Obamacare rollout status report: central place for updates

[werepossum]

I guess you didn't read the rest of the thread; 3M persons age 26 and under are on parent's healthcare plans because of ACA, so combined with private exchange enrollment that's 3M + 2.1M = 5.1M). Then, you have 3.9M that were deemed eligible for Medicaid just through November (not including December in other words), as I previously referenced in this same thread, here. Now, as I said in that post, further clarification was needed on the Medicaid numbers, as that 3.9M aren't all directly attributable to ACA; for example, due to people re-upping existing Medicaid or those being eligible under the non-ACA expanded Medicaid rules, something that was recently discussed by the ever illuminating Sean Trende on RCP here. Nonetheless, it's almost certainly already 6M+ if you take everything into account.

So while I can understand how you'd conclude the Bloomberg article gives a full accounting of ACA enrollments....it doesn't.

I did see where you said "someone said" there were three million people now on their parents' insurance, just not where anyone actually backed that up. (Although I may have just missed it.) Also not seeing where your 4.2 million Medicaid enrollees comes from; this article says 1.6 million THROUGH December, not IN December.

 

[JEDI]

so if only ~30% of young people signed up, whats happens to the 10% ($95 max) penalty $ they have to pay?

does it just goto the fed govt's general fund?

or must it be used for a specific purpose like give $ to insurance companies to make up the difference in their profits from not enuf young people signing up to substidize old people's capped rates?

 

[sactoking]

so if only ~30% of young people signed up, whats happens to the 10% ($95 max) penalty $ they have to pay?

does it just goto the fed govt's general fund?

or must it be used for a specific purpose like give $ to insurance companies to make up the difference in their profits from not enuf young people signing up to substidize old people's capped rates?

It's not that ~30% of young people signed up, it's that ~30% of people who signed up are young people. It's a distinction with a difference. If one were theoretically able to ignore the law of large numbers in its actuarial application one could say that only 1 young person needed to sign up nationwide so long as only 3 people signed up in total.

Whatever penalty money is collected is intended to offset the various costs of various programs associated with the ACA. That is not to say that the revenue is somehow legally embargoed from being used for some other purpose.

 

[First]

I did see where you said "someone said" there were three million people now on their parents' insurance, just not where anyone actually backed that up. (Although I may have just missed it.)

I didn't know it was difficult to believe that lots of young people would choose to stay on their parents plan up to age 26.

But sure, HHS is my source, courtesy of a 30 second google search.

Also not seeing where your 4.2 million Medicaid enrollees comes from; this article says 1.6 million THROUGH December, not IN December.

No, the Bloomberg article does not say through December. Read it again.

The Medicaid enrollees link from CMS was literally provided in the post of mine you're quoting. Check the link I provided, hyperlinked "CMS" in this post here.

 

[werepossum]

I didn't know it was difficult to believe that lots of young people would choose to stay on their parents plan up to age 26.

But sure, HHS is my source, courtesy of a 30 second google search.

No, the Bloomberg article does not say through December. Read it again.

The Medicaid enrollees link from CMS was literally provided in the post of mine you're quoting. Check the link I provided, hyperlinked "CMS" in this post here.

The Business Week article you quoted says:

"More than 2.1 million Americans selected private health plans through healthcare.gov and state-run websites through Dec. 28, the Obama administration announced today. Another 1.6 million were judged eligible for Medicaid, the federal-state insurance program for the poor. Most of the new enrollees in private health plans—1.8 million—signed up in December, after the White House relaunched the Affordable Care Act’s stuttering website on Dec. 1."

Granted, the article may just be poorly written, but it seems to me to mean that 1.6 million were judged eligible for Medicaid through Dec. 28. Remember, part of Obamacare is the "no wrong door" policy, meaning that if you are judged eligible for Medicaid on any ACA portal you can get your application filed from wherever you are. That also includes CHIP and other such programs.

The Medicaid.gov page citing the 3.9 million figure specifically says "Total Individuals Determined Eligible for Medicaid and CHIP by State Agencies (includes those newly eligible under the Affordable Care Act and those eligible under prior law)"

and

"States reported receiving more than 1.7 million applications at their State Medicaid and CHIP agencies during the month of November."

Sounds to me like there have been 1.6 million newly eligible from Obamacare and 2.6 million eligible under existing rules, although I agree it's arguable. Regardless, the interpretation is very important because Obamacare also has bad effects. In order to judge its performance and value we need accurate data for the good and the bad. This side should be fairly easy to quantify. The bad will be less so since most people who lose health insurance because of Obamacare probably pick up new health insurance outside of the exchanges, with only a small minority purchasing health insurance through the exchanges and probably fewer going without. Difficult to tell those people from people who simply change or obtain health insurance without being affected either way (other than cost) by Obamacare.

