Vermont

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

WIth the DC and Vermont updates this evening, there are now only 4 states which haven't brought their enrollment data up through the end of open enrollment: CO, CT, ID and KY:

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Sunday, February 15, 2015.

New Vermont Health Connect Customers

15,422 individuals have checked out a 2015 health plan. This includes 6,211 individuals in Qualified Health Plans (private health insurance) and 9,211 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 15,422 individuals who checked out, 11,704 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment). Of those who completed the process, 3,471 are on a Qualified Health Plan and 8,233 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

I'm not at all surprised that the exchanges are starting to announce "tax season" enrollment periods already. The only thing I'm surprised by is the length of these special periods. I figured they'd do something like April 1st - 15th...instead, all 3 (Washington, Minnesota and now Vermont) are going for 2-month periods or even longer:

  • WA: 2/17 - 4/17 (effectively just extending the enrollment period by 2 months)
  • MN: 3/01 - 4/30
  • VT: 2/16 - 5/31 (a full 3 1/2 months...with the caveat that it has to be "within 60 days of discovering" that they have to pay the fee, which isn't exactly the sort of thing that one can prove one way or the other, y'know?)

Again, it's important to keep in mind that there are 3 main reasons for having a deadline/cut-off at all: First, prevents people from gaming the system by waiting until they're sick to enroll. Secondly, it allows the insurance companies ample time for their actuaries to crunch the numbers for the next year. Finally, it acts as a great motivator, as evidenced by the huge surges in December and again last week (even if the 2nd surge wasn't quite as large as I was expecting).

Three more updates to the #ACAOvertime Deadline Extension Roundup:

  • First, as noted this morning, California has tacked on an extra 2 days to their "In Line by Midnight" period (previously ending on 2/20; now extended to 2/22)

But by February 18, the exchange was offering an extension to people who tried to enroll by February 15 but were unable to do so by the deadline.  This has not been published on the exchange website, but an exchange representative confirmed that the extension runs through February 23, and that the call center (855-899-9600) will help enrollees complete the process between now and then.

D'oh! OK, one more late-breaking number today, out of Vermont:

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Monday, February 9, 2015.

New Vermont Health Connect Customers

12,344 individuals have checked out a 2015 health plan. This includes 4,786 individuals in Qualified Health Plans (private health insurance) and 7,558 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 12,344 individuals who checked out, 10,678 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 3,293 are on a Qualified Health Plan and 7,385 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

The latest numbers out of Vermont...

The following numbers are up-to-date as of 11:59pm Monday, January 26, 2015.

New Vermont Health Connect Customers

10,399 individuals have checked out a 2015 health plan. This includes 4,098 individuals in Qualified Health Plans (private health insurance) and 6,301 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 10,399 individuals who checked out, 8,853 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 2,713 are on a Qualified Health Plan and 6,140 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

Unless a customer requested otherwise, all individuals who had an active health plan through the end of 2014 currently have health insurance coverage through Blue Cross Blue Shield of Vermont, MVP Health Care, Medicaid or Dr. Dynasaur. The insurance issuers have their information in their systems and ID cards remain active.

A few days ago I posted an article about how Rhode Island is having trouble scraping together the $19 million or so that they need to operate HealthSource RI, now that the federal funds have pretty much dried up and the exchange has to pull its own weight. Some exchanges were set up with a funding mechanism in place (generally by charging either the insurance companies operating on the exchange, or the enrollees themselves, some sort of tax or fee), but others, like Rhode Island, were funded with federal dollars but never got around to setting up a way to pay for themselves after that funding stopped.

Anyway, a Republican state legislator in RI came up with an ingenious solution: Dump the exchange, even though it's functioning perfectly well. The reasoning is that the federal exchange, Healthcare.Gov, is operating more efficiently, so why not just do what Oregon and Nevada had to do this year (due to technical problems) and add themselves to the pile of 3 dozen states already being run through HC.gov?

The Vermont exchange just released their latest numbers:

New Vermont Health Connect Customers

9,454 individuals have checked out a 2015 health plan. This includes 3,791 individuals in Qualified Health Plans (private health insurance) and 5,663 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 9,454 individuals who checked out, 7,981 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 2,506 are on a Qualified Health Plan and 5,475 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

Unless a customer requested otherwise, all individuals who had an active health plan through the end of 2014 currently have health insurance coverage through Blue Cross Blue Shield of Vermont, MVP Health Care, Medicaid or Dr. Dynasaur. The insurance issuers have their information in their systems and ID cards remain active.

As you may recall, a week or so ago I ran into a weird discrepancy with the numbers out of a few states. In the case of Vermont, it turned out that the enrollment data they were releasing included both QHPs and Medicaid without distinguishing between the two.

Fortunately, they've corrected this, so today's update (and future ones) has it all broken out:

The following numbers are up-to-date as of 11:59pm Monday, January 12, 2015.

