Connecticut

A few days ago, AccessHealthCT (Connecticut's state-run ACA exchange) gave me their exact total enrollments as of 8/02: 250,633. Unfortunately, they were unable to provide a breakout between QHPs and Medicaid/CHIP enrollments. Yesterday the Hartford Courant reported a higher combined total:

Access Health CT, the state-run onlinehealth insurance marketplace created under the federal Affordable Care Act, has enrolled more than 256,000 state residents in private health plans or Medicaid since the website launched last fall.

The open enrollment period total of 218,100 (including everything through 4/19) broke out roughly 36:64. Assuming "more than 256K" is roughly 256,100, that means about 38,000 more people since then. If that ratio has stayed consistent, it should be around 13,700 QHPs and 24,300 Medicaid. However, as I noted the other day, with off season enrollment being limited for QHPs but open-ended for Medicaid/CHIP, the ratio has almost certainly shifted substantially in Medicaid's favor.

Sometimes you just have to go straight to the source. I flat-out asked Access Health CT (Connecticut's ACA exchange) if they could provide an off-season enrollment update, and here's their response:

@charles_gaba our total as of July 22nd is 250,633 overall enrolled. That's all I can share now, but more coming near OE

— Access Health CT (@AccessHealthCT) August 2, 2014

They weren't able to provide a breakdown between private QHPs and Medicaid/CHIP enrollment, but I can make a pretty good guess.

According to the final HHS report, Connecticut's official exchange QHP total as of 4/19 was 79,192, and Medicaid determinations were 138,908, for a combined total of 218,100. Since then, this total has gone up 32,533. The QHP/Medicaid ratio during open enrollment was roughly 36/64, which, if consistent during the off season would mean around 11,700 more QHPs to around 20,800 Medicaid enrollees.

There's been a recent batch of insurance rate change requests reported across various states which has gotten a lot of press. However, as I noted a couple of weeks ago, there can be a big difference between what the insurance companies ask for and what the state insurance commissioner approves. This is one of the most important (and least-written about) aspects of the ACA: Insurance companies can no longer just jack up their prices however much they feel like; those rates have to be approved by the insurance commissioner for the state they're operating in if they want to sell their wares on the exchange.

Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:

Illinois:

After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.

The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.

...United's participation also could help lower rates for consumers, a key concern among the law's supporters.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

This story out of Connecticut breaks down their Medicaid enrollees using a handy chart and some very specific numbers, giving fairly hard "Strict Expansion" and "Woodworker" updates:

Unsurprisingly, the biggest percentage growth occurred among adults who don’t have minor children. The income limit for people in that category [HUSKY D] to qualify for coverage rose Jan. 1 as part of the federal health law commonly known as Obamacare, from 56 percent of the poverty level to 138 percent.

...But another portion of the Medicaid program also saw a significant enrollment increase, even though eligibility requirements remained largely unchanged. That portion, known as HUSKY A, covers low-income children and their parents.

...Between the end of September and the end of April, total number of people in HUSKY D rose from 94,058 to 137,260 -- a growth of 43,202 people.

During that time, the number covered by HUSKY A grew by 29,792 people, to 460,103 members.

After my back-to-back Cranky Screeds, this is a breath of fresh air.

Given the "How many have PAID???" fuss & bother, I've been debating how to handle an interesting number-crunching dilemma ever since the (final???) HHS report for March/part of April was released a few weeks back.

The question is this: When people ask "how many have paid?" their first month's premium, are they really interested in the percentage or in the actual number of people who are paid up?

This may seem like a curious distinction, but consider the following: Officially, the maximum total number which could potentially be "fully enrolled" (ie, premium paid) is 8,019,763. That's the number that the HHS Dept. listed in their last report, which runs through April 19th.

So, 90% of that number would be around 7.22 million, give or take.

Connecticut officially didn't have an extension period, but they did allow late enrollments on a "special case" basis, which apparently amounted to about 5,000 more people:

A total of 208,301 Connecticut residents enrolled in health care coverage through the Access Health CT online marketplace as of Sunday, the quasi-public agency announced Thursday.

The numbers reflect those who signed up before the March 31 deadline for open enrollment, plus 5,000 people who attempted to enroll by that date but encountered some difficulty, but were able to enroll over the last two weeks.

“Over the past two weeks, our team has made follow up calls to each of those individuals to assist them through the enrollment process, and we have now completed all open enrollment applications,” Kevin Counihan, head of the agency created as the state’s response to the federal Affordable Care Act, said in a news release.

