District of Columbia

A second nice DC find today by contributor deaconblues; as he put it, "so much for the triple-digit increases predicted by the Republicans"...

The D.C. Department of Insurance, Securities and Banking received proposed health insurance plan rates to sell on the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2015.

Four major insurance companies – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – have proposed rates for individuals, families and small businesses.

 UnitedHealthcare proposed rate decreases of eight percent for all of their 2015 plans; Aetna and Kaiser Permanente proposed a mix of rate increases and decreases resulting in a slight overall net decrease for Aetna and a slight overall net increase for Kaiser; and CareFirst proposed rate increases for all plans. Most of the individual plans and all small business or “SHOP” plans reflect increases greater than 10 percent.

While that last item about CareFirst raising rates over 10% puts a damper on the good news, it may not be final:

When we last checked in with the DC exchange, I had to do an estimated breakdown between QHPs, SHOP and Medicaid enrollments of around 11,100, 14,200 and 22,700 respectively.

Today they released the actual totals, which are shoved around a bit from my estimates:

From October 1, 2013 to June 11, 2014, 48,188 people have enrolled through DC Health Link in private health plans or Medicaid:

  •  11,582 people enrolled in private health plans through the DC Health Link individual and family marketplace;
  •  23,008 people were determined eligible for Medicaid coverage through DC Health Link; and
  •  13,598 people enrolled through the DC Health Link small business marketplace.

So, QHPs are about 600 higher than I thought, SHOP about 600 lower and Medicaid about 300 higher. Not bad!

The DC exchange has always been a bit of an anomaly: It's one of only 2 exchanges where SHOP enrollments exceed QHPs (the other is Vermont), mainly because the ACA requires Congressional staffers to enroll via the DC SHOP exchange instead of their home states or even the DC QHP side. As a result, as of April 30th (the most recent update), the breakdown was 11,106 QHP's (25%), 13,230 SHOP (30%) and 20,497 Medicaid enrollees (45%). Add them up and you get 44,833 total.

As contributor deaconblues notes, the QHP number seems to be almost identical, so the bulk of the 3,200 additional enrollments are broken out between Medicaid and SHOP enrollees. I'll assume a 70/30 split until better data is made available.

A spokeswoman for DC Health Link said this week that reports of problems, “if true, were isolated incidents.” She noted that the exchange has enrolled more than 48,000 individuals and families; about 11,000 are enrolled in private plans.

The District of Columbia is one of a handful of exchanges which went beyond the 4/15 extension period out to 4/30; here's DC's final tally:

From October 1, 2013 to April 30, 2014, 44,833 people have enrolled through DC Health Link in private health plans or Medicaid:

  • 11,106 people enrolled in private health plans through the DC Health Link individual and family marketplace;
  • 20,497 people were determined eligible for Medicaid coverage through DC Health Link; and
  • 13,230 people enrolled through the DC Health Link small business marketplace.

The quotes around "final" are there because DC also announced that they're bumping out the extension period one more time, to April 30th:

The exchange had 699 people enroll for coverage in the two weeks after open enrollment was originally supposed to close, with 22 percent of those signups coming on Tuesday, the final possible day. That brings the total number of private health coverage enrollments to 10,630, Medicaid signups to 19,217, and small business enrollments to 13,118.

OK, the various ACA exchanges are just messing with my head now.

First, Nevada announced that they've extended their enrollment out to May 30 for those who started by March 31st.

Then Oregon announced that they've extended full open enrollment out to April 30.

Then I found out that anyone who submitted a paper application by April 7th in any of the 36 states run by HC.gov still have until April 30 to finish.

Colorado, I've discovered, is allowing people who applied for Medicaid but were denied up until May 31st to finish their enrollment process.

And, of course, Massachusetts has over 200K "Limbo Status" people who may (theoretically) get squared away as late as June 30.

Late last night I learned that Hawaii has bumped their extension deadline out to April 30.

The third state-based exchange (well...technically not a state) to release their 3/31 total is the District of Columbia. Fortunately, they specifically separate out the SHOP numbers:

The DC Health Benefit Exchange Authority today released new data showing strong enrollment activity through DCHealthLink.com as of March 31st.  Since the marketplace opened for business on October 1, DC Health Link has enrolled 40,234 people. This includes District residents who enrolled in private health plans and in Medicaid, as well as people with coverage through their employers.  In the final week alone, more than 2,000 people enrolled through the individual and family marketplace -- accounting for over 21% of all individual enrollments in private coverage. 

Enrollment

As of March 31, 2014, 40,234 people have enrolled through DC Health Link in private health plans or Medicaid:

 9,838 people enrolled in private health plans through the DC Health Link individual and family marketplace;
 17,489 people were determined eligible for Medicaid coverage through DC Health Link; and
 12,907 people enrolled through the DC Health Link small business marketplace.

This is kind of a thin article; it doesn't give an exact number, doesn't specify the date of the conference (I'm assuming it was yesterday), and doesn't break out the total between QHPs, Medicaid...and the DC SHOP exchange. DC is the only exchange in which SHOP enrollments outnumber the Individual QHPs due to the to the wording of the ACA requiring Congressional staffers to use the DC SHOP.

The existing breakout was 7,926 individual / 12,743 SHOP and 14,379 Medicaid, or around 22.6% / 36.4% / 41%. I'm assuming the 37K figure is broken out similarly until I learn otherwise, which adds 443 QHPs, 710 SHOP and 800 Medicaid.

More than 37,000 have signed up for health insurance through the D.C. Health Link exchange under the Affordable Care Act, officials said during a news conference.

A nice little update out of DC...they even did the net gain math for me! Unfortunately they didn't separate out QHPs from Medicaid (the 17,899 number includes both).

If I assume the a slightly lower 32/68 breakout of the new enrollments (it was 36/64), that should mean an extra 1,410 QHPs and 2,996 Medicaid enrollees.

That gives a total of 7,926 exchange QHPs and 14,379 new Medicaid total.

DC's numbers are so small that I'd normally say that even if my breakout is wrong, it won't impact the projection enough to worry about...but in this case, they were running 40% below the February rate, so this jump to 26% higher actually bumps the projection back up a smidge after all, to a solid 6.4M.

Since March 10 (the last data release), enrollment through DC Health Link increased significantly.  To date a total of 22,305 people have enrolled through DC Health Link’s individual marketplace, up from 17,899 on March 10.  This is an increase of 4,406 people just in the last few weeks. (Note this data does not include enrollment through the small business marketplace.) 

Earlier today, contributor Esther Ferington brought an old New York Times article from last October to my attention. The article is actually about off-exchange enrollments as an option to using the exchanges, but the opening line of the story includes an interesting snippet:

WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites.

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