As always: I could be dead wrong here. It's entirely possible that my recent tweaking of The Graph, which projected that 1.5 million people would select exchange QHPs between 12/06 - 12/12 via HealthCare.Gov alone and continued to see the number shoot up from there for December 13th, 14th and 15th is way off the mark.

HOWEVER, assuming that both the Week Six total as well as the "spike" trend I projected turn out to be accurate, that means that these final days should be playing out something like the following:

  • Sunday, 12/13: Around 350K nationally (270K via HC.gov)
  • Monday, 12/14: Around 460K nationally (350K via HC.gov)
  • Tuesday, 12/15: Around 780K nationally (600K via HC.gov)

Yes, that's right, it's conceivable that HealthCare.Gov could see up to 600,000 people select private policies in a single 24-hour period tomorrow, plus up to another 180,000 via the various state exchanges.

As I noted last week, as of Monday, December 7th, here's the sort of information which could be found on outgoing Democratic Governor Steve Beshear's "Healthier Kentucky" webpage:

Open Enrollment stats as of Thursday 2/19/2015:

A few weeks ago, I attempted to figure out at what point the cost of paying for healthcare policy premiums would start to outweigh the Shared Responsibility Mandate Penalty for not having ACA-compliant coverage for 2016. For my own experiment, I was looking purely at the "young invincible" target market: Single, childless individuals between 26-35 years old, earning between $20K - $40K. I ran "real world" checks across 10 major U.S. cities. My conclusion was that for this market in particular, signing up through the ACA exchanges was obviously the smart play up until they hit around $25,000/year in income. After that it started to become more of a judgment call depending on their circumstances and how much of a gamble with their health they're willing to take.

Last month, right at the launch of the 2016 Open Enrollment Period, HealthCare.Gov announced that they were beta-testing a couple of important new tools via a pilot program:

Beginning today, HealthCare.gov is piloting a new beta feature that allows consumers to search plans by their preferred provider or health facility. Some consumers will be part of a pilot that allows them to use the beta Doctor Lookup feature as they compare their coverage options in window shopping or when selecting a plan.

...For the first time, insurers are required to provide up-to-date information about which doctors and facilities are in their networks. Plans must also provide access to information on what medications are covered in the health plan formulary. In the coming weeks, HealthCare.gov expects to pilot the Prescription Drug Check feature, as well, which will allow consumers to search for whether a plan covers their prescription drugs.

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

In 2014, Massachusetts' ACA exchange website was one of the biggest disasters of the site rollouts, managing to enroll fewer than 32,000 people while flushing tens of millions of dollars down the drain. The biggest problem was that the system couldn't accurately determine whether enrollees were eligibile for federal tax credits or not...which was kind of important since around 85% of enrollees nationally qualify for them.

This was especially embarrassing given that not only is Massachusetts considered a major technology base (hey, it's right there in the name: Massachusetts Institute of Technology...), it was also, of course, the home of the precursor to the Affordable Care Act, aka "RomneyCare". You can read the entire ugly story in vivid detail thanks to Ed Lyon's amasingly detailed Health Connector Autopsy Report.

As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.

If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.

(sigh) OK, this one is not related to the Risk Corridor Massacre, since Community Health Options was actually profitable in 2014 and therefore never qualified for any RC payments anyway. Also, unlike the dozen ACA-created co-ops which are in the process of winding down operations by the end of the year, CHO is not going out of business, and in fact is remaining fully operational for 2016.

Having said that, this development is still a serious bummer given the carnage wreaked across the co-op landscape earlier this fall:

Maine's Community Health Options said Dec. 9 that it will cut short its sales of individual policies for 2016, in a sign that it is the latest Affordable Care Act-funded consumer operated and oriented plan to encounter financial difficulties.

So, a couple of days ago I publicly called out Avik Roy over some "math he did as a Republican to make himself feel better" in a Forbes piece he had published on December 6th.

My response received a bit of attention.

Here, again, is the original wording of the passage from Roy's article in question (Google's Cache tool seems to bring up a blank screen for the article for some reason, but I assure you, this was the original wording, verbatim):

Obamacare has reduced the uninsured rate by only 2%

In 2010, when Obamacare was passed, the Congressional Budget Office projected that the law would reduce the number of uninsured in 2014 by 19 million, relative to the number of people without health insurance in 2010. By 2016, CBO estimated that 30 million fewer people would be uninsured.

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