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Cross-posted at ACASignups.net
I've written about this in passing before, but after repeated requests about the subject, I've decided to devote a full blog entry about the serious problems inherent in the CMS's state-level Private QHP projection numbers.

As far as I can tell, while the national "7 million" private enrollment projection figure issued by the CBO was based on solid analysis of the demographic situation at the time, the state-level CMS projection breakdown is, in many cases, based on little more than educated guesswork.

As the CMS put it in their own report: 

 In general, the enrollment targets provided by state- based Marketplaces are more ambitious than the initial Department enrollment targets for those specific states. As a result, using the publicly available SBM targets without adjusting other states would have raised the projected number of 2014 Marketplace enrollees by 1.4 million; therefore, the Marketplace ramp-up rates for other states were revised downward accordingly to maintain the 7 million total. 

Basically, they lowered the estimates for states that didn't provide their own estimates in order to shoehorn all the state target numbers into that overall 7 million target. As a result, you get some pretty strange projections: Connecticut's CMS target was only 33,000, while Kentucky, whose uninsured population is only 1.8x as high, has a target 6.6x higher. Vermont and Utah, with a 4.5x difference in population and wildly different socioeconomic conditions, have IDENTICAL projection numbers, not just for the final tally but for every individual month in between.

10 states did issue their own projection numbers: CA, DC, KY, MD, MA, NV, NM, OR, VT and WA. The projections for the other 41 states are basically just numbers that the CMS sliced up to "match" the 7 million total...and as far as I can tell, the CBO didn't utilize the projections by those 10 states when they came up with the original 7M number anyway.

in other words, while the CMS projection numbers may have been baked into the public consciousness to the point that they're touting their success when hitting them, I also wouldn't get too concerned about states which don't meet these "targets" either, since the target numbers don't necessarily bear a whole lot of connection to the population or demographics of that particular state anyway.

So, if using the CMS projections (which allow Connecticut to declare "100% achieved!" when they only reached 33,000 enrollees out of 359,000 uninsured residents, while Kentucky is "stuck" at only 19% of their "goal" of 220K enrollees even though their total uninsured is only 83% higher) doesn't make sense, what does?

Well, commentor Brutus56 at Daily Kos has long been pointing out that 7.066 million is roughly 14% of the 50 million people uninsured nationally. If you then divide that 7 million proportionally by each state's uninsured population, you get a much more reasonable indicator of how to measure success on a state-by-state basis.

For instance: Kentucky has around 657,000 uninsured. 14% of this is 91,980 people, a much more reasonable goal than expecting KY to enroll a full 1/3 of their uninsured population in the first year while a state like Connecticut is only expected to enroll 10% of theirs.

Using this measure, Connecticut is still doing very well (87% of their 14% goal), but Kentucky is doing much better (about 46% of theirs, vs. only 19% of the CMS number).

Now, don't get me wrong; the projections reached by the 10 states which did issue their own goals don't always match this '14%" figure, and I'm sure there are legitimate state-specific demographic reasons for that. However, when you only have that reasoning for 10 out of 51 states (w/DC), the "14%" method sure sounds a lot more rational overall.

Therefore, I've added an extra column to the Private QHP spreadsheet representing this "Proportional % of 7M Total" yardstick. Unfortunately, you'll have to scroll horizontally on the spreadsheet to see it, since I've run out of space.

There's also an additional column by request: The official HHS Report through 12/28; this is only listed so you can compare updates since 12/28 for various states.

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In other ACA Signups news, there's some updates out of both Rhode Island and Washington State; visit the site for more details on both.

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Comment Preferences

  •  WV newspaper fixed article (2+ / 0-)
    Recommended by:
    Brainwrap, Larsstephens

    sometime after your post, fyi.

    Iron sharpens Iron. Normal is a dryer setting. STOP illegal immigration NOW! -- Make it LEGAL. If Corporations are People--Let's draft them.

    by benamery21 on Tue Jan 28, 2014 at 01:04:40 PM PST

  •  Great work as always (1+ / 0-)
    Recommended by:
    Meteor Blades

    Do you have any links to how many people have ACA exchange private insurance in effect (enrolled and premiums paid)?  Any data on what share of these were not previously covered by private insurance?

    I am trying to estimate the number of people who have been added as customers to private insurance.

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Tue Jan 28, 2014 at 01:29:11 PM PST

    •  Thanks for the kudos, but... (0+ / 0-)

      ...the answer to your first question is kind of the main point of the website: http://acasignups.net/...

      The 3 million total does NOT include unpaid policies from 4 states, but I have no idea what the breakdown is for the other 46 (+DC).

      And no, I still don't know how many were previously covered or not. Estimates have ranged from 11% to 46% depending on the source, but even those aren't in any way comprehensive. I would imagine around half, if I had to guess.

