No Sleep 'til Brooklyn Part IV: A Guest Post by Esther Ferington

...and then there were eight...

A spokesman for the insurance exchange, Ben Davis, said Colorado already has enrolled enough people to make the Connect For Health Colorado exchange sustainable.

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

With all eyes on exchange-based enrollments by March 31, it's worth remembering that there is more ACA-related health coverage to come in 2014. Aside from some possible workarounds for technical problems, like the ones in Massachusetts and elsewhere noted here on ACAsignups, here's some of the post-March action:

MEDICAID

• National Journal, 3/19/14, The Six States That Can't Decide on Medicaid Expansion
• Medill on the Hill, 3/4/2014: Medicaid Expansion Still Up in the Air for Many States
• Richmond Times Dispatch, 3/2/2014: Virginia Health Care Program Could Start by Fall
• SeacoastOnline, 2/13/2014: N.H. Senate Medicaid  Health Plan Would Start July 1

Signups for Medicaid take place every month in every state. In each month of 2014, they'll include still more people who are now newly eligible in the states that have agreed to Medicaid expansion—and perhaps some more "woodworkers" as well. The state of Michigan is also set to expand Medicaid in April.

There's also one other thing to bear in mind. Some states haven't decided yet if they're expanding Medicaid. If they choose expansion, some may begin this year. "Marketplace Virginia"—whose fate is still entirely TBD—could launch by fall. In New Hampshire, Medicaid expansion would start July 1. See links above for both.

SHOP (SMALL BUSINESS)

Small business enrollments in the ACA's SHOP program continue year-round, too, although the federal exchange and some state exchanges are not offering SHOP online in 2014, which took some of the wind out of its sails this year. That also means that many, possibly most, SHOP enrollments in 2014 are taking place off exchange, through brokers, making them harder to track this year. In the meantime, those state exchanges that do offer SHOP presumably will be providing monthly updates on their numbers.

This audio interview with the Rhode Island exchange director makes two points about SHOP, from about 7:15 forward: a new group of businesses comes up each month for potential SHOP enrollment, and the Rhode Island exchange, at least, is envisioning an immediate shift to SHOP outreach after March 31. This is an excerpt, of course; there's more in the interview:

HealthSource RI director Christine Ferguson: Overall, in the state, there's about 1200 to 1500 small businesses that renew [their insurance] in January, and then there's like 800 that renew in February. So, every month, there's a different number that you're basically targeting. ...

And as soon as open enrollment for individuals ends, you'll see a lot of our efforts shift to a real focus on the sales side for small business.

SPECIAL ENROLLMENT

Back on the exchanges, 2014 health insurance for individuals and families will be generally unavailable after March 31... but with exceptions. People who experience several rather major life events during 2014 can buy new policies within their own special enrollment periods. The events include things like getting divorced, having a baby, leaving a job, and more.

How many new QHP enrollments will result? It's hard to know: Someone who loses a job might buy insurance on the exchange, for example, but they also might go on their spouse's insurance. Unless there's a strong seasonal effect (for example, the May to August peak house-moving season), perhaps we'll have an average monthly number for these enrollments by mid-summer.

NATIVE AMERICANS

• MyDesert.com, 2/25/2014: Tribes Take Closer Look at Affordable Care Act
• KUNM, 2/15/2014: Health Guides Work to Convince Native Americans to Try Obamacare
• USA Today, 10/15/13: Affordable Care Act a Hard Sell for Native Americans

Under the ACA, Native Americans can purchase QHPs on the exchanges throughout the year; they qualify for some other incentives as well. But the federal government is obligated by treaty to provide free health care to Native Americans (think the Indian Health Service); there's a fuller explanation here. The ACA also does not require Native Americans to buy insurance. So why sign up? Most reports (see the links above) point to better coverage, including access to specialists.

USA Today last fall:

"As a group, the nation's 5.2 million Native Americans have poorer health and less access to health care than the rest of the U.S. population. ... nearly half of all Indians have incomes low enough to qualify for Medicaid in states that have chosen to expand coverage, according to the Center on Budget and Policy Priorities. More than 1 million Native Americans are already enrolled in Medicaid.

[And yet...] "Even optimistic advocates for Indian enrollment in the exchanges said convincing tribal leaders and individuals to sign up could take years."

Numbers are rare so far, but that last line may be about right. KUNM reported these figures in mid-February for a nonprofit working with New Mexico on Native American outreach (to be fair, its efforts are still ramping up for spring and summer):

Guides have already completed more than 8,600 “outreach encounters,” leading to 593 Medicaid applications filed and 81 Native people enrolling in the Exchange.