Of the 208,301 enrollees, 78,713 enrolled with a private insurance carrier and 129,588 enrolled in Medicaid. Of the 78,713 residents who enrolled with a private insurance carrier, 78 percent received a tax subsidy and 22 percent did not.

No exact numbers here, but the wording of the article gives the rough breakdown:

About 3,500 Connecticut residents have enrolled in health insurance through the state’s health care exchange, Access Health CT, since the official open enrollment deadline passed on March 31. That’s in addition to the nearly 200,000 who enrolled by the health care deadline.

Access Health CT CEO Kevin Counihan said there were roughly 10,000 people in the state who wanted to enroll but couldn’t complete the process by deadline for some reason. Those people were told to leave their contact information, and that the state would follow up with them to make sure their enrollment was completed.

...Customers to the state marketplace could either buy insurance through one of three private carriers on the exchange, or get covered through Medicaid. The majority of those covered through the exchange — more than 120,000 — were covered under Medicaid.

Last night I posted that Washington State, which officially is not offering any sort of extension period, actually is allowing late enrollments on a special, case-by-case basis.

Then, earlier today, I learned that Hawaii (which I never really read an official policy on one way or the other, but which I thought was not extending enrollments) actually is doing so for up to potentially 1,100 people or so (192 to date).

Now it appears that Connecticut, which had been very explicit about their "no extension" policy...apparently is allowing up to 10,000 people to (potentially) sneak in under the wire after all:

Connecticut’s health insurance exchange ended its first open enrollment period with 197,878 people signed up for health care coverage, including 5,917 who enrolled Monday.

Connecticut reports their 3/31 totals...just shy of their 200K upgraded goal, but still very impressive:

A total of 197,878 residents secured a policy through the system, including 76,597 with a private carrier and 121,281 in Medicaid. Since open enrollment began last October, Access Health CT logged 801,509 unique website visitors. 

Connecticut chimes in, with nearly 192K total, including 74K exchange QHPs...

As of Sunday night, 191,961 people had signed up for coverage, with 74,000 in private health plans and the rest in government-funded Medicaid plans, said Access Health CT's CEO Kevin Counihan.

He said the exchange had been "swamped" on Monday, prompting the predictions of possibly 200,000 total enrollees since open enrollment began in October. It's unclear how many of those people were previously uninsured. An analysis is expected this summer.

A very nice little update from CT. Clean numbers, and this is the first specific reference to policies being subtracted from the total due to non-payment (presumably for policies that started in January, February and possibly March), which is perfectly fine.

I've said all along that I have no problem at all with subtracting any people who truly are deadbeats or cancel their policy for one reason or another...it's just that they shouldn't be subtracted until they actually are past due, that's all.

Connecticut’s health insurance exchange has been enrolling between 3,000 and 4,000 members per day as the sign-up deadline approaches, exchange CEO Kevin Counihan said Thursday.

As of Wednesday afternoon, 178,601 state residents had signed up for Medicaid or private insurance through the exchange, Access Health CT.

Of those, 62 percent, or 111,050, will receive Medicaid coverage. The other 67,551 signed up for private insurance. Among private insurance customers, 78 percent are receiving federal financial aid to pay their premiums.

In an editorial piece from the The Courant newspaper, a non-exact QHP update is revealed: 65K, up from 62K as of 3/13:

Even without that money, Connecticut created a model portal in http://www.accesshealthct.com. This state should take pride in being among the most successful in enrolling at least 65,000 consumers in private health insurance plans. Maryland is reportedly considering abandoning its own dysfunctional portal and using Connecticut's in the next open enrollment period in November.

Connecticut continues to Do It Right®. Not only have they broken their own combined goal by 60%, they're also now 37% past their fair share of the CBO's original 7 million QHP figure. The exchange's CEO is quoted in the article as saying that CT doesn't expect to see much of a "March surge", but that isn't too concerning to me--they're already doing fantastic, so any enrollment rate increase wouldn't be as dramatic by comparison anyway.

Oh, yeah--and 92% of all of their enrollees to date are paid up, even more impressive considering that this should include people whose policies don't even start until April.

In Connecticut, 160,580 people have enrolled in coverage through Access Health CT, surpassing the exchange's self-imposed goal of 100,000 people. Counihan said roughly 62,000 of those who enrolled signed up for one of three private health plans represented on the exchange. Most of the remainder signed up for some form of Medicaid.

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

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