I've been getting a little worried about the Minnesota exchange of late. Their first two years were pretty rough, and their most recent update prior to today had them at only 26.5K QHPs as of 12/13. Of course, that didn't include the critical final few days before the January enrollment deadline...nor did it include the extended deadline for Minnesota, which was pushed all the way out to 12/28.
Abby Goodnough had an interesting story in the NY Times yesterday about the fact that for some people, simply paying the Affordable Care Act's "Shared Responsibility" tax (otherwise known as the Individual Mandate penalty) may actually be more affordable than actually signing up for an ACA-compliant healthcare policy.
I've written about this before, of course. It is absolutely true that for some people (the Kaiser Family Foundation estimates roughly 7.1 million people), their mandate tax (whether a flat $695/person or 2.5% of their household income, whichever is greater) is indeed less than the annual premiums for the lowest-cost policy available in their area (even after taking federal tax credits (APTC) into account). By KFF's estimates, the mandate tax would cost more than the least-expensive policy for only around 3.9 million currently-uninsured Americans (although the actual number of uninsured who could potentially enroll in exchange policies, whether with APTC or at full price, seems to be closer to 15 million according to the very same KFF study from which they stated the 11 million figure...I'm not sure what accounts for the 4 million difference, but that's actually besides the point here).
Now, as I noted in my own analysis of the potential impact of the mandate tax on "Young Invincibles", I noted that given a choice between paying $X for nothing and $X + (some variable amount) for a ACA-compliant healthcare policy, my guess is that most people are likely to still go ahead and sign up as long as the cost is less than perhaps twice as much, even if the plan itself seems somewhat skimpy.
In other words, if the choice is between a $700 penalty for bupkis and, say, $1,000 for a Bronze plan (43% more), most people will probably go ahead and spring the extra $300...but they if the least-expensive plan is more than twice the penalty (say, $1,500) they're much more likely to say "screw that!" and just pay the tax. Again, I'm not basing this on any hard analysis, it's just my gut instinct; I could be wrong about this.
Three portions of the total are eligible to enroll in private policies through the ACA exchanges: "Tax Credit Eligible", "Ineligible for Financial Assistance due to ESI Offer" and "Ineligible for Financial Assistance due to Income" (22%, 15% and 12% respectively). It's important to remember that "Ineligible for Financial Assistance" means that they can enroll through the ACA exchanges, they just have to pay full price if they do so. Many of these folks will simply enroll off-exchange, directly through the insurance carriers, but there's nothing preventing them from going through the exchange instead.
One other small Medicaid expansion entry: Alaska, which just formally launched the expansion program on September 1st, has enrolled about 7,700 residents to date. While that's a pretty tiny number, Alaska only has about 740,000 residents total, of which only 42,000 are even eligible for ACA expansion anyway:
JUNEAU, Alaska (AP) — About 7,700 people have enrolled in Medicaid since the state expanded the program on Sept. 1 to cover more lower-income Alaskans, a state health department official said.
The agency appears on track with projections that a total of about 20,100 newly eligible people would enroll in Medicaid during the first year of expansion, Chris Ashenbrenner, Medicaid program coordinator for the health department, said Tuesday.
A study commissioned by the department estimated that about 42,000 people would be eligible for Medicaid under expansion but only about 20,100 would enroll the first year.
I somehow managed to completely miss the September Medicaid report released last month, but it turned out to be a virtual non-issue; there was a net increase of just 2,599 people enrolled in Medicaid nationally from the end of August through the end of September 2015.
In October, however, things picked up; while not nearly the half-million-plus-per-month that we saw during 2014 and the first half of this year as the bulk of ACA Medicaid expansion went into effect in most states, the total number of people enrolled in the program did still increase by a respectable 187,958 people month over month.
This has resulted in a net enrollment increase of over 13.5 million people since the ACA expansion program went into effect two years ago, and a grand total of 71.8 million enrolled in the program nationally.
Back on December 17, I noted that the Maryland ACA exchange had managed (with the help of automatic renewals) to achieve just under 150,000 QHP selections as of 12/15...which happened to be both their and my projected target for the full 2016 Open Enrollment Period. This was excellent for two reasons: They had effectively hit the target (well, 149,765, anyway)...and had done so with nearly 7 weeks to go.
1) More than 382,000 Marylanders have gotten coverage since Open Enrollment started.
As of Dec. 28, 362,520 Marylanders enrolled in health coverage for 2016, including 71,055 Marylanders who chose a new Qualified Health Plan, and 79,238 people already enrolled who renewed their plan for next year. This also includes 212,227 Marylanders who enrolled in Medicaid coverage through the state marketplace since Nov. 1.
As expected, Week Eight was extremely quiet; not only did the entire week take place after the (extended) deadline for January coverage, but there was also Christmas Eve and Christmas Day to contend with. Needless to say, very few people feel like enrolling in healthcare coverage on December 24th or 25th.
Last year, just 96,000 people chose to do so between 12/20 - 12/26 in the 37 states covered by HC.gov. I was expecting slightly more this year (100K even), but only 74,000 did...26% fewer than the same week in 2014. Whatever else is going on, it's safe to say that the Open Enrollment Periods are starting to become more and more "front-loaded".
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Kentucky, New York or Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).
With all those caveats out of the way, here's where things stand. Just like last year:
When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.
As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:
