OK, due to my unexpectedly-far-longer-lasting bout of shingles, I've gotten a bit backed up with my ACA news the past few weeks, but I did want to address the "cost per enrollee" story which popped up a week or so ago:
Sometimes there really are economies of scale. And the nation’s health insurance exchanges may be a case in point.
As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.
The article (and others like it) goes on to break out the individual state exchange costs. Some do better than others, of course, and Hawaii comes in dead last (in part simply because their uninsured population is so small to begin with). While it's certainly interesting to see which ones were the most efficient and which were the least, there's a big part of me which keeps asking "why is anyone surprised by this?"
In spite of all the hand-wringing that people have had about the insurance company premium rates for the 2nd year of the exchanges (this is the main reason for all the freaking out about how many "young invincibles" there would be, etc etc), the truth is...the new premium levels appear to be all over the place:
May 15--A first-glance snapshot of the lowest premium rates being proposed for individual health-insurance plans to be sold in the Washington Healthplanfinder exchange marketplace reveals spirited competition and more choices for consumers.
These rates are not yet approved, and it's likely the number of plans requested will decline, according to the Office of the Insurance Commissioner.
That office is now reviewing rate changes the companies requested.
Changes proposed by companies asking to sell plans on Healthplanfinder ranged from a nearly 7 percent decrease in one case to an increase of more than 11 percent in others.
If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:
Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.
...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.
They may have flushed a couple hundred million dollars down the drain on their website, but that just makes Oregon's manual QHP processing achievement all the more impressive. Over 6 weeks after the official enrollment period ended, and over 2 weeks after their extension period wrapped up, Oregon continues to push their QHP and Medicaid enrollment totals up:
Medical enrollments through Cover Oregon: 280,334 Total private medical insurance enrollments through Cover Oregon 1: 81,358
Oregon Health Plan enrollments through Cover Oregon: 198,976
A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:
As of April 29, 2014, 275,090 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.
As of May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.
The New Jersey Medicaid expansion tally has jumped around a bit due to differing definitions of the enrollments, but this new one seems in line with my expectations and the wording is pretty specific:
Another 140,000 residents joined the state’s newly expanded Medicaid program, which now allows people who are slightly above the poverty line to qualify for coverage.
Well, here at ACASignups.net I'm nothing if not comprehensive...Hawaii has added a whopping 69 exchange QHP enrollees and 3 (yes, 3) SHOP enrollees in the past week or so...
Total since October 1, 2013
31,758 Applications completed in the Individual Marketplace
9,286 Individuals and families enrolled in the Individual Marketplace
595 Employers applied to SHOP Marketplace
631 Employees and dependents enrolled via SHOP Marketplace
Minnesota's official exchange QHP tally has dropped by a whopping...9 people since the end of April. Meanwhile, their Medicaid tally has shot up another 10,262 people:
The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.
