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View Diary: ACA Enrollments Pass 228K; New Features Added! (53 comments)

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    •  On your second chart (3+ / 0-)
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      Cardinal Fang, Lujane, Nowhere Man

      ...even though you mention MA on the chart, there is no graphic presentation.

      One thought is to do the same chart as a percentage of goal met at Y and a percentage of time allotted at Z, with two lines -- one following totals of MA and the other following totals of ACA. No need to go granular regarding Medicaid vs premium, etc. on either line.

      •  Yeah, the MA chart is going to be less useful (3+ / 0-)
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        Pluto, Ignacio Magaloni, Sylv

        I'm not going into that much detail on it; for one thing, it's an imperfect example (they had a full year vs. 6 months, and I don't even know if the 36K figure that they did achieve was even close to their original goal).

        In fact, I'm thinking of scrapping it completely depending on how the November numbers come out--at a certain point, it will no longer matter how closely we match their rate (whether good or bad).

      •  I thought the giant light-blue part (0+ / 0-)

        was the Massachusetts numbers. But the Massachusetts data doesn't look that informative; there are only four data points, apparently, so it's not clear what's happening.

      •  I have such a chart drafted (2+ / 0-)
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        Brainwrap, Sylv

        (Chatted back and forth in comments with Brainwrap in last week's diary update).

        While I try to get it into an easily linked form, let me simply say this - the result is very interesting - I'm running cross-checks of the math I employ. Why? Because the data looks too good versus Massachusetts experience.

        Of course, the goal for the ACA was always more challenging than MA - 7MM out of 50MM uninsured is 14% signed up by end of open enrollment.

        For MA the achieved rate was less than 7% of an estimated 540K uninsured - and they had a year over which to achieve that goal, with only four reporting periods from which to glean information. Countering which the pool of uninsured was smaller (proportionately) than that from which ACA can draw. Still, very interesting as a side-by-side comparison.

        In my graph, I assume MA met their goal - I mean, this was the benchmark trial for ACA, right?

        •  Well, as I noted, I have no idea whether... (0+ / 0-)

          ...the 36,000 figure that Massachusetts achieved in the first year was even close to their goal...or that they even had a particular goal (that is, I'm sure they had a target, but I don't know if it was based on program viability or simply a nice number to shoot for).

          •  Here for comment 3 graphs (3+ / 0-)
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            Brainwrap, Cardinal Fang, Sylv

            First - the rosy picture

            Massachusetts experience with 1st year open enrollment shown for comparison. Rate of Enrollment against a uniform time-scale - Proportion of Open Enrollment Elapsed.
            Note: The % for Med-SCHIP and for ACA Open Enrollment are proportioned against goals previously stated for individual insurance (7 million goal) or imputed (administratin seeks as many Medicaid enrollees as individual enrollees). Thus the % achievement amplifies rate of yield vs. goal for ACA. There is little known as to Massachusetts goals for 1st year enrollment in the Connector.
            The bottom, purple line is the rate at which previously uninsured are being covered - and that is proportioned against the ~ 50 million pool previously lacking insurance.

            Second - also using % of goal for ACA

            Keeps experience in Massachusetts on graph, but eliminates the line for total newly covered. ACA performance whether Medicaid-SCHIP or individual insurance is measured gainst he respective goals for each pool.

            Third, the not yet so rosy picture - and this is I think the closest equivalent to a measure of goal achievement.

            Rate of enrollment with time uses a proportion of open enrollment time scale. # of enrollees (or Medicaid-SCHIP) are both expressed as a proportion of the total number of uninsured at onset of the open enrollment, as is Massachusetts 1st year experience with private HI enrollment. Massachusetts and ACA goals plotted on 2nd and 1st axis repectively.

            I take back any assertion that the graphs for ACA look too good based on this 3rd chart - though clearly we are on an upward trend.

            •  One other very important factor - baseline data? (1+ / 0-)
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              The baseline data I have employed for MA is that which ends with about 36K individuals enrolled, after one year.

              Well, it is worth asking if Massachussets had such a desultory performance.

              There is reason to believe otherwise.

              And the new data comes from what might be termed an unimpeachable source, Jon Gruber. Romeny/Obama/Care/ACA helper architect.

              Published in the New England Journal of Medicine - 2011. In which you can find a graph that suggests a different head count for the private insurance enrollees than that recently touted - and, as important, a different timescale. 3 quarters, not 12 months. This is the best data I can find anywhere - and possibly allows me to pull off comparative rate of enrollment data that is more granular than the four reporting periods previously employed.

              Because of copyright concerns I will not embed the graph - but it is available on DK Image Library under ... /59241/large/ill4.png

              •  Fix the link? (0+ / 0-)

                ItsSimpleSimon, could you fix the link to the Gruber data? Thanks.

                However, clicking over to the article and looking at the second graph, we see clear evidence of procrastination. Between when the Massachusetts mandate started to phase in and the when the mandate started to bite, we see about 4000 people signing up a month. There's an initial little leap in the second month, perhaps as word gets out, but the signup is fairly steady.

                Then, in the last month, at the deadline, we see a sudden leap of 8000 people, double the previous trend.

                This is both good and bad. The procrastination evidence is good, but a mere doubling of the previous trend is not enough.

