The problems with the Obama Administration’s rollout of HealthCare.gov are reminiscent of the troubled rollout of the Medicare Part D expansion under President George W. Bush. In a candid interview with Kaiser Health News, former Health and Human Services Secretary Michael O. Leavitt offers telling details of their technical problems – and the Bush Administration’s solution.
…people were walking up to the pharmacy counter to get their drugs and their name wasn’t in the computer. Ultimately, we had to say, ‘give them their drugs, and we’ll work it out later.’ Then we spent 15 or 18 months working it out later. It was an expensive proposition and less than ideal. But it allowed the limited number of people who were having problems with the system to have their human needs met.”
By contrast, the Obama Administration has spent just over three months working out glitches of HealthCare.gov, which was launched on October 1st, 2013. Perhaps after 15–18 months have passed, we can do a more complete comparison with President George W. Bush’s rollout of Medicare Part D?
We have our 3rd Oregon update this week today; they're now up to 20,000 private enrollments as of Monday, plus another 35,000 Medicaid expansion additions. Add this to the 114,500 automatic enrollments via the Oregon Health Authority, and that brings their total Medicaid tally to 149,500.
In total, about 170,000 people have new health insurance beginning this month under new funding and rules of the Affordable Care Act. A majority of them are Oregon Health Plan enrollees, a program for low-income residents...
Monday was the last day for Oregonians to finalize their commercial plan selections on Cover Oregon. Of the 55,000, about 20,000 new enrollees purchased private plans. About 35,000 enrolled in Oregon Health Plan through Cover Oregon, and the majority of the new OHP enrollees signed up directly through Oregon Health Authority.
The Nevada ACA exchange, which apparently only uses Twitter for press releases, just announced that private enrollments have gone up from 12,745 as of 12/23 to 17,673 as of January 4th, a 38% increase.
They're also one of only 3 states to specify paid vs. unpaid status so far; they've gone from 49% paid as of 12/23 to 60% paid (10,647) as of 1/4.
Update as of 1/4: 915,977 unique individuals visited Nevada Health Link. 17,673 consumers confirmed QHP selections, 10,547 have paid.
The final December tally for Rhode Island is in, and also gives a clearer picture of the "But how many have PAID???" talking point. As of New Year's Eve, 11,305 people had enrolled in a plan, of which 2,300 still hadn't paid as of 2 days ago. That means that at least 80% of RI private exchange enrollees are paid in full. No new Medicaid numbers in the article.
Depending on your POV, this also means that Rhode Island has also now hit either 94% (if you're counting unpaid enrollments) or 75% (if you're not) of their 12,000 CBO projection for 3/31/14. See this story for additional discussion.
Monday night, HealthSource RI, the Obamacare marketplace in Rhode Island, sent emails to 2,300 people who had not paid as of Jan. 5 to tell them they had until 4 p.m. on Jan. 8 to pay the first month's premium, and their plans will still be effective retroactive to Jan. 1.
HealthSource RI reported Monday that 11,305 people selected plans as of the Dec. 31 deadline, but not all had paid.
Yesterday, Theda Skocpol of Harvard University cited the data at this site in a brief about state progress in implenting the Affordable Care Act posted at the Scholars Strategy Network website. This brief--particularly the accompanying visual graph--was in turn cited in articles posted at both Talking Points Memo and Mother Jones. The gist of both the brief as well as these articles is that the states which have been cooperating with the ACA have been far more successful in enrolling people in both private insurance plans as well as publicly-funded plans such as Medicaid, SCHIP and related state-run programs.
It is well known, and highly embarrassing, that Oregon has yet to enroll a single person in a new insurance plan online. Since the 1st of October, Cover Oregon has had to do it all by hand, based on paper applications.
That, of course stands in stark contrast to today’s situation. In the course of three months, Cover Oregon has managed to enroll just 18,000 people in private insurance plans – and towering piles of applications are still awaiting the attention of their stressed case workers.
Connecticut, the first state to exceed their March 31 enrollment deadline back on December 23rd, continues to keep their momentum up, adding at least another 12,000 people to their rolls since the 12/23 deadline for January coverage. The article doesn't distinguish between private plans and Medicaid expansion, so I've broken it out roughtly 55/45 for now to match their previous numbers.
This brings CT up to nearly 41,000 private enrollments and over 33,000 added to Medicaid/CHIP.
Many state residents are aware that enrollment is still open, as Counihan said enrollment through Access Health CT has remained strong over the past week or so.
"We're still doing a thousand a day," Counihan said. "I would have thought that, after Dec. 23, things would have really dipped."
For California, we presently have data through the December 23rd. However, at the last minute, California extended its deadline to 12/27. This means that we are still waiting for four days of enrollment data! Keep in mind that just prior to the deadline, California was seeing 20,000 private plan enrollments daily.
It that rate continued unabated, we could be looking at as much as 80,000 signups beyond the 428,000 already registered. During the three days December 20–22nd more than 77,000 Californians enrolled in private plans. Granted, this is speculation – we won’t know until Covered California releases its figures.
The Vermont numbers have been alternately impressive and confusing at the same time. The wording of a prior article from 12/12 made it sound like the 45,000 (at the time) people were split between private enrollments and Medicaid expansion, but also made reference to 29,200 people being enrolled "directly via their employer". At the time, I wasn't sure what to do with that number, so I ignored it. However, the more recent article again references the same 29,200 people; after comparing the 2 articles, it seems pretty clear to me that these would fall under the category of "direct" or "off-exchange" enrollees (although they also might fit under "small business exchange enrollments", which is a category I haven't even added yet). Add this to the 22,800 private exchange enrollments and you have 52K total.
In a December 23rd interview with the Des Moines Register, CoOportunity Health (1 of 2 companies participating in IA's ACA exchange (and 1 of 3 participating in NE) said they had enrolled 2,577 people in private plans in Iowa via the HC.gov exchange as of 12/20. However, they also mentioned a total of 8,583 enrollments state-wide as of 12/20, meaning another 6,006 people were enrolled directly through the company, bypassing the exchange completely.
I contacted Leigh McGivern, the PR representative for CoOportunity Health, who informed me that CoOportunity operates in Nebraska as well, and gave me more recent and detailed numbers for both states: 3,468 exchange-based enrollments (not sure if this is people or households) in Iowa, and another 7,362 exchange-based enrollments in Nebraska.