7 Million will be reached (reprise)

On January 24th, I wrote the following:

This data strongly implies one million people enrolled for the February 1st coverage start date during the month of January.  That is a minimal pressure deadline as someone who was healthy enough to not get in on the December rush is probably healthy enough to not really need to get in on February. Procrastination is only so much fun.  I am projecting the same number of people will sign up for the March 1, 2014 coverage start date by February 15th.  That pushes the number to roughly 4 million private policies. 

The Massachusetts experience was that the greatest wave of enrollment was right before the hardest deadline when actual money was on the line.  We know there was a big flurry of older and probably sicker people signing up in December.  The young are entering the pools number, so getting an enrollment wave as large or larger than December for the March 15th deadline is highly probable.  And if that is the case 6.5 to 7 million people will be enrolled by April 1, 2014.  And then there will be the normal enrollment churn as people have different qualifying events that will put them on and take them off Exchange. 

And then CBO lowered their estimate to 6 million on Exchange enrollments for the 2014 open enrollment period.

And then Avalere Consulting projected on March 12th

New Avalere analysis finds that exchange enrollment is on track to reach 5.4 million by the end of March when open enrollment is set to end. That number falls short of current Congressional Budget Office (CBO) estimates that six million people will enroll in exchanges in 2014.

Charles Gbaba at ACASignups.net has been continually revising his model upwards. He started at 6 million and is now up to at least 6.5 million for March 31st.

I understand Charle’s model. It is a fairly simple model that has trouble dealing with spikes. I’m curious as to what the hell Avalere was doing with their model if it was anything more sophisticated than taking Medicare Part D roll-out monthly percentages and applying it against Exchange percentages and populations. My model was an implicit model that health insurance for younger and healthier people is a very nice to have but not need to have now good. Procrastination is fun, and the Massachusetts’ experience showed a massive spike at the end of the enrollment period as the quasi-optional early coverage people got in before they had to pay something for “nothing”, they would rather pay something for something.

I sometimes know what I’m talking about.

35 replies
  1. 1
    c u n d gulag says:

    I wish everyone would also include, maybe as a separate category, the people who received Medicaid after the ACA roll-out – in the states that allowed it.

    And then, another category that shows the number of people who would be eligible for Medicaid, if it weren’t for their state’s sociopathic Governors and state legislatures.

  2. 2
    Mary G says:

    Yes, you do!

    I find it intriguing how many people on the other side, like the “unskewed polls” guy, and Dick “it’s going to be a landslide victory for Mitt Romney” Morris, seem to think that if you say it loudly enough, wishing will make it so.
    Wonder if the consulting firm wil lose any clients? I suspect not,

    Love your posts, Richard.

  3. 3
    Violet says:

    I caught a minute of whatever the morning show is on CBS. Their graphics package said 7 million was the goal the total was going to be 6.5 million and then whoever the male host is asked whoever the guest was if that meant it was a failure.

    Your liberal media at work.

  4. 4
    bemused says:

    @c u n d gulag:

    I’d like to see that too.

  5. 5
    EconWatcher says:

    Richard, maybe I missed it, but have you addressed this scary-sounding lawsuit, claiming that ACA is poorly worded and does not allow for subsidies for those not on state exchanges? It sounds like it’s going to be decided initially by a very bad panel and might be headed for the Supremes. Whether Roberts would carry the water a second time would be, I think, very much in question.

    Many thanks.

  6. 6
    bemused says:

    @Violet:

    Any excuse to use the word failure. They must get paid more for each time they say it.

  7. 7
    cckids says:

    Procrastination isn’t necessarily fun, but it is easy. That’s why there are deadlines for most things in life.

  8. 8
    Mnemosyne says:

    @EconWatcher:

    Cole did an initial post on it yesterday. Take a look at the comedy that ensued when the jackass who filed the lawsuit showed up to defend himself (no, really!)

    FWIW, the lawyers in the thread seemed to think the case should have been thrown out since it depends heavily on pulling a single section out of context.

