A lengthy comment in response to my "5M as of Sunday" post from yesterday criticizes the work done at ACASignups.net for a variety of reasons. For the most part these are the same issues which I've already addressed repeatedly, but he's more polite about it than the prior critic and some of his points are new (or at least I haven't really talked about them before), so I've decided to respond:
Let me start by saying that the work you have done is truly impressive but it is beyond comprehension that we can not get this type of granular info from the people who are actually responsible for designing, implementing and running this program. They are either completely incompetent or intentionally withholding the detailed data and simply releasing the more favorable headline numbers.
Just throwing that out there again. Since it's a Sunday, I wouldn't expect an HHS announcement until tomorrow. I could be wrong, of course; as I keep stressing, I'm NOT Nate Silver...and judging by the reactionto Mr. Silver'srelaunched FiveThirtyEight site the other day, even he doesn't seem to be acting like Nate Silver at the moment, at least when it comes to climate science. Hopefully this is all a big misunderstanding, but as a long-time fan of his, I admit to being extremely disturbed by this development.
Anyway, back on topic: Regarding my 5.5M projection for today (Sunday, 3/23), it's pretty simple: If QHPs haven't hit 5.5M by today, the odds of hitting 6.2M by 3/31 are worse; if they have, then I'm virtually certain that 6.2M will be reached by 3/31...and in fact could be somewhat higher. The 6.2M number has held pretty firm until today, but now we're entering the real crunchtime as we head into the final week--that number could start jumping around quite a bit.
If I am correct about 5.5M today, however, reaching 7M by 3/31 would be pretty much a pipe dream, as QHPs would have to shoot up to over 187,500 per day for the entire final week. I noted last week that 100K - 150K is conceivable for a few days based on California hitting 30K in a single day on 12/23...but it's been another week with the average appearing to hold steady at around 60,000/day, and sustaining 187K for 8 days straight just seems pretty implausible. 6.5 million, on the other hand, would "only" require 125K/day for 8 days straight...which, while also pretty implausible, isn't too crazy.
On a related note, I do figure that I've earned the right to archive my accuracy record a bit at this point, so I've added a permanent link to my Greatest Hits to the site, right under the March Projection link. Each projection is in turn linked to the earliest source I could find containing my projection (this was more difficult than you'd think, since I wasn't really making a big deal out of the estimates until the past month or so).
This article contains a breakdown between "strict expansion" (30,000) and "bulk transfers" (51,000), modified from the 13,000 and 55,000 prior estimates (not sure what happened to the other 4,000 who were listed as being transferred from IowaCare previously). Still a net gain of 13,000 people.
In addition, state officials say about 81,000 Iowans have enrolled in the new Iowa Health and Wellness Plan or Marketplace Choice Plan, which are Iowa’s versions of an expanded Medicaid program.
About 51,000 of those people used to have limited coverage from IowaCare, a program that ended Dec. 31.
Interestingly, there's even a reference to a specific "woodworker" figure
In February, 403,609 people were enrolled in the program. That represented an increase of 0.5 percent from the 401,582 who were in the program in February 2013.
When I first read this article submitted by contributor Maurice H., I was pretty concerned, as it made it sound like Arizona's exchange QHP total was only around perhaps 60,100 as of March 18 (the artilce was posted on the 19th):
Final numbers for Arizona enrollment will not be available for a few weeks, but more than 80,000 Arizonans have enrolled in Medicaid and more than 60,000 have enrolled in private health care plans through the site, said Herb K. Schultz, regional director of the Health and Human Services Department.
This concerned me because Arizona already had 57,611 QHPs as of March 1st...and had 43,495 on February 1st. That means that AZ's February average was 504/day.
If the 3/18 number was only around 60,100, that would mean they were only at 2,489 for March, or only 146/day…a 71% plummet from February.
Nice find out of South Dakota from contributor Maurice H.; SD was at 6,765 on 3/01. This represents only an 8% increase over February's rate in March so far, although I'm not sure how much "just over 8K" is or what date that number runs through (I'm assuming 3/20).
Just over 8,000 people have signed up for health care coverage in South Dakota. Those signing up in the last week will also need to pay their first month's premium to get coverage. But those premiums may be lower than people expect.
"In the state of South Dakota about 90 percent of the people purchasing insurance are getting subsidies from the federal government," Krystolpolski said.
Excellent news out of West Virginia: Medicaid expansion has increased yet again, from 87,000 to 98,000 residents. This is particularly impressive considering that the total number of people in WV who are eligible for Medicaid post-expansion is about 143,000, according to the Kaiser Family Foundation.
