Boundless

[rubato]

The lengths to which you will go to avoid admitting that Obamacare has been a huge success is interesting. In the way the behavior of tapeworms, ticks and neoplasms are interesting. But I am the son of a pathologist and that is really the only reason I keep coming back here. The many varieties of emotional and mental cancers you exhibit are illustrative.



yrs,
rubato

[rubato]

the "paid unpaid" bullshit question" (answered more than a year ago, for people who actually cared as opposed to people asking bullshit questions)


http://acasignups.net/14/05/27/ok-repub ... -have-paid

Home » Blogs » Charles Gaba's blog » OK, Republicans: NOW you can ask ALL of the insurance companies "How many have PAID???"

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OK, Republicans: NOW you can ask ALL of the insurance companies "How many have PAID???"
Posted on Tue, 05/27/2014 - 1:54pm

Way back on March 21st (wow, that seems like forever ago, doesn't it?), I posted the following towards the end of "The Paid/Unpaid Brouhaha":

So, I'll say this here and now:

Whatever percentage of total exchange-based QHP enrollments still haven't been paid by the policyholder as of May 31st should indeed be subtracted from the official HHS total number, assuming that those non-payments are due to either a) the policyholder bailing/refusing to pay or b) the government-run exchange (not the insurance company's billing system) screwing up.

If the total number ends up being 6.2 million but the non-payments fitting these criteria are 7% as of May 31st, I'll gladly subtract 434,000 from the total. If the total number is 6.5M and the non-payments are 10% as of 5/15, I'll subtract 650,000, and so on.

Well, it's not quite May 31st, but I wanted to make sure to get this blog entry off my chest before June 1st, so I'm giving the Republican Party a 4-day lead time.

At this point, yes, it is quite reasonable to ask the question which Republicans, conservatives, Tea Party nutbags and so forth have been blathering about since the moment they realized that hey, a shitload of people actually are enrolling in QHPs via the assorted ACA healthcare exchanges after all! Namely: Out of the 8.02 million people who enrolled in exchange-based QHPs between 10/1/13 and 4/19/14 (wow! look at how tame my sample projections seemed a couple of months earlier!), just how many of them have actually completed the process by paying for their first month's premium?

Now, for some states that's easy. Washington and Massachusetts didn't even report their QHP enrollees to the HHS Dept. unless they were paid up, so that's 100% apiece.

In other states, it's easy to get a rough idea: Connecticut and Oregon "purged" several thousand of their earlier unpaid enrollees (those whose policies would have otherwise started in January, February or March), but still included those who weren't set to start until April or May.

In yet other states, such as Nevada, California, Minnesota, Rhode Island and Vermont, the exchange reported the total number (whether paid or not) to HHS, but also has given out either a hard paid number or a hard percentage...although some of these are quite out of date by now (California, in particular, reported 85% paid, but that was a month ago, on 4/27; presumably this number has shot up a few more percentage points since then).

Finally, there's a handful of states running on the federal exchange (Alabama, Maine, North Carolina, South Carolina, West Virginia and Wyoming) which have actual percent paid figures available due to either statements/interviews with the state insurance commissioners or, in a few cases where only one insurance company was operating on the exchange, by the insurance company itself releasing their paid enrollee data. However, again, some of these numbers are weeks or a month out of date by now.

Out of all of the states listed above, the paid percentages ranged anywhere from 71% - 100%, with an average of 88.4%. However, obviously the raw numbers varied greatly from state to state (85% of 1.4 million in California carries a lot more weight than 100% of 164K in Washington State). And, again, some of these percentages are as much as a month out of date (again, California in particular).

This is why after estimating the "paid/will pay" percentage at around 93% for over a month, I dropped back my overall estimate to an even 90% for states which haven't issued any hard numbers, which is where it currently stands (this means an 89% payment estimate nationally on my spreadsheet). However, again, that's just an estimate. The time has, indeed, come to try and lock down the actual number.