  9. 9
    Lee says:

    I occassionally know what I’m talking about.

    That is why you’ll never really fit in here ;)

  10. 10
    Lee says:

    @Mnemosyne:

    Have you read the CV of that guy?

    It reads like someone who is a home schooled acolyte of Koch’s wet dream. I’d put money down that his parents are ‘quiver full’ adherents.

  11. 11
    Richard Mayhew says:

    @EconWatcher: Not a lawyer, but most lawyers think the argument fails 1st year principles of structural analysis. if this was just a legal question, it should be laughed out of court. But it is a political question and our judiciary has narrow majorities of nihilists or sociopaths on the Supreme Court and several appeals courts to take a whack at it.

    Nicholas Bagley (a law prof at UMich) at the Incidental Economist has a good overview.

    But, judges are pretty uncomfortable disregarding clear statutory language just because they suspect that Congress screwed up. Most judges would prefer to stick with the statutory text, even if it’s dumb, because it’s often so hard to tell what Congress “really” had in mind. That’s why it’s not enough for the federal government to show that Congress didn’t mean what it seems to have said. To prevail, the government has to show that Congress didn’t actually say it in the first place.

    I think the government can make that showing. To begin with, a subtle textual argument favors the government’s position. Look back at section 1321. When a state fails to set up the “required Exchange,” section 1321 instructs the Secretary of HHS to establish “such Exchange.” What could “such” exchange possibly refer to except the exchange “required” under 1311? As my colleague Sam Bagenstos pointed out more than a year ago, this language creates a strong inference that the Secretary “stands in the shoes” of state officials when she sets up an exchange. Although she acts pursuant to authority under 1321, she’s still establishing a 1311 exchange.

    This argument may not clinch the case for the government. After all, the tax-credit calculation links subsidies not to 1311 exchanges in general, but to those 1311 exchanges “established by the State.” But there’s more. Consider the statutory provision requiring every exchange—including those established under 1321—to provide information to Treasury about “[t]he aggregate amount” of advance tax credits that each individual receives when purchasing a plan on the exchange. What possible purpose would this provision serve if no one on a federal exchange could get a tax credit?

    Better still, the ACA allows only “qualified individual[s]” to buy health plans on the exchanges. But a qualified individual is defined as someone “who resides in the State that established the exchange.” Does that mean that no one can purchase a plan in those states that have declined to establish their own exchanges? That’d be crazy. The more natural inference is that, in a refusal state, the federal government acts on the state’s behalf when it sets up an exchange.

  12. 12
    Cervantes says:

    @Richard Mayhew: Blue!

    Also: “occasionally.”

    But never mind all that. Thanks yet again for the analysis and commentary.

  13. 13
    LanceThruster says:

    My co-worker is trying to sign up her BF online right now….she’s #1004 in the cue.

  14. 14
    hoodie says:

    @Richard Mayhew: Under the ACA, assuming pre-emption applies (I think that has been litigated, right?), the state has no power to prevent an exchange from being established, i.e., the feds allow the states to do it themselves (according to federal guidelines) to give them “flexibility,” but there is no “opt out” option for states; whatever exchange is created, the state “establishes” it by either doing it themselves or having the feds do it by default.

  15. 15
    boatboy_srq says:

    One wonders whether Avalere was under any pressure to underplay the numbers, though 5.4 million is hardly the “nobody” the GOTea wished would sign up.

    @Mary G: This is DC we’re talking about. Somebody has to get indicted for election-rigging, running a prostitution/drug ring, or consorting witl unGawdly Librul IslamoFascoSoshulists to lose clients in this town. And there are plenty waiting to take Avalere’s place. For a city supposedly a magnet for the Best And Brightest, DC has far more than its share of really, really stupid people.

  16. 16
    Tommy says:

    I was so worried we would not hit the estimated numbers. I am so glad I was wrong. I keep saying this here, it is working. Now if we could just get Congress to make some minor tweaks here or there, many of them you have talked about Richard, we could have something pretty good going on.