New Vermont Health Connect Customers

8,709 individuals have checked out a 2015 health plan. This includes 3,506 individuals in Qualified Health Plans (private health insurance) and 5,203 individuals in Medicaid or Dr. Dynasaur plans.

Last week, after the first official HHS report came out, I was perplexed by data discrepancies between the HHS and several state exchanges. Many of these turned out to be due to the dates on the reports not matching up, but others remained.

One of the remaining ones was in Vermont:

Vermont: I don't have a 12/15 report from the VT state exchange, but they did release one from 4 days earlier. It claimed 25,867 total QHP selections for 2015. The HHS report says it was 21,709...as of 4 days later. Again, a 4,100 difference.

Today I received my answer: It turns out that until now, the official state exchange enrollment reports were including both QHPs and Medicaid in both the "renewed" and "new" enrollment numbers. Medicaid/CHIP enrollments make up around 7,000 of the total (around 2,800 renewals and 4,300 new).

The broken-out numbers for Vermont, as of last night, directly from my contact at Vermont Health Connect, are as follows:

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Tuesday, December 30, 2014.

  • Renewals: 23,356 individuals have been checked out into 2015 health plans.
  • New to Vermont Health Connect: 6,881 individuals have been checked out into 2015 health plans.

Customer Support Center Metrics (Week of Dec. 22-27)

  • Number of calls: 6,154
  • Average wait: 14.1 seconds
  • Number of calls answered in less than 30 seconds: 93.1%

Tracking Progress of New Applications

The following graph shows where new applicants are in the process between submitting their application and being covered by a qualified health plan. Please note that applicants who qualify for Medicaid are not included. The numbers are up-to-date as of Monday, December 29, 2014.

No press release yet, but here's the latest numbers out of Vermont:

The following numbers are as of Sunday, December 21, 2014:

  •     Renewals: 22,640 individuals have been checked out into 2015 health plans.
  •     New to Vermont Health Connect: 5,663 individuals have been checked out into 2015 health plans.

Customer Support Center Metrics (Week of Dec. 15-20):

  • Number of calls: 9,948
  • Average wait: 26.4 seconds
  • Number of calls answered in less than 30 seconds: 80.9%

I haven't written much about the recent announcement by Vermont's governor that after years of pushing a single payer plan for the state, he's basically pulled the plug on it (at least for the time being). I noted the announcement but didn't have much to add myself.

Part of this is because I'm swamped with the actual ACA open enrollment itself, of course. Part of it is because it's too depressing a development for me to really think about right now. Part of it is because others far more knowledgeable than I am have much more to say about it.

One such person is Vox's Sarah Kliff, and she's written a fairly definitive explanation of what went wrong. The short version: Vermont's tax base is too small to support the initial costs, even if it would save gobs of money in the longer term.

In Vermont, this is massive: the state only raises $2.7 billion in taxes a year for every program it funds. Early estimates said that Vermont's single-payer plan might need $1.6 billion in additional funds — a huge lift. But $2.5 billion was impossible.

OK, strictly speaking this isn't directly ACA-related, but come on...

Shumlin: "The time is not right"

Vermont has long had a two-pronged approach to building a single-payer health care system. First, they would figure out what they would want the system to look like. Then, they would figure out how to pay for it.

The state passed legislation outlining how the single-payer system would work in 2011. And ever since, the state has been trying to figure out how to pay for a system that covers everybody. Most estimates suggest that the single payer system would cost $2 billion each year. For a state that only collects $2.7 billion in revenue, that is a large sum of money.

What Shumlin appears to be saying today is that the "time is not right" to move forward on the financing of the single-payer system. And that means putting the whole effort aside, with no clear moment when the debate would be reopened.

Ouch.

Thanks to Morgan True for the link to this PowerPoint report which explains why VT is pulling the plug on their ambitious Single Payer attempt:

As you can see from the graphic I posted yesterday (and had to revise several times throughout the day), the official enrollment deadline for private policies starting on January 1st, 2015 has now passed for all 37 states operating via HealthCare.Gov, as well as residents of DC, Hawaii and Kentucky. It's certainly possible that any or all of these will announce some sort of "special circumstances" allowance for those who didn't make the midnight cut-off (10pm in Alaska), but I'm assuming those would be done strictly on a case-by-case basis.

OK, so what about the remaining 11 states?

Well, 4 of them (MD, MA, RI & WA) had later deadlines for January coverage all along: Maryland on 12/18 (Thursday) and the other 3 on 12/23 (next Tuesday).

New York and Idaho bumped their deadlines out from yesterday until 12/20 (Saturday), although Idaho had previously claimed that their deadline was 12/23, but are now claiming that it was originally 12/15. I still don't understand what happened there, but so be it: 12/20 it is for ID.

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