  •  Brainwrap, can you answer a question..... (1+ / 0-)
    Recommended by:
    Vatexia

    During the initial rollout of the ACA exchange, we know enrollment was poor through the exchanges, so many people might have signed up directly, not through the exchange(s).

    Can we ass-u-me that these folks are not being counted in your totals?

    Follow-up if, "Yes." - what is this missing (approx.) amount?

    •  Look at the spreadsheet: (1+ / 0-)
      Recommended by:
      petral

      http://acasignups.net/...

      See the columns in the middle that are white but almost entirely blank? Those are the "Private Off-Exchange Plans", ie, direct via insurance companies.

      So far I only have 1 entry. This is sort of the "holy grail" of data. The problem is that the only way to get it is to contact individual insurance companies and politely ask. They aren't legally required to give that info out since it's a purely private transaction and there aren't any tax subsidies involved (with a few exceptions).

      ArcticStones and I hope to get to this, but life and stuff keeps getting in the way...

  •  States Appear Highly Variable (1+ / 0-)
    Recommended by:
    Brainwrap

    It is clear that the states appear highly variable compared to the 14% criterion with states running their own exchanges generally, but not always, doing a lot better.  I ran a regional analysis couple of weeks ago and found that the Northeast was doing extremely well while the Southeast was somewhat suppressed and the South Central region (Texas, Oklahoma, Arkansas, and Louisiana) was very suppressed.  I quick glance suggests that this breakdown still seems to be holding although I would have to carefully plot up all the data to be sure.

    You also might try plotting up the state names again in the far right column to help with reviewing any data shown on the far right.

  •  Breakdown by Census Region and Division (1+ / 0-)
    Recommended by:
    ybruti

    The breakdown for the percentage of the 14% target obtained for census region and division obtained from the map given in the link below

    http://en.wikipedia.org/...

    and breaking out Washington DC from the South Atlantic region since our capital is a distinctly different region from the South Atlantic and breaking out Alaska and Hawaii from the Pacific Coast gives

    New England:          110.88%
    Middle Atlantic:         38.94%
    East North Central:    31.76%
    South Atlantic:         25.41%
    East South Central:   28.70%
    West South Central:  15.22%
    Midwest:                 29.00%
    West:                     34.36%
    Pacific Coast:           73.28%

    Most regional divisions average between 25 to 35%.  New England and the Pacific Coast report very high numbers and the Middle Atlantic reports fairly high numbers with the numbers pulled substantially up by both New York and Pennsylvania but pulled down substantially by New Jersey.  The West South Central, the region containing the proud state of Texas, comes in at only 15.22%.  

    Clearly states doing their own exchanges tend to be doing a lot better and more progressive states and regions tend to do much better.  The highly regressive West South Central Region does very poorly.  

  •  R.I.P., GOP. (1+ / 0-)
    Recommended by:
    petral

    3,000,000 26-and-under insured.

    9,000,000 ACA and Medicaid insured.

    12,000,000.

    What ??? At least 5,000,000 GOP voters, soon to be way less enthusiastic maybe-GOP voters ???

    At worst the Dems get a million, maybe a couple million poached GOP voters.

    Gotta love it.

    "I hesitate to agree with Ted Nugent...."

    by waterstreet2013 on Tue Jan 28, 2014 at 07:14:33 PM PST

  •  Maybe they need to expand provider networks (0+ / 0-)

    One possible obstacle to enrollments is the extremely narrow provider network. We have only two insurance agencies on the exchange in my state. Anthem's Silver plan makes our local hospital and all but four of our local physicians (obvious newbies who are not affiliated with the hospital) out of network.

    This is a problem around the state. The capital city has found that the plans available on the exchange have likewise made most of their hospitals and physicians out of network. So it's not that I'm out in the boonies (we actually are big enough to be considered a small city). Our local hospital serves a rather large region beyond the city limits.

    I don't have a car and we no longer have intercity busses. I would have to pay someone for probably a full day to drive me to the closest in-network hospital (at least a 1.5 hour drive one way) and back if I needed anything other than emergency care at a hospital.

    Anthem and other insurance companies are justifying all this by the need for reducing costs for us peons on the exchange. But the government and I are putting $816 per month into Anthem's pocket for a Silver plan, which is as obscene a premium as I've ever seen pre-ACA when I had to drop insurance (couldn't afford to pay them 53% of my income). So the Feds and I are paying the usual inflated premiums for essentially just emergency care for me. I was willing to sign up anyway, because otherwise one trip to the ER would bankrupt me or put me in crushing debt. But I can see that others who expect to need routine care (as was intended by the ACA) might wonder if it was worth it to enroll in a plan that doesn't really give them access to anything but emergency care.

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