  17. 17
    Tommy says:

    I have a client that does a lot of work related to the ACA. I get the Kaiser daily emails so I appear to have some clue what is going on when I talk with said client. The tone of the emails and their blog posts are telling. A few months ago they felt like the sky was falling. Now they seem to be almost giddy the law is working, well like it is supposed to work.

  18. 18
    Another Holocene Human says:

    @Mary G: They scream so much about the unpaid premiums that Charles Gaba had to create an entire tab just to deal with those claims.

    Shorter: most of the unpaid premiums are due yet; the rest are low percentages.

  19. 19
    Another Holocene Human says:

    @Tommy: There’s a reason the law had this 6 month roll out period. Plan for Murphy. He’s coming. Guess what, he showed up right away.

    I was really dismayed to see the immediate and total freakout by some Dem “leaders” in October. Obama reacted appropriately to solve the issues … some of our Congress critturs, not so much.

  20. 20
    Tommy says:

    @Another Holocene Human: I just wonder what the numbers would be if a large percentage of the talking heads and organizations that are against the law would have just sat on their hands and not actively fought the law.

    Myself and many others have said this over and over again. This is the Republicans worse fear. The ACA is working. And it will continue to work. And now almost 7M have care, there is NO way they can roll it back.

    If they tried to take away my care, that I got through the Federal Exchange, I would be out in the streets protesting.

  21. 21
    Hill Dweller says:

    @Violet:

    I caught a minute of whatever the morning show is on CBS. Their graphics package said 7 million was the goal the total was going to be 6.5 million and then whoever the male host is asked whoever the guest was if that meant it was a failure.

    Your liberal media at work.

    The Twitter machine is telling me this is the line all the media is using. They call a CBO projection(7 million; which was revised to 6 million) the Obama admin’s projection, and the ACA a failure for not reaching 7 million. They are, and have been, heavily invested in the failure talking point.

    Although some of the Village is just ignoring passing 6 million enrollments.

  22. 22
    Tommy says:

    @Hill Dweller: I got rid of cable a few weeks ago. One of the main reasons is I am like a moth to a light as it comes to watching news programs. And honestly I just couldn’t handle it anymore. Even MSNBC made me want to throw things.

    Look I am not in a habit of making excuses for Obama or our government in general. They might miss their numbers a little in the end. But my god, I am stunned (and happy) they are getting as close as they have. The web site roll out was a cluster fuck to say the least.

    24/7 campaigns against the law. More misinformation then just about anything I an recall. And even with all of that, they pretty much did what they said they would do.

    I find that both amazing and wonderful.

  23. 23
    MazeDancer says:

    The “Massachusetts Model” is experiencing some ACA fall-out.

    Because of ACA, everyone in MA had to sign up again by Monday. Open enrollment in MA is in July and August. The policies that many MA residents have on auto-pay and don’t think about much are all going to expire on April 1, not the usual re-up date. And not everyone will have realized this.

    Many letters, emails, and robo-calls have gone out saying: Sign-up! Sign-up! Sign-up! And a different kind of bill – not the regular one – for people who have paper bills, also showed up. You had to send it in with a check – no online payments – to sign-up for a policy that the tech beseiged MA system has determined was “most like” your current one. Except you have to pay more for some things now. A lot more in some cases – notably ER and Cat Scans – Which no one likes, of course.

    No question all kinds of healthy people in MA who thought Obamacare wasn’t about them because they had long-standing Romneycare do not know they’re about to lose coverage. If you’re healthy, were on auto pay, you likely never open any mail because it all looks like junk mail anyway. You may have thought your carrier was sending you some “get healthy” malarky you don’t want marked “important plan information”, which they all do.

    So don’t know what MA will have happen. Or if any new sign-ups – people do move to MA – will count as ACA sign-ups or not.

