I've written about this in passing before, but after repeated requests about the subject, I've decided to devote a full blog entry about the serious problems inherent in the CMS's state-level Private QHP projection numbers.
As far as I can tell, while the national "7 million" private enrollment projection figure issued by the CBO was based on solid analysis of the demographic situation at the time, the state-level CMS projection breakdown is, in many cases, based on little more than educated guesswork.
In general, the enrollment targets provided by state- based Marketplaces are more ambitious than the initial Department enrollment targets for those specific states. As a result, using the publicly available SBM targets without adjusting other states would have raised the projected number of 2014 Marketplace enrollees by 1.4 million; therefore, the Marketplace ramp-up rates for other states were revised downward accordingly to maintain the 7 million total.
Contributor deaconblues provides an interesting Rhode Island update. While the standard Private QHP and Medicaid/CHIP numbers haven't changed from what I already had listed (although the paid QHP number has increased slightly), there's also the addition of 4,311 RIte Care parents automatically enrolled in RI's non-profit Neighborhood Health Plan.
As deaconblue notes, "Rite Care looks like it fully covers the premium for up to 150% FPL and offers premium assistance to those between 150% and 250%...the context implies that all of the 4,311 should be somewhere under QHP - if some of these plans were fully paid by the state, would they have appeared as an asterisked note under the Medicaid Enrollments section?"
I see his point, but at the same time, seeing how it fully covers the cost up to 150% FPL while even the ACA's Medicaid expansion only goes up to 133%, it really sounds like the vast majority of these folks should be categorized on the Medicaid/CHIP side. I'll look into it and may move some or all of these over to the Private QHP side later, but for the moment I'm listing them as "Medicaid/CHIP".
Meanwhile, I've been informed that Washington State only has their SHOP program running in 2 counties, while Maryland's won't be operational until April (SHOP enrollments are open year-round, while individual/family enrollments are only available through 3/31).
As of Jan. 15, 368 people had purchased insurance through New Mexico’s SHOP (Small Business Health Options Program) exchange for small businesses.
...So far, 370 people have enrolled in insurance plans on the SHOP exchange, according to the NMHIX. A total of 1,542 employers have set up accounts on the exchange and they represent 3,962 employees.
Kentucky continues to slowly but steadily increase their tally, hitting 19% of their CMS projection target with 42,000 private QHP enrollees as of last Thursday. The 2,200 new additions have been subtracted from the "Not broken out by state" pool, bringing that total down to 486,500. Again, any new exchange enrollees which are added up through Jan. 23 will be subtracted from this since it fills out the "3 million" total announced by Kathleen Sebelius last week.
Meanwhile, on the Medicaid side, Kentucky added another 12,000 new enrollees, bringing them up to 189,000 when you add the 55K direct additions. It's important to note that according to the CMS reports, these people should all be new to Medicaid, not renewed accounts.
As of Thursday, according to the state, 176,000 Kentuckians have signed up for health insurance.
So far 42,000 have signed up for private insurance, or roughly 14 percent of the total number of uninsured Kentuckians. That compares to 134,000, or 44 percent of those eligible, who have signed up for Medicaid.
Some minor updates buried in the MNsure Board of Directors report; thanks to an anonymous tipster for calling my attention to it. Nothing major, but some small updates to both the Private QHP and Medicaid/CHIP enrollment figures (27,775 and 52,225 respectively). The most noteworthy addition is the 475 SHOP (Small Business marketplace) enrollments noted on page 27 of the report.
The story itself is pretty negative on the SHOP Small Business exchanges--apparently the Federal one (at HC.gov) won't be ready until this fall--but it at least gives the SHOP enrollment number for New York.
Exchanges in larger states aren’t doing much better with their business plans. In New York, about 5,000 employees of small businesses have enrolled in the SHOP exchange, James O’Hare, a spokesman for the state’s Department of Health, said in an e-mail.
...in which we find the third ACA-created SHOP (Small Business Health Options Program) addition of the day. 2,155 employees is a pretty miniscule number (especially for the largest state in the country), but it's something. Note that it says "2,155 employees", which most likely means about double that when you include dependents, but as always, I'm leaving it here unless I find specific sources stating otherwise.
A total of 289 small employers have signed up for coverage through Covered California’s Small Business Health Options Program, better known as SHOP. These employers will provide coverage to a total of 2,155 employees.
If you take a look at the Private QHP spreadsheet you'll see a new column: "Private SHOP Market". This is for enrollees in the ACA's Small Business Health Options Program, basically the small business (fewer than 50 employees) counterpart to the individual/family exchanges getting so much attention.
This is one of those cases where percentages mask the real picture. Yes, Hawaii has seen their Private QHP enrollments increase by an impressive 43% since December 28. However, they only had 2,192 people enrolled in the first place...the actual increase is only 934 people, to 3,126.
Furthermore, those 934 have to be subtracted from the almost half-million "Not Broken Out By State" tally at the top of the spreadsheet, since they came in before 1/24/14.
On the other hand, this also gives the first SHOP (Small Business Exchange) entry for Hawaii...another 307 people.
Hey, a person is a person...
As of Jan. 18 the Connector enrolled 3,126 people, though 13,000 applicants were deemed eligible for tax credits to reduce the cost of coverage. Of the 373 small-business groups that applied, only 75 employers were enrolled with 307 workers selecting plans.
A very nice bump in Oregon's numbers today, especially given their ongoing technical issues. Private QHP enrollments are up from 23,800 as of Jan. 15 to 30,157 as of Jan. 24. However, since yesterday's HHS Dept. announcement of appx. 3 million total enrollments was "as of this week", this doesn't impact the overall total; it simply subtracts about 6,000 from the "Unspecified" number. Expect a lot of this over the next week or two until the enrollment updates "clear" the Week 16 point.