Vermont

Three more quick hits...the third one really deserves its own entry, but frankly, I'm too exhausted today and want to get it off the books, so...

Vermont: STATE SIGNS $9.5 MILLION CONTRACT EXPANDING ROLE OF OPTUM IN HEALTH CARE EXCHANGE

Vermont signed a revised contract with the tech firm Optum that expands its role in Vermont Health Connect’s operations.

Optum already had a contract worth $5.6 million for consulting work, and the latest deal, signed Aug. 15, is worth an additional $9.5 million for a total of $15.1 million.

 

...At latest count, Optum has helped the state halve its backlog of coverage changes and information errors from a high of more than 14,000 to roughly 7,000. Also, close to 4,000 people are having billing issues with Vermont Health Connect. There is some overlap between the two groups, Miller said.

Minnesota exchange gets new marketers

The news that MNsure is switching to a new ad team isn't that noteworthy, but check out the reasoning (in bold):

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick hits:

HEALTHCARE.GOV: Lack of Back End Software for Federal Exchange

One of the big news stories in 2013 and early 2014 was the botched launch of the federal Exchange (and several key state Exchanges), which led to many Americans having to wait to be enrolled in an ACA-sanctioned health plan.  Although some technical snafus have been addressed, many still remain.  For example, a top White House official told Congress recently that the automated system to send payments to insurance companies is still under development, and didn't offer a completion date. The lack of an electronic verification process is only one part of the "backend" of the software that is still problematic five years after the Act was passed.

NEVADA: After health care debacle, Gov. Brian Sandoval reluctantly extends Nevada’s ties with Xerox

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:

ARKANSAS:

Mark Pryor shows Democrats how they should campaign on the Affordable Care Act in a red state. You don't have to mention Obamacare (which technically doesn't even exist), you don't have to even mention the Affordable Care Act. You do have to personalize what the law actually means for real people with real medical issues which were fixed or improved by the law:

Read more on this ad & angle from Greg Sargent of the Washington Post.

VERMONT:

Finally, a solid update out of Vermont; thanks to Morgan True of VT Digger for pointing me towards the most recent Vermont Health Connect report as of just a week or so ago:

There's a lot going on in the table above. For one thing, this demonstrates, again, how stupid it was to hyperventilate about "How many have PAID???" back in February or March, when a good 40% or more of the people who would eventually enroll wouldn't even have their policies kick in for weeks or even months yet. Note that of those whose policies started between January 1 - May 1st, over 95% have paid their first premiums by now:

Once toothless, Cover Oregon board tackles an uncertain future

...After taking political heat for the exchange's technological failure, the appointees of Gov. John Kitzhaber are taking on a more significant role, transforming the agency for the future. At a time when critics of the agency say it should go away, it's the bureaucratic equivalent of an existential moment for an agency considered crucial to federal health reforms.

... The state's planned 2015 partnership with the federal exchange is called a "supported state-based" exchange. But it's supposed to be a temporary fix before setting up a full-fledged state-based exchange. It allows Oregon to keep insurer fees of about 2.5 percent of premiums for itself until the state resurrects its own website.

Vermont Health Connect shakes up practices, adds personnel

OK, the Medicaid number is a bit squirrelly since it isn't broken out by expansion/woodworkers/churn; the official number as of 4/19 was 27,268, so I'm estimating it at an even 30K.

Otherwise, the QHP total is for paid enrollees, up from 27,221, and the SHOP number is up from 33,614.

Vermont Health Connect has helped 144,500 Vermonters get health coverage. More than half, 80,400, were enrolled in Medicaid, many as a result of the program’s expansion under the Affordable Care Act.

However, the website was launched with significant problems, and eight months later it is still incomplete. State officials said this week that they will continue to rely on the two participating insurance carriers to enroll small businesses throughout the upcoming open enrollment period that begins Nov. 15. There are currently 34,800 people in that group.

There are also 29,300 people in the individual market who purchased commercial insurance. More than half, 62 percent, qualified for subsidies that lower the cost of those plans, though advocates say they are often still difficult to afford.

As I noted yesterday, there are three states which had unusually large discrepancies between the official HHS and state exchange QHP enrollments:

  • New York came in over 65,000 lower than the number I had for a simple reason: The New York exchange lumps enrollees in their Child Health Plus program in with QHPs, even though technically this isn't a QHP program. There were over 40,000 of these as of the end of February; this number has climbed to 65,028 as of 4/19.
    Since Child Health Plus is privately funded (and therefore isn't on the Medicaid/CHIP side), but also isn't officially a QHP either according to HHS, I've moved it over to the "Off Exchange QHP" column.

Latest Vermont Health Connect stats

• 52,156: Vermonters who used the Vermont Health Connect website, call center or navigators to shop for 2013 health insurance and now have coverage.

• 24,888: Vermonters who purchased commercial coverage through Vermont Health Connect.

• 27,268: Vermonters who shopped on Vermont Health Connect but qualified and are now enrolled in Medicaid. Eligibility expanded under the federal Affordable Care Act.