    I met a person last week who had just moved to MA from NY and had no idea there was either an ACA or RomneyCare mandate. Or that they could get great insurance for very little money because they didn’t have high income. They had made an appointment to discuss insurance at the local hospital – hospitals are helping with sign-ups. But had no idea that insurance was required by law. Always surprised by people not knowing things that could help them. Especially when it’s not in a red state where harm is the intention of information being withheld.

  24. 24
    Tommy says:

    @MazeDancer:

    I met a person last week who had just moved to MA from NY and had no idea there was either an ACA or RomneyCare mandate. Or that they could get great insurance for very little money because they have high income. They had made an appointment to discuss insurance at the local hospital – hospitals are helping with sign-ups. But had no idea that insurance was required by law. Always surprised by people not knowing things that could help them. Especially when it’s not in a red state where harm is the intention of information being withheld.

    I chat with the guy that works the night shift at my local 7/11 type store. Makes like $8/hour. No healthcare. Almost 50. For weeks and weeks I have been telling him about the ACA. He didn’t know anything about it. Didn’t know it was the law and required. He has serious back problems and I told him it didn’t matter. He could still get coverage.

    I told him that he could get aid he was blown away. In fact I really think he thought I was making it up. But alas, he never went and signed up even though many times I’ve written down the URL on my business card and gave it to him. It makes me very, very sad!

  25. 25
    Rob in CT says:

    @Tommy:

    Christ.

  26. 26
    ruemara says:

    @Tommy: Can’t save stupid. Sorry, but there’s a limit to my tolerance for serfs just searching for a lord.

  27. 27
    Tommy says:

    @Rob in CT: Yeah. This guy is literally the person this law was written for. He isn’t dumb in the least, maybe just not informed. Heck he is kind of non-political. Not a raging far right Republican or anything. I know the guy pretty well (we went to high school together) and I was almost begging him to just visit the site. He had told me he makes up about minimum wage, so I brought up the aid he could get. Just go to the site. Heck I said call me if you have questions, I already went through the process.

    I am not that emotional of a guy, but I almost broke down talking to him. I wanted to almost scream at him, but alas I’ve found yelling or talking down to somebody rarely has a good end result.

  28. 28
    Rob in CT says:

    I’m happy that my brother-in-law has parents who were all over getting him signed up (mostly his dad, who is more tech-savvy than his mom). He’s not well-off, he’s got a pre-existing condition, and, well… I could totally see him just not dealing with it if not for family pushing. It helps that my FiL is an unapologetic Democrat.

  29. 29
    Tommy says:

    @Rob in CT: Good for them.

  30. 30
    rikyrah says:

    @c u n d gulag:

    I wish everyone would also include, maybe as a separate category, the people who received Medicaid after the ACA roll-out – in the states that allowed it.

    I also wish they’d make a note in every report

    THE FIVE MILLION BEING DENIED HEALTHCARE BECAUSE THEY LIVE IN STATES WITH GOP GOVERNORS.

  31. 31
    aimai says:

    @Tommy: Bring a laptop into the 7/11 and sign him up while he’s on break.

  32. 32
    Comrade Mary says:

    I just found out a family friend in Colorado was in a bad accident. Don’t know what insurance he carries as a self-employed person or what costs he’s accrued already for the current hospital stay. Does he stand a chance of enrolling before the deadline and getting coverage for the ongoing care he’ll need?

  33. 33
    Betsy says:

    @Tommy: some people, when you care more than they seem to, that’s part of what keeps them from acting on their own behaves. And when you let up from that, not long after, they make their move.

    Maybe. It’s just a thing I’ve noticed.

    As long as you hold on, they let go; when you let go, that’s when they have to hold on.

  34. 34
    Betsy says:

    @Comrade Mary: If he says in good faith he was trying to enroll by march. 31, he will get the grace period after that, i think.

  35. 35
    Comrade Mary says:

    Thanks! It turns out that he’s already covered, so that’s one less thing to worry about.

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