I was fascinated when I saw this phenomenon happen here in Michigan last year, but it's repeated itself in several other states since then. State and federal officials crunched their demographic data and came up with estimates of the maximum number of residents who they expected to be eligible for the ACA's Medicaid expansion provision a couple of years back, along with the number of those expected to enroll in the program in the first year. They're then caught offguard when not only does the actual number eligible turn out to be far higher than they expected, but far more of those eligible go ahead and sign up in the first year than expected.

In Michigan, estimates ranged from 477K - 500K being eligible; instead, the number broke 600,000 the first year, where it's hovered around ever since (as of last week it stood at 615,536).

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

About a year ago I wrote about a bill working it's way through the California state legislature which, if passed and signed into law, would have allowed all of California's 1.5 million uninsured, undocumented immigrants to either enroll in Medi-Cal (CA's name for Medicaid) or in ACA exchange policies via Covered California (with the state picking up the tab for the APTC/CSR financial assistance). Since the ACA specifically prohibits any federal dollars from being used, the state would be on the hook for 100% of the cost.

The bad news is that this ambitious bill didn't end up making it through the process. The good news is that a stripped-down version of it did become law:

Thanks to Adam Cancryn for calling my attention to Molina's quarterly earnings report, which has this rather eye-opening section:

I've used Molina's Q1 2016 report, along with the Q4 2015 reports of Cigna and Humana, to further fill in the "Major Insurer" table I've been working on all this week; here's what it looks like now:

At first glance, this month's Kaiser Family Foundation Tracking Survey looks like bad news for the Affordable Care Act...

Sorry, that's really the only headline which came to mind when I read this story:

Ryan wants to end Obamacare cost protections for sick consumers

U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare's financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools.

In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.

The rule, a cornerstone of President Barack Obama's Affordable Care Act, has been praised by patient advocates for providing access to medical care for people who previously could not afford private health insurance. The Affordable Care Act also bars insurers from excluding coverage for pre-existing conditions.

Maryland's ACA exchange saw a dramatic 35% year over year enrollment increase during the 2016 Open Enrollment Period, totalling 162,177 QHP selections.

I was just informed by the MD Health Benefit Exchange that as of April, their effectuated individual enrollments are down to 139,379 people. That's a drop of just over 14%. This is completely in line with my numbers for 8 other states.

Last fall, Aetna reported a total of 1.1 million members in the individual market as of the 3rd quarter, including both ON and OFF exchange enrollees. That was broken out as 815,000 exchange-based (74%) and 280,000 off-exchange (26%).

Just moments ago, Bob Herman reported:

$AET finished Q1 with 1.2 million individual members. (Not sure of #ACA exchange vs off exchange breakout.)

— Bob Herman (@MHbherman) April 28, 2016

Herman just reported that the actual number of exchange-based enrollees is 911,000, a drop of 4.1% year over year.

Noteworthy: Aetna's exchange-based indy enrollments have inched up to 76% of their total indy market.

Here's what the Big Boys are looking like so far:

A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.

In the past few days, this has become increasingly clear, as Centene's news from yesterday shows.

As Kevin Drum at Mother Jones notes (quoting Richard Mayhew of Balloon Juice):

As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.

Over the past week or two I've been compiling the currently effectuated exchange enrollments for as many states as possible (the official Q1 ASPE effectuation report likely won't be available until early June). So far I have the data from either February, March or April for 7 states: CO, CT, MA, MN, NH, OK and WA.

Today I can add Idaho to the list, and unlike some of the other states, Your Health Idaho's number appears to not only be cut & dry, but very good news indeed:

Hello Mr. Gaba,

Your Health Idaho’s effectuated enrollments for March stand at 95,522. Numbers for April are preliminary at this point.

That compares to 101,073 QHP selections as of the end of the 2016 Open Enrollment Period, which means that as of 3/31/16, Idaho had only lost 5.5% of their total enrollments, which is fantastic considering the 13-17% drop on average from the other states so far.