Contributor ArcticStones forwarded this to me. I'm not in a position to either confirm or debunk many points in this article, but a quick search of this site for "Massachusetts Limbo" will bring up a number of references made in it. The author is a quite open Republican activist. However, if his claims are correct--and the bulk of them certainly seem to be--then those in charge of the first version of Massachusetts' ACA exchange should be held accountable for some rather appallingly bad decisions before, during and after the 2014 open enrollment period.
I generally support the Affordable Care Act, and states like Kentucky, Connecticut and (for the most part) Washington State, New York, Rhode Island and Colorado have proven that when the technology, budget, personnel and other project aspects are handled properly, it can be extremely successful. However, that also means not turning a blind eye or blaming the wrong source when things go wrong...and in the case of states like Oregon and Massachusetts, things did indeed go very, very wrong.
I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:
First in a series of profiles about KY women in charge of the state exchange:
Energy exudes from Carrie Banahan when she talks about her work with others to bring affordable health care to more than half a million Kentuckians.
“I worked all my life to see this happen, that we can provide affordable health insurance to people, and it has actually happened,” she said. “I am thrilled that we are actually helping people in Kentucky. It is the highlight of my career.”
Banahan is executive director of the Kentucky Health Benefits Exchange, which the state has branded as Kynect, partly to avoid identification with the pejorative nickname Obamacare. She shares the credit for its success.
This is a classic case of one's attitude determining whether this is good or bad news. The headline and lede make a huge deal about 400,000 people having to re-enroll in the Massachusetts ACA exchange this winter...except that I've been pushing hard for everyone to be required to re-enroll once per year anyway regardless of whether their personal incomes/circumstances have changed over the past year or not...which means that to me, it's not only not a big deal that everyone in MA will be required to re-enroll, but it's actually a good thing:
Nearly 400,000 people in Massachusetts will need to reapply for health insurance before the end of the year, and many of them probably do not even know it.
They are people who do not have employer-sponsored health insurance and who instead sought insurance through the state. After the Massachusetts insurance website failed last year, most of them were enrolled in temporary coverage that ends Dec. 31, which is why they must select a new plan.
Some good news (relatively speaking) on the Massachusetts front: As you'll recall, the state which inspired the ACA (ironically due to the program being spearheaded by then-Governor Mitt Romney), and which has been operating under their state-level version of the law smoothly for some years now, had an incredibly embarrassing misfire with their ACA-specific exchange website. After hobbling through the first enrollment period (and leaving over 200,000 residents in healthcare limbo as a result), it was determined that the existing site was such a mess that they had two choices: Either replace the existing software with an entirely new system, or drop the whole thing and move over to the Federal exchange as Oregon is doing.
Instead, Massachusetts decided to hedge their bets and pursue both: They've been working with a new vendor to rebuild their own exchange from scratch, while simultaneously arranging for a quick move to HC.gov just in case Plan A doesn't work out.
The good news is that so far, anyway, the new platform seems to be working out in early testing, though it's way too early to be sure of anything:
When Massachusetts passed its landmark health coverage law under Gov. Mitt Romney in 2006, no one claimed the state would get to zero, as in 0 percent of residents who are uninsured. But numbers out today suggest Massachusetts is very close.
Between December 2013 and March of this year, when the federal government was urging people to enroll, the number of Massachusetts residents signed up for health coverage increased by more than 215,000. If that number holds, the percentage of Massachusetts residents who do not have coverage has dropped to less than 1 percent.
According to the Kaiser Family Foundation, Massachusetts only had around 242,000 uninsured residents out of 6.65 million total as of last September (about 3.6%), just before the ACA exchanges launched. So on the one hand, Massachusetts already had the lowest uninsured rate in the country due, of course, to RomneyCare, the precursor of Obamacare (no matter how much Mitt wants to deny it now, Lord knows why...)
OK, Massachusetts' exchange is still seriously screwed up, and their reporting methodology is equally confusing, but it appears to be, as contributor deaconblues notes:
QHP: 32,706 unsubsidized + 773 subsidized = 33,479 (up from 31,695 as of 4/19)
Medicaid: 195,955 (expansion plus churn)
Limbo Status: 93,778 + 10,382 + 201,113 = 305,273
SHOP: 4,982? (1,869 members in Business Express and 3,113 members in QHP)
Really not sure how to handle the SHOP numbers, and that "Limbo Status" number keeps growing (it was 270K last I checked). Come June 30, I have no idea what those 300,000 people are going to do...
OK, not exactly the most stunning headline in the world (although this does appear to be shocking news to a certain anti-ACA political party), but still kind of cool to have some solid numbers on just how many lives could be saved with universal coverage:
Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.
Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.
Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.
Not exactly surprising, but rather embarrassing for the state which spawned the ACA in the first place.
If the "off-the-shelf" replacement works, great. If not, and they follow Oregon into having HC.gov take over, that would mean a net change of...zero states, with MA and OR moving into the fold while New Mexico and Idaho break out on their own exchanges.
Massachusetts has scrapped its hopes for a totally customized state-based health exchange under the Affordable Care Act, and will instead purchase an “off-the-shelf” solution that can be installed by the fall with the possibility of joining the federal exchange if all else fails.
The state announced Monday that it would contract with Virginia-based hCentive for health insurance exchange software that has been used to power online marketplaces Kentucky, Colorado, New York and other states.
Health and IT officials will simultaneously work to ready the state and its insurers to join the federal health exchange in case the hCentive software solution cannot be implemented in time for the next insurance open enrollment period that begins in November.
The wording of the story makes it look like MA's exchange QHP total dropped by over 6K, but in fact they had only reported 12,965 to HHS as of March 1st, so this still represents a slight increase over the last number entered on 4/02 (29,720):
Unsubsidized enrollment in exchange plans fell to 29,775 April 8, from 36,060 Dec. 1, 2013, when the state had its own, homegrown exchange plan program in place. The exchange is planning to conduct a survey to learn why enrollment fell.
deaconblues, ever detail-oriented, also made sure to find the subsidized number of QHP enrollees as well: 769
As deaconblues reminds me, the 29K is in addition to the 720 subsidized enrollees that they've managed to get through their messed-up system.
Massachusetts will not meet its goal of moving more than 200,000 people into insurance plans that comply with the federal law by the end of June. It has managed to enroll about 29,000 residents in unsubsidized coverage, 138,000 in temporary coverage, and another 114,000 in extended coverage since the October launch of its new website, with a significant number applying on paper, said a Connector spokesman Thursday.
