Ohio

David Ramsey has the full skinny on the unpleasant situation in Arkansas, where their "private option" Medicaid expansion program, which was always weird with a beard to begin with, is very much at risk of collapsing altogether:

Well, here we go again. The legislature is once again ready to debate the private option – the state’s unique version of Medicaid expansion, which uses funds available via the Affordable Care Act to purchase private health insurance for low-income Arkansans. Gov. Asa Hutchinson will take a long-awaited position on the policy in a speech at UAMS tomorrow morning. Then it will be up to the legislature. Health insurance for more than 200,000 Arkansans is at stake. Here are some keys to remember as the debate unfolds tomorrow and in the coming weeks. 

The short version: The AR program has to be re-approved by the legislature every year, and requires a 75% majority to do so, so it's a wonder that it's survived this long, frankly.

Thanks to commentor farmbellpsu for bringing my attention to this article from the Cincinnati Enquirer, which demonstrates everything I was concerned about with yesterday's monthly HHS report...although many of the problems are with whoever wrote/edited the story not understanding the basics either:

Fewer Ohioans choose a health plan in 2015 enrollment

Nearly 89,000 Ohioans chose a health insurance through the Affordable Health Care marketplace during the second open enrollment in November and December, the federal government reported Tuesday.

Ohio Republican Governor John Kasich, folks:

Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context.

...Mr. Kasich, referring to repealing the Affordable Care Act, was quoted as saying “that’s not gonna happen.”

...“I’ve always thought if we got a majority we would repeal Obamacare,’’ he said. “My only point was they’d probably make an accommodation for Medicaid expansion.’’

...It is an open question how expanding Medicaid benefits as generously as the Affordable Care Act allows, to adults earning up to 138 percent of the poverty level, could be paid for without increased taxes and Medicare cost reductions also created by the health care law.

...“I’m in favor of repealing Obamacare,” he repeated. “That’s all I can tell you.’’

Well, let's see here.

OK, this is a pretty minor update, but according to the last HHS report, as of 4/19, Ohio's official QHP tally stood at 154,668. However, according to this article, it was a few thousand higher than that:

About 157,000 Ohioans signed up for health plans through the federal exchange during the first open enrollment period, which ran from Oct. 1, 2013 into March, 2014. In January, Ohio expanded Medicaid under Obamacare to cover more low-income adults. More than 360,000 people have already enrolled around the state through that new eligibility. And most of the doom and gloom predictions about the Affordable Care Act haven’t come true. Premiums aren’t through the roof, and the website, pretty much works as the federal government prepares for a new round of open enrollment starting Nov.15.

Again, pretty minor stuff, but as we enter the 2nd year of the ACA exchanges being open (slightly different from the 2nd open enrollment period, of course, which doesn't start for another 6 weeks), I figure it's a good idea to get some little details up to date.

It's been over 3 months since I've been able to check in on the status of Ohio's implementation of ACA Medicaid expansion. As of mid-June, OH had racked up 243,230 people newly eligible thanks to the Affordable Care Act out of around 563,000 state residents who were eligible.

As of the end of August, that number has grown to 367,395 people, or over 65% of the total eligible:

Ohio Medicaid enrollment under Gov. John Kasich’s Obamacare expansion hit 367,395 in August, passing the Republican governor’s projection for July 2015.

Kasich told taxpayers and the Ohio General Assembly that an estimated 366,000 Ohioans would be enrolled in Medicaid under Obamacare at the start of the state’s 2016 fiscal year. This projection is reflected in a Governor’s Office of Health Transformation chart released in February 2013.

Last October, at the height of the botched HC.gov rollout, I repeatedly commented over at Daily Kos:

 I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

  • Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
  • California, Colorado, Connecticut and Delaware* are all state-run exchanges.
  • That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

The great irony here is that this accurate and helpful data point is provided by a very anti-ACA story, but whatever:

A total of 243,230 Ohioans have already been added to the state’s Medicaid rolls under the Obamacare expansion implemented by Republican Governor John Kasich this January.

Based on the Ohio Department of Medicaid’s May caseload report released last week, enrollment under the expansion was 232,711 in April — not the 184,671 reported last month.

The March enrollment figure was also revised dramatically upward last week, to 208,213 from the 171,910 reported last month. In April, the Ohio Department of Medicaid estimated that March enrollment for those eligible under Obamacare was 106,238.

Some more fantastic numbers out of Ohio after the earlier ones from Michigan: 185K strict expansion, 124K woodworkers and another 146K in the works:

Through April though, 184,671 newly eligible applicants were approved for coverage, the state said Monday.

About 563,000 Ohioans became eligible for Medicaid when the state agreed to accept federal support provided under the Patient Protection and Affordable Care Act to pay for broadening the health insurance program. The change raised the household income eligibility limit to include families earning up to 138 percent of the federal poverty rate -- about $32,500 for a family of four. They became eligible for coverage in January.

Another 124,195 people, meanwhile, were also added to Medicaid when it was determined they qualified for the program under the old guidelines. State officials had said they expected the public attention on expanding Medicaid would also draw in people who were already eligible but who had not signed up.

...But about 146,000 applications from that time period are still being processed and could add to the totals.

Wow. I'm not certain what the "strict expansion" vs. "woodworker" breakout is here, but am assuming it's roughly a 3:1 ratio:

An even greater number in Ohio, 156,899, were deemed eligible for Medicaid or the Children's Health Insurance Plan, or CHIP, government plans for low-income families that have been expanded under the act. That, however, is only a partial number, based on information that individuals provided when they contacted the federal health care marketplace to see about insurance. According to state figures released by the U.S. Department of Health and Human Services, Ohio has seen a combined Medicaid-CHIP surge of 208,280 since the Affordable Care Act, or ACA.

This is great news, but I have to reduce Ohio's Medicaid total by about 54,000 due to a bit of sloppy double-counting on my part. However, there's another (potential) 120K in the batter's box:

More than 106,000 Ohioans have signed up for Medicaid under an expansion of the taxpayer funded health program, while thousands of others are waiting to hear whether they are deemed eligible.

...Ohio's monthly report on Medicaid caseloads shows that 106,238 residents had enrolled under the extension as of March 31. That's about 29 percent of the roughly 366,000 newly eligible people estimated to sign up by the end of June 2015.

More than 345,000 people have sought Medicaid coverage through the state's benefit site since Oct. 1. About 65 percent of the applications have been resolved, while roughly 120,000 are still pending. Many of those cases await eligibility determinations by the state's largest counties.

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