For months I've been trying to hunt down the ever-mysterious "Off-Exchange" private QHP enrollment data...people who have purchased new, ACA-compliant healthcare policies since October 1st, but have done so directly via the various insurance companies. These are, for the most part (at least in the states which haven't granted a 1-year extension of non-compliant policies) the same (or very similar) policies as those sold via the exchanges; the enrollment process simply bypasses the exchange websites, that's all. There are several reasons why people do this; the most obvious is if their taxable income is too high to qualify for an ACA subsidy. Why go through the hassle (on some exchange sites, not others) of jumping through the extra hoops of the Exchange process if you're certain that you aren't going to qualify for a tax credit anyway? In other cases, the insurance company itself may have made some sort of special offer for enrolling directly (or, in some unfortunate cases, they may have pretended that it was a better deal or not even mentioned the exchange as an option).
In any event, this data is difficult to hunt down because unlike the Exchange enrollments, the insurance companies are under no legal obligation to make it public (at least I don't think they are...possibly in their quarterly SEC filings or something?) Until today, I only had hard numbers from 2 companies: WellPoint, whose CEO revealed last month that about 19% of their enrollees since October 1st have been signed up directly. I don't have a more recent update on this, and he didn't break those numbers out by the half-dozen or so states that WellPoint operates in, but that's still 95,000 people. In addition, one other company, a Co-Op that operates in Iowa and Nebraska, cheerfully provided a full breakdown of their enrollments. Add these together and you have about 124,000 people...until today.
Washington State just released their weekly update, and as usual it's crisp and clean:
Private QHPs are up to 176,095 (90,723 Paid / 85,372 Unpaid) from 175,595 (88,071 Paid / 87,524 Unpaid); the total only went up a few hundred, but the number of paid enrollments went up about 2,700 people.
Medicaid enrollments are up to 276,263 (184,783 Expansion / 91,480 Woodwork) from 258,087 (172,715 Expansion / 85,372 Woodwork), an increase of about 7% from last week.
Qualified Health Plans: 90,723
Medicaid Newly Eligible Adults: 184,783
Medicaid Previously Eligible but not Enrolled: 91,480
Qualified Health Plan Applicants – Need to Pay: 85,372
As always, Washington State is the Gold Standard in breaking down their enrollments; Private QHPs are up to over 175,000 (88,071 paid, 87,524 unpaid as of January 30), up from about 168,000 a week earlier. Medicaid enrollments are up to over 257,000 (172,715 newly eligible and 85,372 "woodworkers"), up from about 238,000 the prior week.
Washington State just released their latest official update, and as usual, they do a fantastic job of breaking down the numbers in an easy-to-follow manner, especially on the Medicaid/CHIP side.
Private QHP enrollments are up from a total of 149K (73,098 paid, 76,058 unpaid) as of 01/09 to about 168K (86,031 paid, 81,872 unpaid) as of 01/23, a 12.7% increase in 2 weeks.
Medicaid enrollments are up from a total of 198K (134,700 via Medicaid Expansion + 63,070 "Out of the Woodwork" folks who were previously qualified but weren't already enrolled) as of 01/09 to a total of almost 238K (160,587 expansion + 77,144 "woodwork") as of 01/23. This represents a 20% increase.
Between these and the other recent updates, the grand totals now stand at 3.16M Private QHPs and 7.38M Medicaid/CHIP enrollees. It's also important to stress that the Medicaid number does not include renewals of existing Medicaid/CHIP recipients.
Meanwhile, I've been informed that Washington State only has their SHOP program running in 2 counties, while Maryland's won't be operational until April (SHOP enrollments are open year-round, while individual/family enrollments are only available through 3/31).
As of Jan. 15, 368 people had purchased insurance through New Mexico’s SHOP (Small Business Health Options Program) exchange for small businesses.
...So far, 370 people have enrolled in insurance plans on the SHOP exchange, according to the NMHIX. A total of 1,542 employers have set up accounts on the exchange and they represent 3,962 employees.
I really, really like the way that the Washington Health Exchange does their press releases. No screwing around, they make the key numbers clear and obvious, and they make sure to separate out unpaid private QHPs as well as Medicaid "redeterminations" (ie, those who already had Medicaid under the pre-ACA rules and are simply renewing it).
As a result, here's where Washington State stands as of January 9: Private enrollments went from 71,205 paid / 72,178 unpaid (143,383 total) to 73,098 / 76,058 (149,156 total), while new Medicaid enrollments increased from 177,065 up to 197,770.
Thus, since Jan. 2nd, WA has increased private QHPs by 4% and Medicaid enrollments by almost 12%.
As an added bonus, WA also separates out the other Big, Important Number: How many Medicaid enrollees are renewals vs. how many are new. I do not include renewals in the spreadsheet in cases where I can separate them out.
Qualified Health Plans: 73,098
Medicaid Newly Eligible Adults: 134,700
Medicaid Previously Eligible but not Enrolled: 63,070
Qualified Health Plan Applicants – Need to Pay 76,058
Some interesting numbers out of Washington State. While private enrollments are only up 6% over 12/23 (143,383 vs. 135,078; the % paid as of 01/02 has increased from 48% to 52%), the Medicaid numbers are quite different, due to changes in how they're being reported.
Previously, "Newly Eligible" and "Previously Eligible" were lumped in together with "Redeterminations" (ie, people who were already on Medicaid prior to ACA expansion and are simply renewing their accounts). However, WA is the only state (so far) to list "redeterminations" separately, so I've left those out this week. With all the concern and confusion about how many ACA enrollees are "new" to having healthcare coverage, this seems like a wise move. Of course, this also means that the Medicaid total is actually somewhat lower than I had it previously, even with the additional new enrollees since 12/23.
As a result, the total Medicaid number for WA is now 177,065 vs. the previous 194,398, a "drop" of 17,333. The new number is lower, but more accurate reflection of the actual impact of the ACA on Medicaid...in 1 state. Hopefully other states (and the HHS) will start separating out "redeterminations" going forward as well, if possible.
Enrollments in private health plans on Healthplanfinder, the state’s online insurance marketplace, surged past 65,000 as applicants hustled to beat the Monday night deadline for coverage beginning Jan. 1, Washington Health Benefit Exchange officials reported Tuesday. Nearly 69,000 others have completed the enrollment process, but haven’t arranged payment, and another group of undetermined size has begun applications that are in varying stages of completion. ... As of Monday at midnight, about 100,800 people newly eligible for health insurance through the state’s expanded Medicaid program had signed up. Almost half of those were transferring from the now-discontinued Basic Health program or were presumed qualified for a federal assistance program for the disabled. An additional 47,500 enrollments were from those who previously qualified for Medicaid under the old rules — primarily children — but had not been signed up. And more than 88,000 people already covered by Medicaid renewed their eligibility.
For private enrollments, Washington is the only state that distinguishes between "enrolled but not paid yet" and "enrolled and first month's premium paid"; every other state, and the HHS, counts you as being enrolled even if you haven't actually paid yet, so that's the criteria I use, although I did separate out the other 69K on the spreadsheet. For Medicaid, I'm not counting the 88K since they were just renewals, but the 47.5K do count since they appear to fall into the category of people who were already qualified but didn't know about it until the ACA and the state exchange. In addition, as in several other states, another 47,000 people are being automatically transferred over to Medicaid proper from an existing state program; this is one of the "orange cells" on the spreadsheet. Also, h/t to sulthernao, who found the actual WA exchange source that gives the precise numbers.