Iowa

Well, well, well; imagine that...

While Obamacare attacks continue to fade, health reform’s success is even forcing some Republicans to acknowledge the law is having positive effects.

The latest example comes from Iowa’s third congressional district, where David Young (R) is facing former state Sen.Staci Appel (D) to replace retiring-Rep. Tom Latham (R-IA) in a toss-up seat.

...BORG: Did you favor the expansion of Medicaid, which was included in Obamacare?

YOUNG: It seems to be working in Iowa. I would make sure in any regards to Medicaid they would have some kind of flexibility.

...Still, Young was asked twice by Borg whether he would support repealing Obamacare, as has been the Republican mantra for the past four years. Both times, Young refused to say he wanted to do so.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

ILLINOIS: Clock Ticking For Illinois To Form State-Run Obamacare Exchange

Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

Joe Sonka has an excellent (if depressing) analysis explaining why Kentucky Senate candidate Alison Lundergan Grimes isn't campaigning on the Affordable Care Act even though her opponent, Mitch McConnell, has done everything he can to tear away healthcare from a half-million Kentuckians:

The reasons for this disconnect are many and are closely tied to the decision of Alison Lundergan Grimes’ campaign to steer clear of the issue. But this decision by Grimes to avoid talking about the benefits of health care reform is not just an effect of the disconnect, it is also a cause of the disconnect, itself.

If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:

Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.

...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.

This is really more of a confirmation of my own estimates than anything; I had Iowa down as around 81K "Strict Expansion" plus another 800 or so "Woodworkers". The actual total appears to be slightly less: 78,860. Not sure what the breakout between the two is, I'm going to assume roughly 75K "strict" and another 3,860 "woodworkers" for now:

The federal report also said that 78,860 Iowans more were enrolled in Medicaid or related programs at the end of March than were enrolled in those programs last fall. Medicaid is a joint federal and state health-care program for the poor. Under the Affordable Care Act, states could opt to expand their Medicaid programs' rules to allow more poor, working-age adults to join. Iowa chose to do so with a pair of programs, the Health and Wellness Plan and the Marketplace Choice Plan, which have similarities to Medicaid. There is no deadline for Medicaid enrollment. People who qualify for the public plans can sign up any time.

Leigh McGivern of coOportunity Health has helpfully provided their final (well, near-final...through 4/14) tallies for both on- and off-exchange enrollments. The exchange-based numbers aren't really relevant to me since those are reported by HHS, but the off-exchange QHPs and ESI's are vital:

IOWA

  • Individual/Family members: 18,358 (10,809 on exchange/7,549 off exchange)
  • Small group members: 7,848
  • Large group members: 274

NEBRASKA

  • Individual/Family members: 30,668 (20,308 on exchange/10,360 off exchange)
  • Small group members: 11,292
  • Large group members: 2,774

TOTAL ON EXCHANGE IOWA AND NEBRASKA (individuals/families): 31,117

TOTAL OFF EXCHANGE IOWA AND NEBRASKA (individuals/families): 17,909

TOTAL BUSINESS (employees and dependents) IOWA AND NEBRASKA: 22,188

TOTAL BOTH STATES ON AND OFF EXCHANGE (individuals/families/businesses): 71,214

This represents increases as follows:

This article contains a breakdown between "strict expansion" (30,000) and "bulk transfers" (51,000), modified from the 13,000 and 55,000 prior estimates (not sure what happened to the other 4,000 who were listed as being transferred from IowaCare previously). Still a net gain of 13,000 people.

In addition, state officials say about 81,000 Iowans have enrolled in the new Iowa Health and Wellness Plan or Marketplace Choice Plan, which are Iowa’s versions of an expanded Medicaid program.

About 51,000 of those people used to have limited coverage from IowaCare, a program that ended Dec. 31.

 Interestingly, there's even a reference to a specific "woodworker" figure

 In February, 403,609 people were enrolled in the program. That represented an increase of 0.5 percent from the 401,582 who were in the program in February 2013.

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!

Back in January, I found my first solid data on off-exchange enrollments via a Co-Op operating in Iowa and Nebraska called CoOportunity. They helpfully provided their data through January 24, which totalled 10,166 off-exchange enrollments in Iowa and antoher 17,779 in Nebraska.

Last week, they provided an update to these figures. When you add off-exchange individual/family policies to small & large group policies (which are "off-exchange" by definition, since the HC.gov SHOP system isn't operational yet...you get redirected to the individual companies/co-ops), Iowa is up to 12,293 and Nebraska is up to 19,959, as of February 24.

Iowa's Medicaid total just got a nice shot in the arm. It seems that 55,034 Iowans who were previously enrolled in IowaCare have been bulk-transferred over ot Medicaid proper, on top of over 13,000 additional new enrollees. All of these people are specifically listed as being due to ACA Medicaid expansion, they are not woodworkers.

While the total above is 67,893, another article from the next day lists the exchange-based enrollments as "more than 13,000", so I've bumped it up by another 142.

More than 50,000 former IowaCare members automatically were enrolled in the new system, giving them access to more services and a choice in who provides their health care, including – in many cases – local options, McCoy said.

Including those who have signed up since, the Iowa Health and Wellness Plan through mid-February boasted a total enrollment of 67,893 – 55,034 in the wellness plan and 12,859 via the marketplace choice, according to McCoy.

Pages