Doris Selko, Southern Regional coordinator for the West Virginians for Affordable Health Care, said over 98,000 residents had enrolled in the Medicaid expansion by March 15 and an estimated 105,000 are expected to be enrolled by the end of the month.
Selko said three southern counties — Nicholas, Summers and Wyoming — have all enrolled over 100 percent of the anticipated enrollment numbers, and Raleigh County has enrolled 99 percent.
Tavenner’s involvement made a difference in other ways, too. Beginning this summer, Mississippi will have one of the nation’s few state-run small-business exchanges. Federal officials approved the request even though Chaney doesn’t have the support of Gov. Phil Bryant, a Republican who doesn’t want anything to do with the law. Bryant didn’t expand Medicaid and shunned creating a state insurance exchange, which he called a portal to a “massive and unaffordable” new federal entitlement.
In addition to the 15 state-run exchange SHOP programs (only 12 of which are actually operational right now), Utah and New Mexico are actually running their own SHOP exchanges; this means that Mississippi will join them.
The number is given in a negative context, but NM is up to 18,691 from 15,012 as of March 1st...263/day, up nearly 2.2x from February's 121/day:
As of March 15, 18,691 New Mexico residents had enrolled in the exchange, Ezekiel said. After already adjusting enrollment expectations for 2014 downward from 83,000 to 50,000 because of problems with the federalhealthcare.gov portal, the state is struggling to reach its target.
Nice find by deaconblues: OH Sen. Sherrod Brown was pushing people to enroll at an event on Thursday. His office had a press release posted on the site on the same day, so I presume that the 97K figure was as of Wednesday at the latest.
More than 5 million Americans, 97,000 in Ohio, have entered the health insurance marketplace, but more than 115,000 Ohioans are eligible to enroll with financial assistance.
This gives Ohio a daily QHP average of 1,004 in March, up 50% over the February rate of 672.
More than 321,000 Kentuckians are now enrolled in new healthcare coverage through kynect, and that number is expected to keep growing in the final 10 days of open enrollment. A preliminary analysis has found that approximately 75 percent of all enrollees report that they did not have insurance before signing up for healthcare coverage through kynect.
Some states have extended open enrollment deadlines because of glitches in their exchanges. Davis said Colorado won't extend the deadline but will give credit to those who attempted to enroll by the end of the month.
This is also a perfect opportunity to work in a special Guest Post by contributor Esther Ferington, who gives a nice roundup of just what will happen to the ACA Enrollment situation after March 31st:
What Happens after March 31st? Guest Post by Esther Ferington
For some reason Maryland's thru-dates are different for QHPs and Medicaid; not sure why. Anyway, they're up to 44,836 QHPs (up over 4,100 from 40,693 on 3/08) and Medicaid enrollments are up to 107,505 from 97,781 on 3/11 (up 9,700).
From October 1, 2013, through March 15, 2014, there have been more than a million unique visitors to the Maryland Health Connection website. 197,818 Marylanders have created identity- verified accounts. Through March 15, 44,836 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.
As of March 18, 203,394 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
On the March Surge side, Maryland is ramping up from 116% of their February rate the first week of March to 150% when you include the second week.
A bit of an update out of Massachusetts; the article is another rundown of the MA Mess, but there's actually small enrollment update included as well: Exchange QHPs have gone up from 12,965 on 3/01 to 15,140 as of "this week" (I'll call it Wednesday the 19th).
As of this week, only 740 Massachusetts residents have been able to enroll in newly subsidized plans under the act, Health Connector Authority spokesman Jason Lefferts said.
He said 14,400 people were able to enroll in unsubsidized plans on the private market by using the connector's website. Their success rate is tied to not needing to go through the income eligibility process, Lefferts said.
I just posted a lonnnnnng explanation the details of the "But how many have PAID???" situation. It gets kind of deep into the weeds, so I'll stop now, but I do just want to simplify things with a shorter, separate post:
Let's be clear about this: SOME of the people who haven't paid ARE going to prove to be deadbeats. That's inevitable in any industry that serves millions of people, just as shoplifting is a real problem that retailers have to deal with (and as I noted earlier, what was the insurance industry norm for cancelled/unpaid premiums prior to the ACA? Probably fairly low, but how low? 1%? 2%?).
The problem is that the "But how many have PAID???" attack seems to be based on the premise that ALL of the non-payments are deadbeats (or, alternately, that they're ALL due to exchange technical problems).
Here's the thing, though: There's 5 reasons I can think of why the first premium might not be paid yet: