I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:


For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

Remember "Florida Health Choices", the brainchild of Republican Senator Marco Rubio which was supposed to be the Florida GOP's response to the Affordable Care Act health insurance exchanges?

The Florida Republican Party flushed $900,000 in startup funds into a website/"exchange" which signed up a whopping 30 paying customers in 6 months, at a cost of $30,000 apiece...or between 46x - 81x as much per enrollee as the "wasteful" HealthCare.Gov.

Of course, it didn't help that "Florida Health Choices" didn't actually sell, you know, "health insurance" but was basically hawking discount coupons for dental checkups and the like.

Remember all last summer and into the fall when I kept pointing out to anyone who would listen that just because the official Open Enrollment period had ended back on March 30th (or April 15th, depending on your POV), there were still a good 9,000+ people per day enrolling via the ACA exchanges due to major life changes?

Of course, those people being added were also being cancelled out to some degree by people dropping their policies (or being dropped whether they liked it or not due to non-payment or immigration/residency issues). From what I could tell, the additions seemed to be outnumbering the subtractions for most of the summer, up until around August, at which point the trend reversed. However, it was difficult to know this for certain until the CMS head unexpectedly mentioned that 7.3 million people were still enrolled as of mid-August (going up!), followed by a drop to 7.1 million as of mid-October (going down!).

A week ago, I reported an update regarding the "Florida Health Choices" website, spearheaded by Florida GOP Senator Marco Rubio, which is a taxpayer-funded healthcare exchange to sell private insurance policies to Florida residents:

TALLAHASSEE — Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

You know...Obamacare, without the "Obama" part.

It also doesn't offer any tax credits to make healthcare policies, you know, affordable.

Then again, that's kind of a moot point, since it doesn't actually even offer healthcare policies anyway--just "discount cards" for dental visits, prescriptions and prescription eyeglasses.

So...you know, it's basically a coupon store.

Oh, yeah...and even some of those coupons are kind of a scam:

Marco Rubio

OK, Sherman, let's fire up the Wayback Machine and revisit August 29th, 2014, shall we?

TALLAHASSEE — Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

Six months after the launch of the state's effort, called Florida Health Choices (floridahealthchoices.net), just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services.

As I noted at the time:

Last week, I posted a major entry in which I painstakingly pieced together the current QHP enrollment data from 16 states in an attempt to extrapolate what the current national enrollment figure stood at as of October. Since last spring, the only data point that HHS had given out was that 7.3 million were enrolled as of August 15th; I was trying to calculate how many were still enrolled 2 months later, after adding "special life event" enrollments and subtracting people who dropped their policies for other assorted reasons.

In addition, there was the question how much the "3 month grace period", "citizenship/immigration data" and the "income data discrepancy" issues would contribute to the attrition rate, as people were dropped due to failure to continue payments or for not being legally eligible for the policies.

Yesterday, in my Big Exclusive Post® about the number of people currently enrolled in exchange QHPs appearing to have dropped down to a bit below 7 million, I noted that based on the 15 states for which I have current enrollment data from September or October (plus 1, Oklahoma, from August), it looks like the national total is right around 7 million on the nose at the moment. However, if you throw Florida into the mix, it drops noticeably, making it look more like 6.8 million.

I also noted that there are two problems with the Florida data: First, that it's had significantly more dropoff (22.5%) from the official April figure than any of the other states listed (with the exception of Nevada, which has had its own technical headaches to the point that it's dropping its exchange entirely).

Even more problematic is that this 22.5% "drop" was supposedly only as of June 30th (it comes from Florida's 2015 policy rate request filing report from the insurance companies operating on the federal exchange).

This makes Florida an incredible outlier; take another look at the chart:

I'm kicking myself for not writing up a full post on this issue, since it's the issue which most directly connects today's election to ACASignups-specific issues, but thankfully, Sam Stein and Jeffrey Young have done a fantastic job anyway. The key takeaway is this:

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

Thanks to the Kaiser Family Foundation's Larry Levitt, who linked to a PDF from the Florida Health Insurance Advisory Board. This report has data which has made the news twice already: First, because of the 13.2% "weighted average" premium increase for the state (which has come under fire for "weighting" based on projected membership instead of current membership), and secondly because of the exchange QHP enrollment number in June, which is 22.5% lower than the 4/19 total (but which, as I've already shown, isn't nearly as bad as right-wing outlets like the Daily Caller are claiming).

Levitt has noted a third interesting data point in this report:

Two-thirds of those buying their own insurance in Florida are now in ACA-compliant plans. http://t.co/JYVo1UXkvf

— Larry Levitt (@larry_levitt) September 2, 2014

I took a look to see what he's referring to, and it's interesting indeed:

Someone just brought this piece from the right-wing Daily Caller to my attention:

Florida Obamacare Enrollment Total Plummets By A Quarter

Florida’s Obamacare enrollment is now over 220,000 lower than the Obama administration’s most recent tally, according to a report from the state insurance department. 

The Obama administration hasn’t released updated Obamacare enrollment statistics since May, when the Department of Health and Human Services put the number of Florida sign-ups at 983,775 — but the Florida Office of Insurance Regulation says that now, just 762,723 Floridians have health insurance through the exchange.

OK, stop right there. Yes, it's true that the most-recent HHS report had enrollments at 983,775, but that was as of April 19th, not "May". Minor error, I agree, but important in the context of what we're talking about there. OK, go on...