A few weeks ago I noted that thanks to the election of Democratic Governor John Bel Edwards (with an assist by David Vitter's diaper fetish), up to 375,000 lower-income Louisiana residents became eligible for the ACA's Medicaid expansion provision starting a month earlier than expected (June 1st instead of July 1st).

Enrollment officially started early this morning (not sure if it was right at midnight or if they had to wait until the state offices opened or whatever), and as of around 11:40am...

Gov. Edwards announces that there are already 175,000 Louisianans enrolled in the expanded Medicaid program. #lagov #lalege

— Gov John Bel Edwards (@LouisianaGov) June 1, 2016

Holy Smokes.

I've writte a lot about the so-called "woodworker effect" with Medicaid expansion over the past 2 1/2 years: People who were already eligible for Medicaid before the ACA, but who never signed up for it for a variety of reasons (they didn't know they qualified; didn't know the process for signing up; were too embarrassed to do so; etc etc). I estimated about 3 million "woodworker" enrollees in 2014, although I downshifted that later on and now have the tally estimated at around 3.8 million nationally as of the end of 2015. That's a lot of people being added to the system who would have been eligible for Medicaid even if the ACA had never been passed.

Last week, a major report from the National Bureau of Economic Research confirmed what I've been saying all along (although their estimates are somewhat lower--around 2 million in 2014 plus an unknown number for 2015), which was written about in a feature story by Kimberly Leonard of U.S. News & World Report.

I haven't posted anything about Louisiana's ACA Medicaid expansion since back in January, just before newly-elected Democratic Governor John Bel Edwards took office. At the time, it looked like the program wouldn't actually kick off until July, and would enroll perhaps 300,000 people.

Today brings a status update: It looks like they're gonna ramp things up a month earlier, and around 75K more Louisianans are eligible than previously thought:

La. Governor Announces Medicaid Expansion Will Begin June 1, Save State $677M Over 5 Years

About 375,000 people in Louisiana are expected to enroll in the program for low-income residents. At the same time, officials in Arkansas continue wrestling with the governor's plan to end the political impasse over expansion.

Over the past week or so, UnitedHealthcare started making good on their threat last fall to drop out of the ACA exchanges in at least some of the 33 states that they offer individual market policies in. On April 8th they said they were pulling up stakes in Arkansas and Georgia (although they're keeping a small presence in Atlanta via their experimental "Harken Health" division). Then, last Friday, they said they were dropping off the Michigan exchange as well...and just today, Adam Cancryn noted that they're pulling the plug on Oklahoma, while Zachary Tracer says they're pulling out of Louisiana. Ugh.

Here's the difference that a state election can make:

Louisiana Gov.-elect John Bel Edwards has set an ambitious timeline for a Medicaid expansion, saying he wants to have government-funded health insurance cards in thousands more people's hands by July 1.

...that's assuming the Republican-led Legislature doesn't try to throw up any roadblocks seeking to slow down an expansion effort.

Edwards, a Democrat who takes office Monday, said he would issue an executive order "within 24 hours from being sworn in" that starts the work required to expand Medicaid as allowed under the federal healthcare law. Health coverage for the people who would be eligible for the insurance under the expansion, he said, would begin July 1.

...The incoming health secretary estimated that about 300,000 people, mainly the working poor, would be enrolled for Medicaid under an expansion.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

The huge political story this morning is Democrat John Bel Edwards winning the Louisiana gubernatorial race by a whopping 12 points.

Much is being written about What This Means for Democrats Next Year®, blah blah blah. The reality is, as happy as I am about the outcome (sort of the Yang to the recent Yin in Kentucky), most of the specifics of the Louisiana results probably don't mean much nationally. As Matthew Yglesias notes at Vox this morning:

Louisiana was a perfect storm

A number of different factors came together to power Edwards' win. One is that Edwards, as a former Army Ranger with deep family ties to Louisiana state politics, had the right kind of biography to win in a red state. The other is that Vitter's rather unusual history with paid sex gave him the wrong kind of biography to win in any state. Add on to that the fact that the Louisiana Republican Party is divided and factionalized and the GOP has a firm grip on the state legislature, so some Republicans aren't exactly weeping to see Vitter lose.