                •  I assume you mean the link to DK image (0+ / 0-)


                  Feel free to inspect - but please do not embed into a comment. Copyright on original is NEJM.

                  Gruber's NEJM article indicates more than one uptick in enrollment, with the largest coming, as you suggest, at the critical December 2007 date after which mandate penalty comes into play for the uncovered.

                  •  Yes, that's it, thank you (2+ / 0-)
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                    ItsSimpleSimon, ybruti

                    Judging by the MA experience, we might expect a big uptick in the next four weeks, as people who want insurance get it, and then another, bigger uptick in March, as people who want to obey the law, but who have been dragging their feet, get insurance. But it all depends on outreach, publicity and advertising, and it'll probably be different in different states.

                    I'm hoping we get good publicity of "Look at how cheap it is" after the first of the year, to capture the laggards.

            •  What about cancelled policies? (1+ / 0-)
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              When we compute the reduction of people uninsured, we also need to count people who were already insured, but whose insurance was cancelled. IIRC, seven million was the goal for reduction in the number of uninsured. But at least some of the new enrollees were already insured, and now are moving to the exchange or to Medicaid, either because their policy was cancelled or because they could get a better deal on the exchange.

              What we want to know is, how many fewer people will be uninsured next year. It's difficult to compute that number without knowing what is going on with private insurance signups.

              •  Already, because of the expansion of Medi-Cal (1+ / 0-)
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                beginning in 2014, there are 600,000 adults now in a temporary Low Income Health Program (LIHP) set up in 2010. These Californians will be moved to Medi-Cal on Jan. 1, 2014. Previously, they couldn't qualify for Medi-Cal, so these 600,000 are among the uninsured who are getting health care because of the ACA.

                Low Income Health Programs in California have identified and enrolled over 600,000 Californians in coverage - just about half of the Medicaid expansion population.  These Californians are then ready to be shifted to full state Medi-Cal on Day One, January 1, 2014.  The goal and expectation when the LIHPs were created in 2010 was that enrollment would be about 500,000 so the LIHPs are already a success story.  In these final months of 2013, counties can use LIHPs to drive Medi-Cal enrollment even further and perhaps go beyond 750,000 Californians as a starting figure for the Medi-Cal expansion. Link

                The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

                by ybruti on Tue Nov 26, 2013 at 11:39:11 AM PST

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              •  You are asking for data which does not exist (1+ / 0-)
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                in a clear form.

                And, if it did exist, would be even more confounding when used as a comparative with some ACA data.

                It might be useful for HHS or others to provide some clarification of whether the new enrollees are dominantly new customers or converted customers.

                Till  then a baseline assumption might be that the new enrollee numbers are dominated by those without current policies.

                Here is a rational basis for that assumption:
                -- Existing policy holders (even some with frightening letters suggesting that by December 31 United HealthCare has quit California or other terribles) might wait through to enroll at the last minute.
                -- It is the enthusiastic and HI deprived who might weather the storm to get their healthcare insurance needs addressed on the exchange no matter the lead time. Pent up demand.
                -- Some of the more well positioned or needy receiving notice that a new policy was theirs for the asking already signed up for the same (several news articles back this up - particularly accounts of some states allowing such 2014 signees, who got their notices and acted upon them before the marketplace went active, to reconsider). Even if they waited till the exchanges went active it would be reasonable for these customers to do what they always did - call their broker. such numbers would not be in the HHS monthly report.

                Finally a word or two on Massachusetts and ACA 7 million.

                In Massachusetts the newly insured might be reasonably expected to contain fewer enrolled who previously held private insurance - they might be more wealthy and thus covered under the later roll-out in MA targeting such customers. In simpler words, the MA numbers are likely close to pure previously uninsured. Yet. the total sho enrolled up till the onset of mandate is really not that high - even from the NEJM graph it implies 37K total for the Commonwelath Care enrolled.

                The 7 million number you suggest is composed of both those who are newly insured and those who are being moved to Medicaid.
                seven million was the goal for reduction in the number of uninsured. But at least some of the new enrollees were already insured, and now are moving to the exchange or to Medicaid,
                That does not marry with statements by Sebelius. The higher target, 7 million insured, many more as Medicaid sign-ups is the one that keeps getting thrown about.
                HHS says of the 41.3 million individuals who are currently uninsured and eligible for coverage, 23.2 million (56 percent) may qualify for Medicaid, the Children’s Health Insurance Program, or tax credits on the exchanges to purchase coverage for $100 or less each month - See more at:
                This surely is in keeping with 7 million paid signees and many more individuals getting on to Medicaid. (Note the baseline number for uninsured in the article differs from that employed by Brainwrap, in his sheet, of 50MM).
                This becomes important to clarify - for, if the goal is as I interpret it (and Brainwrap) then 7 million is new signees. If it is as you describe it (7 million, no matter the means of coverage provision) then the high figure in the sheet (Total  in graphs above) is more encouraging.
    •  I think you mean poblano. (2+ / 0-)
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      Pluto, Brainwrap

      I used to argue with him about polls here. Then he made the big time.

      ...better the occasional faults of a government that lives in a spirit of charity, than the consistent omissions of a government frozen in the ice of its own indifference. -FDR, 1936

      by James Allen on Tue Nov 26, 2013 at 12:23:14 AM PST

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