Last night I noted, in an entry about CoveredCA announcing a 5-day "start by 2/15, finish by 2/20" Open Enrollment extension period and the potential for a separate "Tax Season" enrollment period), that according to the director of advocacy group Health Access, the Affordable Care Act doesn't regulate any specific time window regarding Open Enrollment Periods.
I found this fascinating, because until that point, I had assumed that there was some sort of language in the ACA specifying, if not the exact dates, at least the total number of days (ie, something along the lines of "...not to exceed 200 days in the first calendar year, not to exceed 100 days in subsequent calendar years"). I also assumed that there would be some sort of clause allowing for the limited enrollment the rest of the year for people who have Qualifying Life Events (marriage, divorce, childbirth, loss of income, etc).
Two late-breaking news items, one negative, the other potentially positive:
Arkansas:The good news a few weeks ago was that newly-elected Republican Governor Asa Hutchinson did not kill off AR's unique "private option" Medicaid expansion program as many had feared; instead, he actually proposed extending it pretty much as is for another 2 years, to the relief of decent folks, and the state legislature seemed to be OK with that (another surprise).
LITTLE ROCK, Ark. (Reuters) - Governor Asa Hutchinson of Arkansas has signed legislation that will end by 2017 the state’s innovative but controversial adaptation of the Affordable Care Act, which has provided nearly 190,000 residents with health coverage.
Yes, lame I know, but it's the best I could think of. Assuming my final week projections are playing out accurately, total exchange QHP selections should cross the 11 Million mark by midnight tonight.
There's only been one actual data update so far today, but it's a big one: California just got bumped up by 66K. Tomorrow should bring several final updates before the final weekend, from the 3 M's: Maryland, Massachusetts and Minnesota. A few other states may chime in as well, probably tossing a rounded number out there in the middle of a final deadline press release (the way that California and Washington just did).
At this point, I'd say the odds of hitting given marks are:
11.0 million: 99.999% (nothing is certain...what if there's a national blackout starting RIGHT NOW which lasts for the next 4 days?)
12.5 million: 75% (this has been my official projection since Dec. 12th)
13.0 million: 25% (?)
13.5 million: 5% (???)
On the other hand, even if the demand is there, anything beyond 13 million would probably crash several of the servers/overload the phone lines, requiring an official "extension period" like they added last April, in which case all bets are off.
Here's what things should look like as of tonight:
Since open enrollment began on Nov. 15, more than 354,000 people have selected a plan, including 13,000 people on Tuesday — the second-highest single day of enrollment after the rush to meet the deadline on Dec. 15 to have coverage start on Jan. 1. They join the 944,000 consumers who signed up for coverage for 2014 and began the process of renewing their coverage for 2015.
Let's see how California has ramped up the past week or two:
This is the last time I'll be running a full comparison of how all 50 states (+DC) are doing before the final weekend surge; it'll be interesting to run before/after comparisons. Some important caveats, however:
1) While most of the states are current through at least February 2nd, 4 of them (CO, DC, HI & ID) haven't been updated since mid- to late January. Then again, both DC and Hawaii are already well over the top anyway.
2) For Massachusetts, I've dropped my personal target from 300K to 200K. Yes, it's lame to change my "predictions" so close to the finish, but in MA's case I completely botched my methodology in the first place; I thought they had a lot more people in their special "temporary coverage" who were eligible for QHPs than actually were. It would be a bit unfair to rank them at the bottom for failing to meet a completely unrealistic goal.
3) For Rhode Island and Washington, I'm using a different number than the other states; RI is the QHP selections, but after past-due non-paid ones have been purged from the total; in WA, they're only reporting the paid QHPs at all, so I don't know what the total selections are to begin with.
There's two issues here: First, is the demand going to be there? Second, can the system handle the strain if it's there?
According to Andy Slavitt of CMS:
Right now, we're focused on the next few days on being there for our consumers and to help them select the best plans for their families and the final days of open enrollment. As expected over the last couple of days, interest in signing up for coverage in the final week of open enrollment is beginning to increase and we're seeing a really nice ramp.
Amid today's otherwise excellent news out of HC.gov, WA, MA, RI & VT, there was one other unexpected bit of news from the Centers for Medicare & Medicaid Services:
The Marketplace is constantly changing with new consumers coming in each day and others leaving because of career changes, getting married or other life status changes. We have a responsibility to make sure people who are eligible stay covered and that those who are not eligible for Marketplace coverage do not. Up to 200,000 Marketplace consumers who had 2014 coverage cannot continue Marketplace coverage in 2015 because they did not provide the necessary documentation of their citizenship or immigration status. They will be notified in the coming days that their coverage ends on February 28. This is the same process that started last year and will continue on a regular basis.
D'oh! OK, one more late-breaking number today, out of Vermont:
Vermont Health Connect Open Enrollment and Renewal Update
The following numbers are up-to-date as of 11:59pm Monday, February 9, 2015.
New Vermont Health Connect Customers
12,344 individuals have checked out a 2015 health plan. This includes 4,786 individuals in Qualified Health Plans (private health insurance) and 7,558 individuals in Medicaid or Dr. Dynasaur plans.
After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 12,344 individuals who checked out, 10,678 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment). Of those who completed the process, 3,293 are on a Qualified Health Plan and 7,385 are on Medicaid or Dr. Dynasaur.
MA's number starts with the 119K confirmed as of last Thursday, then adds 50% of those determined eligible for QHPs since then (this has proven to be a pretty accurate rule of thumb to date).
RI actually provides the hard paid enrollment number, and even provides the total QHP selections...but only after having purged an estimated 1,800 or so who didn't pay by the due date. I'm glad that they're purging those folks, but it makes it a bit tricky since most other states are being based on their total selections, whether paid or not.
WA, like Rhode Island, provides the paid enrollment number, but doesn't provide total selections at all.
In the cases of RI & WA, I'm assuming that their hard paid number represents 88% of the total selections, which means their estimated QHP selections are 30.7K & 158K respectively.
OK, with that out of the way, here's where things stand (and remember, while most of the states are current through 2/06, a few of the State Exchange states haven't been updated since as far back as January 15th, so the picture could be quite different once those are updated):