 

[First]

The Business Week article you quoted says:

"More than 2.1 million Americans selected private health plans through healthcare.gov and state-run websites through Dec. 28, the Obama administration announced today. Another 1.6 million were judged eligible for Medicaid, the federal-state insurance program for the poor. Most of the new enrollees in private health plans—1.8 million—signed up in December, after the White House relaunched the Affordable Care Act’s stuttering website on Dec. 1."

Granted, the article may just be poorly written, but it seems to me to mean that 1.6 million were judged eligible for Medicaid through Dec. 28. Remember, part of Obamacare is the "no wrong door" policy, meaning that if you are judged eligible for Medicaid on any ACA portal you can get your application filed from wherever you are. That also includes CHIP and other such programs.

wolf, it says private health plans through healthcare.gov, not Medicaid. I'm not aware of anyone anywhere claiming that the 2.1M is anything but private plans (assuming I'm even understanding you correctly) and, to again drive the point home, the Bloomberg article doesn't say Medicaid through December, it only says private plans through December.

The Medicaid.gov page citing the 3.9 million figure specifically says "Total Individuals Determined Eligible for Medicaid and CHIP by State Agencies (includes those newly eligible under the Affordable Care Act and those eligible under prior law)"

and

"States reported receiving more than 1.7 million applications at their State Medicaid and CHIP agencies during the month of November."

Sounds to me like there have been 1.6 million newly eligible from Obamacare and 2.6 million eligible under existing rules, although I agree it's arguable. Regardless, the interpretation is very important because Obamacare also has bad effects. In order to judge its performance and value we need accurate data for the good and the bad. This side should be fairly easy to quantify. The bad will be less so since most people who lose health insurance because of Obamacare probably pick up new health insurance outside of the exchanges, with only a small minority purchasing health insurance through the exchanges and probably fewer going without. Difficult to tell those people from people who simply change or obtain health insurance without being affected either way (other than cost) by Obamacare.

We agree that the Medicaid numbers specifically are arguable, clearly no question about that. The uncounted numbers for ACA include those that are only now applying for Medicaid because they've been hearing a lot about Obamacare generally, and the mandate specifically, and even those these people were Medicaid-eligible before ACA ever existed, the combination of the mandate and media coverage has prompted them to apply. There are also plenty who are signing up directly with insurers because of the ACA mandate and because their plans were cancelled, something that is again not counted in any official HHS/WH figures, that I'm aware of. There's also those who got cancelled and never signed up again or couldn't for some reason, which I imagine is pretty small but we don't know for sure.

Either way, I'd say it's extremely likely it's above 6M at this point. The best way to measure is probably just total number of uninsured in the country. If there were 49M uninsured in September 2013 and there ends up being, say, just 30M or 40M uninsured by the end of 2014, it's hard to see how ACA doesn't get the lion's share of credit. But again, we'll see.

 

[berzerker60]

Not looking great for haters, though still a lot of ball to be played:

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/14/the-death-of-obamacares-death-spiral/

4. The risk of a "death spiral" is over. The Kaiser Family Foundation estimates that if the market's age distribution freezes at its current level -- an extremely unlikely scenario -- "overall costs in individual market plans would be about 2.4% higher than premium revenues." So, in theory, premiums costs might rise by a few percentage points. That's a problem, but it's nothing even in the neighborhood of a death spiral.
5. That calculation, however, omits the transitional policies in Obamacare that help insurers keep premiums low as the risk pool sorts itself out over the first three years. Add those in, and it's unlikely that 2015 will see any premium increase at all. Robert Laszewski, a consultant for the insurance industry, agrees. "I think the 2015 rates will be the rates you’re looking at today, more or less," he says.

http://www.washingtonpost.com/blogs...insurers-think-obamacare-is-going-to-be-fine/

Obamacare's troubled rollout hasn't scared insurers out of the marketplace. Instead, speaking to thousands of health-care investors gathered in San Francisco, plan executives describe the Affordable Care Act as, at worst, a fixable mess and, at best, a major growth opportunity.
The executives' commentary was a reminder that the health-care industry doesn't set its watch by the election cycles which dominate Washington. They expected Obamacare to be a bit of a mess in 2014 -- but they're in it for the long haul.

"We believe that over time, a lot of these bumps will work themselves out," Joe Swedish, president of Wellpoint, the country’s second-largest health plan, said in an interview with The Washington Post."We have always expected it to have a sort of lumpiness to it, the rollout. It's certainly become more lumpy than one would have predicted [but] over time, this will work out."

