With all the gloom & doom over UnitedHealthcare pulling out of over 2 dozen states next year due to large losses on ACA exchange policies, one might wonder whether anyone is actually making money on the exchanges.

Well, today, Centene appears to have answered that question:

Centene (a Medicaid insurer) is achieving profit margins on its #ACA exchange plans "at the higher end of our targeted range."

— Bob Herman (@MHbherman) April 26, 2016

Last fall, Centene's quarterly report stated that they had around 155,600 ACA exchange enrollees nationally, or just 1.7% of the total, so this might not seem that significant.

HOWEVER, I just checked their Q1 2016 10-Q report, and there's an eye-opener on page 24:

The UnitedHealthcare Dropout Odometer grew by two more states today, as both Kentucky and Iowa were scratched off the "2017 Exchange Participation" list.

However, there's some positive news for Iowa, at least; as noted by Cynthia Cox and reported on by Tony Leys of the Des Moines Register, Wellmark is joining the Iowa exchange next year:

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.

Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.

A couple of weeks ago I noted that New Hampshire may be the only state on the federal exchange which actively tracks their effectuated exchange enrollment on a monthly basis.

At the time, I noted that unlike most states, their effectuated numbers seem to have increased from February to March (January doesn't really apply since Open Enrollment was still ongoing at the time):

• January 2016 Exchange-Based QHP Enrollment: 49,937 (+33,604 PAP enrollees)
• February 2016 Exchange-Based QHP Enrollment: 53,109 (+38,735 PAP enrollees)
• March 2016 Exchange-Based QHP Enrollment: 55,212 (+43,732 PAP enrollees)

Well, thanks to Louise Norris for the heads up: NH's April numbers are out, and there's something odd:

According to the Kaiser Family Foundation, California averaged around 7.8 million Medicaid/CHIP enrollees prior to the ACA; this number has since shot up about 58%, to 12.3 million people.

One of the chief arguments in favor of the ACA has always been that uninsured people tend to not get treated for ailments/injuries at all (for obvious reasons), and then end up going to the emergency room when that gangrenous foot leaves them no choice. Not only does this end up costing much more to treat, the hospital is also stuck footing the bill (no pun intended) since the uninsured also tend not to have any money to pay out of pocket either (if they did, the odds are that they'd have some form of insurance, after all).

Sometimes you just need the headlines to tell the story:

• 09/25/15: NEW YORK: Health Republic 4th ACA Co-Op to close down

• 11/01/15: NEW YORK: Good grief. Health Republic CO-OP enrollees won't even be covered thru the end of 2015.

• 11/03/15: NEW YORK: Up to 166K people facing literal disaster in 12 days due to bureaucratic f*ckups.

• 11/07/15: NEW YORK: Latest Health Republic Co-Op developments not exactly confidence-building

From Peter Sullivan of The Hill:

The conservative Republican Study Committee (RSC) on Friday submitted its recommendations for a Republican replacement for ObamaCare as it seeks to shape a plan being formed by a group of House chairmen. 

The recommendations come from the RSC’s already-existing legislation, the American Health Care Reform Act, which would completely repeal ObamaCare and replace it with a new system. 

AT LAST!! A completely new "system"! Let's take a look:

The proposal would replace ObamaCare’s refundable tax credits with a tax deduction, which tends to provide less help to low-income people by reducing the taxes people owe rather than allowing for the possibility of getting money back in a refund. 

Ah, yes...because "less help" is exactly what low income people need most these days. Go on...

In a classic case of missing the forest for the trees, I posted two very wonky, detailed entries over the past couple of days about Minnesota and Connecticut's latest enrollment numbers...but completely missed one crucially important data point.

Investor's Business Daily's Jed Graham picked up on some of my work for his post today, including the enrollment data for both Minnesota and Connecticut...but in addition to that extra data point (which I'll come back to in a moment), he also nabbed the latest number out of a third state, Oklahoma, from one of Adam Cancryn's updates on what I'm calling the UnitedHealthcare Disenrollment Odometer:

When I reported on Colorado's monthly enrollment report a week or so ago, I noted that they had added around 15,000 QHP selections via off season SEPs, mainly due to the meltdown of their state Co-Op last fall. However, like I did with Minnesota (I'm slipping!), I forgot to note the effectuated enrollment number as of 3/31...and if I'm reading this correctly, it's not pretty:

There's a bunch of different numbers there, but as far as I can tell, the one I'm looking for is "Effectuated Enrollments with APTC/CSR (medical)" combined with "Effectuated Enrollments Without APTC/CSR (medical)". That's 69,519 + 46,371 = 115,890 effectuated, individual, medical QHP enrollees as of 3/31/16.

There's definitely some weirdness going on with some of the exchange enrollment reports.

Last night I noted that there's roughly a 17.3K gap between the number of people reported to have selected QHPs during the 2016 Open Enrollment Period according to the official ASPE report (213,883) and the number reported by the exchange itself (196,554).

Based on that discrepancy, the MA Health Connector has increased their enrollment by either a nominal 0.6% or an impressive 9.5%, depending on what you use as the starting number.

Well, this morning I've found a similar report for the Washington exchange, and this one makes even less sense to me because it not only contradicts the ASPE report, it seems to contradict the WA exchange itself.

I noted last month that the Massachusetts Health Connector had increased their effectuated QHP enrollee total by around 12,000 people in the first month of the off season, which goes against the expected net attition expected once Open Enrollment ends.

However, I also noted that MA is unusual in that most of their exchange QHPs are in the form of "ConnectorCare" plans, which are availble for enrollment year round, just like Medicaid and SHOP enrollment. As a result, this increase, while legitimate, can not be used to extrapolate anything nationally.