Last but by no means least, the Louisiana economy is suffering from the global trend toward cheaper oil in a way that naturally helps challengers.

Louisiana's Insurance Dept. website is refreshingly complete: It includes every company on the individual & small group market, lists both the requested and approved rate hikes, and includes direct links to the filings which list the actual total enrollment in a clear-cut, consistent fashion.

In fact, the only data missing is some of the approved rate hikes; they've only posted the approved numbers for 3 of the 5 small group listings and 1 of the 10 individual listings, making it impossible to plug in the approved weighted average. However, the requested average is complete: About 15.4% for the individual market and 9.4% for the small group market.

Regular readers know that I've been a bit obsessed with hunting down the Mysterious World of OFF-exchange QHPs®...enrollees in fully ACA-compliant individual policies which aren't run through the exchanges (ie, no tax credits), but directly through the insurance companies themselves (Blue Cross, Aetna, whatever).

As I noted in my recent piece for healthinsurance.org, last year off-exchange QHPs ended up being a bit higher than as on-exchange: Around 8 million, give or take. However, this was just a rough estimate patched together from various data points, and even then it's likely that some number of those were the so-called "grandfathered" plans (which can continue indefinitely until the enrollee dies or cancels/stops payment) or the "transitional" (aka "grandmothered") plans, which are the ones which were supposed to be discontinued on 12/31/13, but were given up to a 3-year extension period depending on the state and insurance company.

(someone sent me this link, and after the Louisiana/North Carolina debacle a few days back I figured I owed a bit of good Red State news...)

Community health centers offering counseling for the Affordable Care Act (ACA) enrollment process say they are experiencing a surge in the number of people seeking help ahead of the March 31st deadline.

At the David Raines Community Health Centers corporate office in Shreveport, appointments are completely booked through next Monday's deadline, according to Community Development Coordinator, Calvin Young.

"Being in healthcare and kind of understanding how people work and think we anticipated a big surge at the end, but the surge has been a little overwhelming," Young says.

(SIGH) OK, in the words of Emily Litella..."never mind..."

It looks like I was right to be suspicious of the seemingly fantastic QHP enrollment numbers reported out of both North Carolina and Louisiana.

Thanks to Jed Graham (via Twitter) for pointing me towards Page 21/22 of the February HHS Report. Normally I only focus on the 3rd and 4th columns ("Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace" and "Number of 
Individuals Who Have Selected a Marketplace Plan", since these are the actual exchange enrollment numbers through the end of that month.

OK, I either have some very good news...or one heck of a misunderstanding here.

Earlier today I updated both New York and Colorado's QHP numbers...and while both were very fine, they were actually down somewhat from last week (large drop for NY, small one for CO). This may actually make sense, as both of these state exchanges have been running very smoothly for months now; it's possible that they've simply started to reach the end of the line in terms of residents actually signing up (or perhaps they'll both experience a final mini-surge right at the tail end this weekend).

However, the apparent news out of both North Carolina and Louisiana has me thrown for a heck of a loop (visit the links for details).

OK, not only are the numbers here as hard to believe as North Carolina, but the source is the same: Dr. Renard Murray of CMS:

In Louisiana the numbers put the state near the back of the pack.  Dr. Renard Murray with the Centers for Medicaid and Medicare services say there needs to be a late surge in enrollment.

''We've got well over 100,000 who have signed up but well over 800.000 are eligible,'' said Murray.

As of March 1st, HHS only had Louisiana down as having 45,561 exchange QHPs, plus another 9,105 new Medicaid enrollees (again, LA is not an expansion state). Just like with NC, even if the 100K includes both (and he says it's "well over" 100K), assuming an 83/17 split between the two, that would still be an increase of 37,627 QHPs for a total of 83,188...an 83% increase in just the past 3 weeks...at a daily rate 3.8x that of February.

And, just like with North Carolina, if that number doesn't include Medicaid, that would mean a more than doubling of the total through 3/01...at a rate 5.5x that of February.

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!