses, or even being forgiven a couple of bucks in road toll, may not have seemed like much of an incentive – but getting to work (and home) 20–30 minutes faster each day, most certainly was!

City of Angels

Yesterday I issued a reminder/warning that the March HHS report might stop at 3/29, leaving the last 2 (and by far the busiest) days of the official enrollment period, the 30th-31st to be moved over to the April report.

If HHS did this, the March report would appear to only include about 6.5M exchange QHPs, since another 600K would be moved to April, along with the additional 700K (give or take) enrollments from 4/01 - 4/15 (and even beyond).

Fortunately, if this bulletin from Inside Health Policy is true, wiser heads at HHS have prevailed...and then some!

HHS Eyes April 17 Release Of Latest Enrollment Numbers

On top of today's CBO report projecting a $104 Billion savings on the cost of the ACA over the next decade and their projection of 2015 premiums only going up slightly, this is a bit of unexpected news....

As hundreds of thousands of diabetics get health coverage under the federal law, insurance companies are aggressively targeting this glut of new patients, who are expensive to treat and often lax in taking medications and following their diet.

Insurers are calling diabetics when they don't pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor's office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines.

Well I'll be damned. Private, for-profit insurance companies actively assisting their customers in trying to stay healthy.

Exactly the way that the law was intended to work, I'd say.

Hoo, boy...this is gonna cause some heads to explode over at FOX News...

The most expensive provisions of Obamacare will cost taxpayers about $100 billion less than expected, the Congressional Budget Office said Monday.

CBO also said it doesn't expect big premium increases next year for insurance plans sold through the health care law's exchanges.

In its latest analysis, CBO said the law's coverage provisions—a narrow part of the law that includes only certain policies—will cost the government $36 billion this year, which is $5 billion less than CBO's previous estimate. Over the next decade, the provisions will cost about $1.4 trillion—roughly $104 billion less than CBO last estimated.

But wait, there's more...

Monday's report also sheds some light on one of the big challenges still to come for Obamacare: next year's premiums. Some critics have warned that premiums could skyrocket next year, based in part on the demographics of the people who signed up for coverage this year.

It took me a few minutes to figure out why, at this point, Colorado would issue a formal press release with a "final" number when there's still a day and a half to go. However, I realized that it probably simply means that practically everyone who qualified for the 4/15 extension has already done so by now; presumably they're already over 124K and there's only a few hundred partial applications left anyway, so their final tally will come in somewhere between 124K - 125K, thus allowing them to confidently release the news.

On the down side, if this "winding down" effect is true in most other states, it also suggests that instead of one final mini-spike, the 4/15 deadline will actually result in a severe drop-off, making the final total more like 7.7M instead of 7.8M, but that's fine as well.

In any event, CO is up another 3,000 exchange QHPs since last week to over 124K total.

UPDATE 4/14: From a Denver Post article on the same topic:

About 500 small employers participated in the Small Business Marketplace, or SHOP, which saw 220 enroll, covering 1,860 employees and family members.

That's a whopping increase of...90 people. Still, every one counts...

(sigh) OK, until this morning I was under the impression that the exchange QHP enrollment rules were:

  • 46 states +DC (36 on the Federally-run exchange, plus another 11 of the state-run exchanges): April 15 as long as you started the process by 3/31
  • Oregon: April 30, no "started by 3/31" requirement
  • Nevada: May 30 with the "started by 3/31" requirement
  • Connecticut & Washington State: No extensions

I did know that Florida was allowing paper applications received by April 7 to have their enrollments completed by April 30, but I thought that was it.

Well, if this Motley Fool article is correct, the final numbers could be even a little higher yet:

The new federal deadline -- a special enrollment period – already allowed registrations delayed by exchange-related problems to be finished as late as April 30 for those who submitted a paper application by April 7. That extension applied to individuals living in states where insurance enrollment under the Affordable Care Act is conducted through the federal exchange.

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