 

[First]

Yup, add "death spiral" to the ACA talking point dustbin of history, along with death panels.

 

[Daverino]

Yup, add "death spiral" to the ACA talking point dustbin of history, along with death panels.

Also, one of the last major legal challenges to the ACA has been dismissed by the courts today.

 

[sactoking]

5. That calculation, however, omits the transitional policies in Obamacare that help insurers keep premiums low as the risk pool sorts itself out over the first three years. Add those in, and it's unlikely that 2015 will see any premium increase at all. Robert Laszewski, a consultant for the insurance industry, agrees. "I think the 2015 rates will be the rates you’re looking at today, more or less," he says.

I'm not sure I buy point #5 at this time, on a few different fronts:

1. The 2014 loss experience likely won't even be reflected in 2015 rates. Insurers will be developing and submitting 2015 rates in the March-May timeframe. They will have about a quarter of a year of loss data before they get in to the meat of their rate development. How will they be able to accurately reflect 2014 experience into 2015 rates if open enrollment is still ongoing or has just closed? Practically, they will be rating based on marketplace assumptions that could not be accurate.

2. The 2014 transitional programs likely won't be reflected in 2015 rates. 3 R's money for 2014 won't be paid out until mid- to late-2015. Insurers won't know their loss experience until the end of 2014. Rates must be developed early in 2014. Rate filings will have a difficult time justifying the actuarial assumptions used under those circumstance.

3. CCIIO announced that the transitional reinsurance program fee for 2015 was going to decrease to about $45 per person per year (down from about $63 pppy in 2014). However, the White House also announced that self-insured plans not using a third-party administrator would be exempt from the transitional reinsurance fee for 2015. It seems likely that the fee will have to increase to cover the mass exodus of fee-paying lives.

4. ALL currently-compliant health plans will have to re-price in 2015 owing to CCIIO making changes to the AV calculator. Some of these changes are rather profound, to the point that insurers are worried that existing plans might jump as many as two tiers up or down based on plan design.

Anecdotally, we've been having discussions here about "rate shock #2" in 2015 not about "2015 is more of the same."

That's not to say that there are not some factors that might work to suppress rates in 2015:

1. Many established insurers, especially those in states without true rate review authority, may have been keeping rates artificially low (to the point of being legally inadequate), relying on reserves to bring them through 2014 in a hope of grabbing market share (history shows that individual insurer and plan choice is "sticky"). Since 2014 has had, to date, a disappointing enrollment they might try again in 2015.

2. In states that did not support the President's plan to allow policies purchased or renewed before 10/2/13 to renew again in 2014 the current non-compliant, nongrandfathered market will disappear. This market is generally healthier than the 2014 open enrollment market, so that may depress rates (though in states that allowed early renewals in December the effect may be nonexistent).

That being said the re-emergence of the employer mandate in 2015 could push individual rates higher. There is a school of thought that says self-insured employers, once faced with the mandate, will jettison their worst risks onto the exchanges and pay the resultant fines because it will make their self-insured risk pool much healthier. Given some of the rules around employer coverage (the exemption from the transitional reinsurance plan described above, the fact that offering insurance to all employees actually has a 95% safe-harbor provision) it is theoretically possible that a self-insured employed could dump the unhealthiest 5% into the individual market, face no penalty, and really sour the individual risk pool.

 

[Londo_Jowo]

I had physical therapy this afternoon and noticed a woman who was checking in for an appointment with an orthopedic specialist. The person checking her in was verifying her insurance and determined that she had no coverage with the provider she said she had insurance through. The woman flipped out and was screaming that the doctors office computer was not operating properly. They asked if she had received any insurance cards via the mail and her reply was "no". They asked who the insurance provider she had selected via the exchange was and they called the insurance company, the woman was not shown on their system. While on the phone with the insurance company they asked the woman if she had made a payment for coverage yet and she said she hadn't received any bills in the mail. It appears that this woman must have been one of the people who's information/application was dropped from the system rather than being processed.

 

[glenn1]

Target is joining WalMart and either retailers in dropping coverage for part timers and encouraging them to enroll in Obamacare.

 

[Daverino]

Target is joining WalMart and either retailers in dropping coverage for part timers and encouraging them to enroll in Obamacare.

Because it's cheaper for the employee and Target. Smart move and everyone wins, IMHO.

 

[theeedude]

Because it's cheaper for the employee and Target. Smart move and everyone wins, IMHO.

Yep. Plus I shudder to think what Target's plan for part time employees even covers.

 

[Fern]

Because it's cheaper for the employee and Target. Smart move and everyone wins, IMHO.