Now, back on April 30, the House Republicans, in a rather desperate and sloppy attempt to try and torpedo the Obama administration's "over 8 million enrolled!" news, issued a press release claiming that only 67% of those enrollees had paid their premiums as of April 15.

The response was swift and universal (even from plenty of right-wing sources): It was a big pile of crap, for several reasons. First of all, the cut-off date was April 15, even though almost 40% of the enrollee policies didn't even start until May 1st (ie, the first payment wasn't even due yet for anywhere from 2-4 weeks depending on the company). Secondly, they only surveyed 160 of the companies on the exchanges instead of all 300+ which participated, and didn't state which of those companies they surveyed (was it the big guys like Blue Cross and Aetna, or was it a bunch of little outfits? No one knows). Third, they actually sent out the survey letters back in mid-March (when less than 5 million of the 8M total had even enrolled, much less had their premiums due), and they didn't give any indication of what the actual "thru dates" of any of the responses were.

In other words, they sent the letter out on March 13. Presumably the companies sent them back anywhere between 3/14 - 4/30. However, we haven't a clue what date any of the company enrollment data was accurate through. Some companies might have given data through April 15...in which case they couldn't have sent their response until after that date. Others might have only given payment data as of the date of the request (3/13) or some point between then and 4/15. We don't know. The GOP report never gave out that information, making it beyond useless. Even the accompanying state-by-state breakdown only listed percentages, not hard numbers, nor did it list the companies or the thru dates. It was an utter joke.

SO, that brings us to today.

Since only a dozen states or so track or report their paid percentages, it does appear that the only way to get a comprehensive national answer to "How many have PAID???" is to indeed survey the insurance companies themselves, and yes, the end of May is a reasonable time to do so for those who enrolled through 4/15 (since any later enrollees wouldn't start their policies until June anyway).

HOWEVER, the ONLY way that such a survey would be meaningful would be if it met the following criteria:

1. Results from every company on all 16 exchanges covering all 50 states + DC has to be included. None of this half-the-companies-and-we-won't-say-which-ones nonsense.

2. The responses from the companies must state how many of their exchange QHP enrollees had paid their 1st month's premium as of the last week of May. None of this mid-April crap.

3. Give the actual NUMBER of enrollees paid/total, not just the percentages.

4. This is something I've addressed before, if not on my response to the earlier GOP survey--the companies should also answer how many of those non-payments are due to their own backlogged or screwed-up billing systems. I know plenty of people who either never had their payment recorded by the company, or who didn't even receive their bill for weeks or months after they enrolled in a QHP (including my own family). If someone "hasn't paid" because the insurance company lost the payment or never issued the invoice, that sure as hell can't be counted against either the enrollee or the Affordable Care Act!

5. Oh, I almost forgot: For the companies which operate in more than one state, ask them to break down their paid/unpaid enrollee numbers by state. This shouldn't be a problem; you guys claim to have done this with your ludicrious "67%" survey (you had to, since you list the alleged "percent paid" for every state for the 160 companies that you supposedly surveyed).

If and when the GOP House Energy and Commerce Committee agrees to these conditions, I'll be more than happy to take a look at their results, and will be the first to publish it. If a few companies refuse to participate, fine; I'll take a look at how many QHPs (and which states those missing QHPs are spread across), and if the missing data is minor and doesn't have an impact on the proportional/representative nature of the rest of it, fine. If everything checks out, I'll also be the first one to lop off however many unpaid enrollees there are, as stated at the top of this piece. My guess is that there will still be over 7 million fully-paid exchange QHPs left, but let's find out.

Otherwise, forget it. I'll stick with a simple 90% paid and call it a day until more data is forthcoming.

UPDATE 10/16/14: OK, California has now corrected their repeated "85%" rate from last spring and now says that their payment rate was actually more like 82%. Based on this, I've dropped the national estimate to 88% overall.