• 33,549: Vermonters previously covered by the Vermont Health Access Program and Catamount Health who the state enrolled automatically in Medicaid based on income information on record.

OK, looks like I completely misunderstood the Vermont figures from a few days ago; half of them were supposed to go on the Medicaid side after all. From a source at the Vermont Health Connector:

In the meantime, I can provide the enrollment figures: 48,150 are fully enrolled in a plan through Vermont Health Connect; 25,930 of those enrolled in Medicaid or Dr. Dynasaur, our CHIP program.

Doesn't impact the overall national total, but it does change the dynamic for Vermont to something...rational (prior to this it looked like they had hit a whopping 585% of their year 1 target!

This means 22,220 QHPs and 25,930 Medicaid.

OK, in addition to the appx. 7.041 million enrollments on the Federal exchange (HC.gov), I've brought CO, CT, DC, HI, KY, MD, MN, NY, RI and WA completely up to date, with all QHP data through midnight on 3/31 (some of the Medicaid/CHIP data is still missing, but that's a lesser concern at the moment).

However, I'm still missing the following exchange QHP data:

  • California: 22 hours (that's right...the current tally runs thru 2am on 3/31)
  • Massachusetts: 3 days (current is thru 3/28)
  • Nevada: 2 days (current is thru 3/29)
  • Oregon: 3 days (current is thru 3/28)
  • Vermont: 1 day (current is thru 3/30)

I can't tell you how frustrating it is to be this close to full data while still missing it.

So, how much is actually missing? Well, if these states were running at their prior average March daily rate, it would be

  • CA: 11,754
  • MA: 512 x 3 = 1,536
  • NV: 427 x 2 = 854
  • OR: 502 x 3 = 1,506
  • VT: 775
  • Total: 16,425

However, this obviously doesn't apply since the final weekend and especially yesterday were insane.

Vermont's numbers can be a bit squirrelly, but in this case they're very specific about 46.8K being exchange QHPs (VT doesn't allow off-exchange enrollments anyway, and the the 30-40K figure is the same from the last update).

As of Monday morning, 46,800 individuals had enrolled to be covered with private insurance either from Blue Cross Blue Shield of Vermont or MVP Health Care. An additional 30,000 to 40,000 people were enrolled through their employers, Yahr said. The federal target enrollment was 56,000 by Monday.

If that's not a typo or a misunderstanding on my part, it means that Vermont has just skyrocketed to 4.5x their February enrollment rate.

OK, after all of today's excitement it's back to the state-by-state grind...

More than 55,000 Vermonters have picked a health plan through Vermont Health Connect since open enrollment began in October and more than 43,000 are fully enrolled in new coverage. That means roughly 12,000 Vermonters have yet to pay their first premium or are having problems completing the process.

Contributor deaconblues has done the math for me this time, which I appreciate since my brain is fried today:

I know Vermont is a tricky beast, but this article specifically says 55K through the Vermont Health Connector (no bulk transfers or SHOP)

The current numbers on the spreadsheet say:

  • QHP: 28,950 (18,507 paid + 10,443 unpaid)
  • Medicaid: 21,525
  • Total: 50,475

This would imply they've newly added about 4,500. If you prorate the 55K across QHP and Medicaid (58/42), and use the paid QHP as a "hard number", you get

  • QHP: 31,900 (19,900 paid + 12,000 unpaid)
  • Medicaid: 23,100

This looks right to me, so there you go.

OK, the cutesy title is kind of a misnomer; my two previous entries didn't use that title originally...but they should have, and do now.

March 31st is supposed to be the final day to enroll in QHPs via the exchanges...but it's looking more and more as though that won't quite be the case in not two, not three...but possibly up to seven states now, including a couple whose websites have been working smooth as silk??

On March 7th I pointed out that due to Massachusetts having some 154,000 people stuck in health insurance limbo, they've been granted some sort of temporary extension, twice...out to as far as June 30th in some cases...

GAH!! OK, earlier today I read two conflicting stories about the Vermont enrollment situation. My conclusion was that the correct numbers were:

  • 18,507 Private QHPs (Paid) / 11,656 Private QHPs (Unpaid)
  • 20,312 Medicaid (Manual enrollment) / 33,549 Medicaid (Auto-Transfers)

However, I've had a chance to look at the actual VT exchange presentation, and it looks like I was partially correct. The actual numbers are as follows (bold-faced are corrected):

Vermont's method of enrolling people has always confused me.

There are 36,846 Vermonters who have enrolled in health coverage, 33,549 who were automatically transitioned to Medicaid and 30,000 to 40,000 in the small-group market who were enrolled directly by the insurance carriers participating in the exchange.

A second article, from the Burlington Free Press, confuses things because it says the 36.8K are households, representing 50.4K people:

a state official reported to lawmakers Tuesday that 36,846 households had signed up for 2014 plans....

Larson’s presentation Tuesday showed that 50,475 individuals applied for coverage using Vermont Health Connect between Oct. 1 and March 17. A significant number of these applicants, 20,312, found they qualified for Medicaid, which has expanded eligibility this year.

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