"Everyone"?

They're doing it to take advantage of government subsidies. Is that a win for taxpayers?

Fern

 

[theeedude]

"Everyone"?

They're doing to take advantage of government subsidies. Is that a win for taxpayers?

Fern

Could be if offloading medical expenses is passed on to employees in higher wages, so they need less welfare and foodstamps to make ends meet.

 

[Fern]

Could be if offloading medical expenses is passed on to employees in higher wages, so they need less welfare and foodstamps to make ends meet.

From what I've read the employees are just getting a lump sum payment of $500 to help with the HI cost. I wouldn't expect much, if any, effect on welfare etc.

Fern

 

[theeedude]

From what I've read the employees are just getting a lump sum payment of $500 to help with the HI cost. I wouldn't expect much, if any, effect on welfare etc.

Fern

OK, you know I am not heartbroken that Target part time employees will have extra $500 and health insurance. They'll just put that money back into the economy so it's net stimulative.

 

[theeedude]

http://www.politico.com/story/2014/01/health-care-uninsured-survey-102503.html?hp=l9

The rate of uninsured Americans has dropped in the early stages of 2014, dipping in the less than one month since coverage from the Obamacare exchanges took effect.

So far in January, 16.1 percent of Americans are uninsured, down from 17.3 percent in December before the exchange coverage began for those who signed up for Jan. 1 health insurance, according to a Gallup poll out Thursday. That’s down from a high of 18.6 percent earlier in 2013 and the lowest registered rate since December 2012.

Good news, this is what it's all about.

 

[Daverino]

"Everyone"?

They're doing it to take advantage of government subsidies. Is that a win for taxpayers?

Fern

As I've said time and time again, the taxpayers were already paying for the uninsured to get healthcare. We were just doing it in the most retarded and inefficient way possible. I would much rather spend my tax dollars on subsidizing a part-time worker's insurance than spending it on them getting treated for diabetes in the emergency room.

So in the long run it saves tax dollars too. Everyone wins.

 

[theeedude]

http://www.sltrib.com/sltrib/news/57438301-78/medicaid-expansion-health-federal.html.csp

Utah will expand Medicaid eligibility rules to get coverage to more residents in need of health insurance, Gov. Gary Herbert said Thursday.

Nehring urged lawmakers to get Utah’s version of an expansion started quickly.
"Every month that Utah waits to start a program, we lose over 4 million dollars in federal funding, thousands of families struggle accessing and paying for care, and continue to face the physical, mental and financial harm that occurs when families are uninsured," he said.

A Republican who can do the math, what do you know.

 

[Londo_Jowo]

From what I heard on the radio it appears Aetna can do the math as well, from what the CEO said either they will need to have double digit premium increases or pull out of the ACA all together.

 

[Daverino]

From what I heard on the radio it appears Aetna can do the math as well, from what the CEO said either they will need to have double digit premium increases or pull out of the ACA all together.

I wonder who you heard that on the radio from?

http://www.cnbc.com/id/101354183

Why not read the story for yourself? The CEO said that current new ACA enrollment is only a small fraction of their insurance population. They don't yet know how many will sign up. If the uninsured do not sign up for insurance through the ACA then it will be difficult for Aetna to support it.

This is nothing new. Enrollments, however, are chugging along. Many analysts have already said that the ACA has reached critical mass, despite many states actively working against the system. Connecticut, New York and Rhode Island have already exceeded the expected number of insurance signups for March. Unsurprisingly, states in the Deep South are lagging far behind.

The state with the second worst signup rate? Massachusetts. Why? Because, thanks to Mitt Romney implementing the ACA years before as a state law, only 4% on MA residents were uninsured in the first place. MA has a population of 6.5 million with only 250,000 uninsured. Contrast that to Texas, which, at a population of 26 million (4 times the size) has 25 times the number of uninsured.

 

[Londo_Jowo]

I wonder who you heard that on the radio from?

94.5 The Buzz

http://www.thebuzz.com/main.html

 

[werepossum]

OK, you know I am not heartbroken that Target part time employees will have extra $500 and health insurance. They'll just put that money back into the economy so it's net stimulative.

They'll have $500 less the cost of health insurance. $500 being $41.67 per month, looks like the vast majority of Target part time employees will have less money to spend, not more.

http://www.politico.com/story/2014/01/health-care-uninsured-survey-102503.html?hp=l9


Good news, this is what it's all about.

That is good news, assuming this isn't like the unemployment numbers where the total number of insured goes down yet the uninsured rate also goes down. The insured rate and the cost to society are by far the two most important metrics by which Obamacare will be judged.