Charles Gaba's blog

[rubato]

The cancelled policies bullshit question answered long ago:

Home » Blogs » Charles Gaba's blog » One More Post re. the "OMG!! 5M CANCELLED!!" talking point


One More Post re. the "OMG!! 5M CANCELLED!!" talking point
Posted on Tue, 03/25/2014 - 12:07pm
Huffington Post, 03/05/14: Obama Administration Allowing 2-Year Extension For Canceled Health Care Plans
Hat Tip To:
danslabyrinth

Yesterday, in response to a partially-reasonable, partially-not critique, I added something to The Graph: A prominent note that no, neither the spreadsheet nor the graph take into account the estimated 4.8 million non-compliant policies which were cancelled last fall (my own included). I concluded my response with the following:

However, you've [the commentor] chosen to completely ignore the single largest missing piece of the puzzle here, which I've discussed many, many times: OFF-EXCHANGE QHP ENROLLMENTS.

I've documented nearly 560,000 of these, and that's from only 2 states (Washington and Wisconsin), plus a half-dozen other companies...out of the 200+ companies throughout the country. Even the WA and WI data for off-exchange enrollments are still out of date, since they only include through the end of January. My guess is that there are easily 4 million or more of these out there (in Washington State, as of the end of January there were about 84,000 exchange-based QHPs and 184,000 OFF-exchange QHPs since October...or 69% of the total! In Wisconsin the numbers were closer to what you'd expect: about 50,000 exchange-based and another 7,900 off-exchange, or around 14% of the total).

So, you're absolutely correct that both unpaid enrollments and previously insured enrollments probably should be subtracted from the total.

HOWEVER, if you're going to do so, you also have to ADD the total number of off-exchange enrollments, SHOP enrollments and Medicaid/CHIP enrollments first.

If you can provide me with the total number of outstanding off-exchange QHP enrollments from the remaining 47 states (Vermont, along with DC, requires all enrollments to be done via their exchanges), then I'll be happy to subtract the 4.8 million canceled policies (which includes my own) from the combined total, and will even subtract the Medicaid "bulk transfers" from the total as well, to get a true picture of people now covered by ACA-compliant policies or Medicaid who were previously uninsured.

My guess is that this would look like the following:

Current: 15.6 Million
ADD at least 4 million more off-exchange enrollments
SUBTRACT about 4.8 million canceled policies
SUBTRACT about 1.5 million "bulk Medicaid transfers"
SUBTRACT about 550 thousand unpaid enrollments

= NET gain of around 12.75 million newly-insured people.

However, until you (or someone) can provide that missing off-exchange QHP data, I'm not going to do so. Instead, I clearly and transparently list all of the possible numbers involved, including fully-linked sources and my rationale explanations for each.

Well, I forgot about one more thing: Not all of those 4.8 million "cancelled" policies were actually cancelled.

Another commentor, danslabyrinth, reminded me that thanks to President Obama and HHS announcing their "grandfathering" policy which extended the deadline for existing non-compliant plans by a year (and, more recently, by another two years, to as far out as the end of 2016), this 4.8 million figure has already been vastly reduced. By how much?

Well, according to this article about the additional 2-year extension, 1.5 million people never had their policies cancelled after all (or at least, they had them reinstated after originally being cancelled, anyway):

It's not clear how many people will actually be affected by the most closely watched provision of the new regulations, the two-year extension on policies that were previously subject to cancellation. The administration cites a congressional estimate of 1.5 million, counting individual plans and small business policies.

About half the states have allowed insurance companies to extend canceled policies for a year under the original White House reprieve. The policies usually provided less financial protection and narrower benefits than the coverage required under the law. Nonetheless, the skimpier insurance was acceptable to many consumers because it generally cost less.

"It's not likely to affect a large number of people but it certainly avoids difficult anecdotes about people having their policies canceled," said Larry Levitt of the nonpartisan Kaiser Family Foundation, an expert on insurance markets. "I think it's a small and dwindling number of people who are affected."

Now, that 1.5 million figure isn't given as solid...but then again, neither is the 5 million figure (I've heard the number claimed being as low as 4.7 million or as high as 6 million, but the 6M sources are, to put it mildly, a bit shakey to say the least).

