Massachusetts Still a Mess...and leaves me in a quandary

Thanks to contributor deaconblues for sending me this story out of Massachusetts, which puts a bit of a downer spin on the otherwise fantastic one-two punch of hitting 1M QHPs in CA and 5M nationally. The short version? MA fired CGI, won't hit their own twice-extended deadline, and has tens of thousands of people stuck in a weird healthcare coverage holding pattern for...no one seems to know exactly how long:

Massachusetts has chosen to toss out CGICorp., the architect of the troubled Health Connector website, amid an ObamaCare enrollment crisis that threatens to spill into 2015....

Massachusetts officials plan to ask the federal government for a third extension of legacy health plans that are not compliant with new federal health reform rules. Some of the plans, part of a program called Commonwealth Care, were initially set to expire by Jan. 1. The state has so far received two three-month extensions, to June 30. A new extension would keep that coverage in place through Sept. 30, but the website may not even be fixed by then....

A rapidly growing number of people - 84,000 on March 14, up from 62,000 on March 5 - have been placed into temporary Medicaid coverage because the website cannot determine whether or not they are eligible for subsidies....

Massachusetts officials plan to ask the federal government for a third extension of legacy health plans that are not compliant with new federal health reform rules. Some of the plans, part of a program called Commonwealth Care, were initially set to expire by Jan. 1. The state has so far received two three-month extensions, to June 30. A new extension would keep that coverage in place through Sept. 30, but the website may not even be fixed by then....

The state continues to use paper workarounds to keep people covered by health insurance. The paper backlog fell to 21,000 pending applications, from 54,000 two weeks ago.

Almost 104,000 consumers remain in the legacy Commonwealth Care plans, which have so far been extended until June 30. The delay in switching consumers over to federal health reform-compliant insurance is costing the state $10M per month, because the state will receive a higher federal matching reimbursements once consumers are transferred to the new permanent plans.

There is one group in danger of losing coverage. That’s about 29,000 people with unsubsidized health plans known as Commonwealth Choice, that will expire on March 31, unless they enroll in new coverage by the end of the month. A new paper-based “fast path” allows this population to re-enroll with their old insurer, but does not allow them to comparison shop to find the best prices.

OK, anyone want to tell me how the hell I'm supposed to categorize these people? deaconblues has a pretty good suggestion on how to handle it:

We're looking at 217K people who have enrolled in plans, and have insurance.  Since the estimate sent to HHS included 250K specifically for these people, should these 217K somehow be included in the spreadsheet?  These are real people, who have filled out enrollment forms for ACA-compliant plans, but who just are stuck because Mass can't fill out the paperwork properly.  Heck, about 2/3 of these people were part of the old exchange, and have been paying for their near-ACA compliant plans for years - and continue to pay for them during the extension period.

I was thinking, could these people be added as separate lines, like the "unpaid enrollees" in other states?  In many ways, the 104K + 29K are "paid unenrollees" - they have insurance, and they're paying for it, but they aren't being counted.  The 84K of transitional enrollees are being put in Medicaid, so they haven't technically paid for the plans they applied for, but how's that different from any new enrollees - they won't pay until they get that first invoice.  I guess these 3 items could be rolled up into 1 line, but they are 3 different beasts.

I know this might invite criticism, but it doesn't seem fair to have these people included in the 7 million/6 million estimates, but not somehow incorporated in the numbers.  From a Mass perspective, it's sort of like "taxation without representation" :)

This works for me, but with a big caveat: I'll go ahead and create a special 3rd row for Massachusetts, but I'm marking them in a different color on the spreadsheet and adding them to the "Enrolled but Unpaid" section on The Graph (ironically, as deaconblues points out, these folks are the opposite: "Paid but Unenrolled").

Let's hope that Massachusetts figures out what the hell their status actually is before 3/31. The graph is getting a bit complicated these days...