Kaiser Health News: Increase in health insurance exchange enrollment mirrors some state programs, including Massachusetts

Phil Galewitz of Kaiser Health News reports that enrollment increases for federal exchanges  mirror “activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, capturedoubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.

“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael March and, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.

Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.

About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.

Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.

All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.

More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.

In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.

Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.

Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.

In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.

Conservatives warn it’s still too early for Obamacare supporters to celebrate.

“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.

Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.

“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”

Globe, Times on some of the the 3 million newly insured

globe-ssWith the uproar about computer glitches with the new health insurance exchanges, you would never know that millions of people were about the get coverage at a reasonable cost.

Today, The Boston Globe’s  Chelsea Conaboy offers stories on five of them. The story is  behind the pay wall. You can look at the pictures, go out and buy the Sunday paper or get a digital subscription. 

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

Or, check out this story from last week’s New York Times about how the law is having an immediate impact on people who suddenly qualify for Medicaid.

WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.

Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.

So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.

 

Who says young people don’t care about health insurance? #aca #obamacare

imagesOver at BU’s Daily Free Press — the independent campus paper — poli-sci/math major Sara Ryan tries signing up for insurance at healtcare.gov.  She too hit some roadblocks,  but had this to say:

So, should you care about my little experiment? It demonstrates that the website has potential. It’s not incredibly difficult to use 

when it’s operating properly. Of course the last part of that sentence seems to be giving the administration a bit of a hassle right now, but that doesn’t mean we should abandon the principle of the program.

I’m not saying that the Obama administration hasn’t fallen down on the job, because it very much has. According to a Reuters r

eport released Tuesday, a consulting firm let the administration know about certain issues as early as six months prior to the website’s launch. The administration made an enormous mistake in this regard. Obamacare will either be the crowning jewel or the fatal blunder for Obama, so to overlook or ignore these extensive issues is a risky gamble.

If they cannot fix the issues quickly, Obamacare will be DOA (haha, medical joke).

This program has the power to be wildly successful and insure millions of Americans.

Data, medicine, insurance reform and a round up of health policy blogs

1950s era analog computer
1950s-era analog computer

Health data is a theme of this edition of the Health Wonk Review because it is also the focus of the current Knight News Challenge. That contest rewards media innovation with seed money. They use the word “challenge” literally, asking for innovative responses to question: How can we harness data and information for the health of communities?

Our definitions of “health data” and “news” are broad, and range from projects in traditional newsrooms to consumer-facing technology to crunching big datasets. We’re hoping to find and accelerate projects that use data and public information in innovative ways to create strong information flows about health in our communities.

Check it out. Health care produces big, big data. Health information technology, surveillance data, electronic medical records, clinical trials, NIH databases.  Payers and providers produce endless streams of data for millions of people.  On the other end of the scale, the quantified selfers keep blood pressure, diet and exercise logs.

US-MapWhat would happen if you had to turn those logs over to your insurer? David E. Williams of the Health Business Blog notes that car insurer Progressive gathers lots of info on drivers through its Snapshot device. Then, the company lowers premiums in return for lower risk behavior. He asks “What will it look like when the same approach is applied to health insurance?” Risk assessment also serves as the basis for public policies and day-to-day individual behaviors. At Workers’ Comp Insider, Julie Ferguson looks at real versus perceived risks in her post about how “Your Daily Shower Can Kill You.”

Former VA research chief Joel Kupersmith writes on the Health Affairs blog about data, privacy and genomic research.  He considers the  challenge of balancing the benefits of widely shared genomic data with privacy concerns, in particular the re-identification of individuals.

The Healthcare Economist reports data about long-term care trends and investigates the systems in Austria, England, France, Germany and the Netherlands. For many disabled elderly individuals, a nursing home is their only option.  How do European countries take care of the long-term disabled?

CDC data suggest 200,000 Americans are needlessly dying every year from preventable heart disease, but over the last decade, that number – on an unadjusted basis – has decreased by about 12%, or that there are 28,000 fewer deaths, notes Jaan Sidorov of the Disease Management Care Blog: That being said, while the greatest jumps in saved lives are among persons of color, they still are the most vulnerable to avoidable cardiovascular conditions.  If we are really going to use this information, that insight is what tells us where the resources are really needed

                  Black men are at highest risk of dying early from heart disease and stroke
Black men are at highest risk of dying early from heart disease and stroke

Moving out of the data world, Health Care Renewal asks:  What Sorts of People are “Most Influential in Healthcare?” The post notes that Modern Healthcare answers this question with with a list of managers from hospital systems and  health care corporations — and very few doctors. The list did include the CEOs of Sutter Health and Advocate Health, two companies known for significant mismanagement of health care technology, HCR notes.

Some of the most influential  run corporations that have been cited time and again for ethical/ legal problems, and some of the corporations have paid hundreds of millions of dollars in legal settlements and sometimes pleaded guilty to criminal charges.  The list included not a single doctor in private practice, very few people with backgrounds in medical or health care academics, and a tiny number who have suggested reforms of the sort we discuss on Health Care Renewal. 

dials

On to the ACA

Anthony Wright of the Health Access Blog notes that the first ads from California’s  insurance  exchange  provide some basic information to Californians, but also “introduce some signposts and open some doors.” Health Insurance Resource Center Blog offers Maggie Mahar, who says that some pundits are claiming that young Americans will have little interest in purchasing health insurance through the ACA’s exchanges. In reality, the subsidies available to about nine million of those young people should actually make the exchanges’ comprehensive coverage attractive to them.

Joe Paduda’s post  discusses the origins of the “idea” of the mandate while positing that repealing the law “won’t do anything to solve the underlying issues inherent in today’s health insurance system.” A post on health and higher education comes in from John Goodman’and the Health Policy Blog. In it, he compares the way the two are funded.

InsureBlog’s Bob Vineyard enthusiastically reports on a new health insurance start-up that leans heavily on transparency and features free telemedicine and generic drugs. Find out why he gets to post a picture of the Oscar Mayer Wienermobile.

Colorado Health Insurance Insider says that the idea of the ACA “ was to make sure that large employers offered good qualify coverage in order to avoid paying a fine, it appears that some large employers will opt for the fine instead.”

Finally:

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Dats graphic by Michael Schieben