UPDATE: Thanks to Tim Dickinson for pointing me towards the source of the "1.5 Million UNcancelled Policies" estimate...which is actually the same updated CBO report which lowered the exchange QHP estimate from 7M to 6M:

In November 2013, the Administration announced that state insurance commissioners could give health insurers the option of allowing individuals and small businesses to re-enroll in coverage that did not comply with certain market and benefit rules, such as the prohibition against adjusting premiums based on health status, that were scheduled to take effect in January 2014. CBO and JCT estimate that, as a result, roughly 11⁄2 million people in the individual and small-group markets will renew policies in 2014 that are not compliant with those rules. In addition, because subscribers may renew such coverage between January and October of 2014, CBO and JCT estimate that half a million people will continue to be enrolled in noncompliant policies in 2015.

So, here's what I'm willing to do: Since 5M is the most-cited figure, I'm willing to use that. And since 1.5 million appears to be the maximum number that have taken the administration up on their extension offer, I'm even willing to knock a couple hundred thousand off of that in the interests of being, shall we say, "conservative".

This means that we can subtract 1.3 million from 5 million, leaving 3.7 million people who genuinely had to replace their existing non-compliant health insurance policy with a fully-compliant one...via either the ACA Exchanges or off-exchange, directly through the insurance companies.

And as I explained yesterday, until I know how many of those 3.7 million replaced their policy off-exchange instead of on the exchanges, I have no way of knowing how many to "subtract" from the graph and therefore can't do so.

Charles Gaba's blog

yrs,
rubato

[rubato]

AAAAAand the 'previously insured' bullshit question also answered long ago. For people were actually interested in the subject and not just raising a crap question because they can't admit that the ACA is a very big success:

Home » Blogs » Charles Gaba's blog » VINDICATION: KFF Study: 57% of EXCHANGE QHPs were Previously Uninsured

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VINDICATION: KFF Study: 57% of EXCHANGE QHPs were Previously Uninsured
Posted on Thu, 06/19/2014 - 2:13pm
Kaiser Family Foundation, 06/19/14: Survey of Non-Group Health Insurance Enrollees
Hat Tip To:
Brian W.

Well slap my ass and call me Susan. Remember that pissing match between Avik Roy and I back in late March over the now-infamous "McKinsey Study" which claimed that only 27% of individual market enrollees since the start of Open Enrollment were "previously uninsured"?

McKinsey itself stated no less than seven times throughout that it included both ON- and OFF-exchange enrollees, and therefore was pretty much useless for trying to figure out how many of the exchange-based QHP enrollees were "previously uninsured", since there was no separation between the two in the data. For all anyone knew at the time, there could have been twice as many off-exchange QHPs as exchange-based ones, and even if it was a 50/50 split, for all anyone knew, it could have been 0% prev. uninsured OFF exchange and 54% prev. uninsured ON the exchange. Basically, it was meaningless for that purpose.

This didn't stop Roy from insisting that...

.@charles_gaba @UriManor Read your blog post. You overstate impact of off-exchange #Obamacare enrollment. See update: http://t.co/DZqoW1FWOT

— Avik Roy (@Avik) March 25, 2014

...I was "overstating the impact" of off-exchange enrollment.

He was certain that they accounted for only 20% of the total, based purely on the opinion of a single, unnamed "Wall Street analyst":

Fortunately, we don’t have to rely on personal suspicions. As my colleague Scott Gottlieb notes, we have actual data from insurers on this topic; most analyses estimate that approximately 20 percent of sign-ups to date have been off the Obamacare exchanges.

I tore this logic to shreds. As for my own estimate of the "previously uninsured" question, as I had stated 3 weeks earlier (on March 8th), in response to Megan McArdle's similarly flawed interpretation of the McKinsey study:

my personal suspicion is that the true "previously insured / uninsured" breakout nationally is closer to 50/50 overall.

There was also a lot of fuss and bother about the definition of "previously uninsured", since some respondants might have been confused; what if their prior policy had just been cancelled the day before? What if they were insured up until a few weeks earlier? Etc, etc.

