November enrollment pace

The LA Times has some really good news on Obamacare enrollment pace:

A number of states that use their own systems, including California, are on track to hit enrollment targets for 2014 because of a sharp increase in November, according to state officials….
California — which enrolled about 31,000 people in health plans last month — nearly doubled that in the first two weeks of this month…
Connecticut saw growing enrollment in November: 3,201 people signed up for health plans in the first two weeks of this month, nearing the 4,371 total for all of October….

As I had updated in my post concerning the October enrollment pace, Pennsylvania (a federal exchange state) seems to be seeing a quadrupling of pace in the first two weeks of November compared to October.  This is evidence that the kinks are getting worked out in the process and people are still willing to look for a good deal on the Exchanges.

Baby, I want you in my network

Hill  Dweller asked a good question about networks yesterday:

Does the doctor decide which policies he/she will accept?

Yes and no.

Providers in most plans that offer multiple lines of business (Medicare, Medicaid, CHIP, Exchange, PPO, HMO etc) have a two stage process of being offered in a network.  An insurance company that only offers one product in a single line of business consolidates the two steps into a single one. 

Read more

Network Shock as a minimal issue

Kevin Drum raises a good question this weekend on different challenges (actual and political) that Obamacare faces in the next six to nine months:

network shock might actually be a bigger issue. It’s one thing to get a rate increase. That’s bad, but it’s often tolerable, and everyone in the individual market is pretty used to big annual premium increases anyway. But a lot of plans on the exchange restrict doctor networks fairly severely, and this could be a big problem for people who are loyal to their current physicians.

In most markets where there are multiple insurers offering plans, the insurers aren’t offering just one plan per metal band.

Mayhew Insurance is not just offering Mayhew Catastrophic, Bronze, Silver, Gold.  Mayhew Insurance is offering Mayhew Silver Basic, Mayhew Silver Premium, Mayhew Silver Enhanced Premium, Mayhew Silver Superb.  The same is with the local Blue Cross affiliate as well as the major national players.

Each of those plans are Silver plans (70% actuarial value).  Mayhew Silver Basic is the cheapest, and Mayhew Silver Superby is the most expensive.  There are probably a few significant differences that drive the prices.  The first is the higher cost plans probably have a more expansive and expensive prescription drug formulary.  The second is the network is wider. 

In most markets where there is a decent number of companies offering plans, Dr. X will be available in at least a couple of plans on the market at a given metal level. It is just unlikely that Dr. X will be available in all of the low price (for the metal band) plans.

Meet the Brady Family

I’ve been in correspondance with a commenter for the past few weeks about a situation where someone under Obamacare may be made worse off or at least no better off and I want to highlight the story as it is intriguing, real and verifiable facts.  I’m changing some names and fudging some details to protect her family’s identity but I have high confidence in the validity of the situation. Read more

Massachusetts Pace vs US Enrollment pace

Just a quick note concerning Obamacare enrollment.  Compared to the comparable time point of the 2006 Massachusetts experience, Obamacare Exchange enrollment pace is matching Massachusetts’ enrollment pace  for private insurance during the Bay State’s 2006 open enrollment period.

At 16% into the open enrollment period, 2,089 Massachusetts citizens had signed up.  As a straight population adjustment (sum *48.75), that would translate into the national experience of roughly 102,000 people signing up.  106,000 people signed up via either the federal exchange or through state exchanges covering all but three Exchange jurisdictions according to the Washington Post.    Three state run Exchanges have not reported their numbers so we can assume a slightly higher number.

Being slightly less charitable if we apply an adjustment to the raw population total to account for the fact that Massachusetts had a much smaller uninsured pool, (8.4% in 2006 vs. 15.4% US nationally in 2013), expectations would have seen 186,000 Obamacare enrollments.

However there is another adjustment that would reduce 186,000 expected pace downwards.  The Massachusetts Medicaid expansion was only applicable to people up to 100% Federal Poverty Line.  For the states that are taking Medicaid enrollment, people who make between 133% and 138% are eligible, so the total US national pool eligible for the Exchanges is smaller than the 1.83 factor adjustment implies.

Even with a crappy three weeks of website work, and pointed political opposition, the pace is either concurrent with the nearest relevant example, or slightly behind depending on how you want to model expected pace.  That ain’t bad. (As a side note, I am curious as to why HHS was so optimistic about first month enrollment)

Additionally, Obamacare, even with the Supreme Court and the reactionary assholes neutering Medicaid expansion in half the country is signing people up for Medicaid expansion at a rate that surpasses Massachusetts’ experience in 2006.

 Update 1: via a commenter in the Pittsburgh region, I was directed to this story concerning Pennsylvania enrollment.

Despite the glitches, Highmark’s health plans appeared to be an early favorite among people who were able to complete the shopping process. The company picked up 827 individuals through Nov. 2, or 37 percent of enrollees in the state.

That number doubled to 1,665 by Nov. 12, a trend Ash called “encouraging.”

Pennsylvania is a Federal Exchange state.  Assuming Highmark is representative, the key is the November pace is at least 3x faster than the October pace, and that is without any time pressure to enroll yet for January 1st coverage.