Well, first of all, the whole "overstated off-exchange enrollment" claim has already been debunked; the actual number of off-exchange QHPs has been shown to be close to 8 million...roughly the same as the exchange-based QHP figure. So yes, we're looking at roughly an even split between on- and off-exchange enrollments, which is kind of handy.

As for the original question: The Kaiser Family Foundation has just issued the results of their own new, comprehensive, properly broken-out survey:

January 1, 2014 marked the beginning of several provisions of the Affordable Care Act (ACA) making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces (also known as “Exchanges”) and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family FoundationSurvey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage (non-group or otherwise).

Their methodology is thoroughly explained and seems to cover all the bases:

The survey was conducted by telephone from April 3 through May 11, 2014 among a nationally representative random sample of 742 adults who purchase their own insurance. Computer-assisted telephone interviews conducted by landline (333) and cell phone (409, including 219 who had no landline telephone) were carried out in English and Spanish by SSRS. Respondents were considered eligible for the survey if they met the following criteria:

Between the ages of 18-64
Currently covered by health insurance that they purchase themselves
Not covered by health insurance through an employer, COBRA, Medicare, Medicaid, or the U.S. military or VA
If purchase insurance from a college or university, the insurance covers health services received both within and outside the university setting
If a small business owner, the health insurance they purchase is only for themselves and/or their family, and does not cover non-related employees of their business
If purchase from a trade association, respondent pays the entire premium themselves
Respondent was able to answer a question about whether insurance was purchased directly from an insurance company, from a state or federal health insurance marketplace, or through a health insurance agent or broker (Q35 in questionnaire)



As for the results? Lo and behold:

The survey finds that roughly two-thirds of those with non-group coverage are now in ACA-compliant plans, while three in ten have coverage they purchased before the ACA rules went into effect (referred to as “non-compliant plans” throughout this report). About half of all non-group enrollees now have coverage purchased from a Health Insurance Exchange, and nearly six in ten (57 percent) of those with Exchange coverage were uninsured prior to purchasing their current plan. Most of this previously uninsured group reports having gone without coverage for two years or more, and for many the ACA was a motivator in seeking coverage; seven in ten of those who were uninsured prior to purchasing a Marketplace plan say they decided to buy insurance because of the law, while just over a quarter say they would have gotten it anyway.

57% of EXCHANGE-based QHP enrollees report being uninsured prior to purchasing their current plan, most of whom were uncovered for 2 years or more.

Even better than I had thought.

Annnnnnd...another GOP talking point bites the dust.

Next?

So how stupid are you? Too stupid even to read the evidence.


yrs
rubato

[rubato]

You got nothin'. You are weak, a failure.


yrs,
rubato

[Joe Guy]

But only stupid people imagined that he could compel your insurance company to offer you the same plan.

That would be you, wouldn't it?.....

Please don't stop....

[Lord Jim]

But only stupid people imagined that he could compel your insurance company to offer you the same plan.

Of course the reason they couldn't offer the same plan is because Obamacare regulations "compelled" them not to... (with the creation of one size fits all policy requirements, so that post-menopausal women had to pay for birth control coverage)

But don't let the facts get in the way of the narrative...

Rube I'd really like to continue to be amused by watching your sputtering meltdown, but even though I'm here by myself today, (The Missuses and the kids are at kiddie birthday party down the Peninsula, and will be spending the night at Little Sister's...which of course means...ANCHOVY PIZZA TIME!!! ) I still have some errands to run so I'll have to catch the rest of your act later....

[rubato]

Learning comes at SUCH a cost doesn't it? First you have to read about the subject and then abandon your ([moronic]) a priori ideas.

And there is the pain of admitting that you were wrong. But at the end of it all you will be able to go forward better armed for the future.

Try it. its a good thing!

yrs,
rubato

[MajGenl.Meade]

Sucking down the Sani-Lav again? It's not working

[Lord Jim]

Dude's gone completely crackers...

I hope you're having a nice lie down rube...

[Gob]

I think he's driving down Quaddriver alley.