Saturday, January 11, 2014

States on have closed the signup gap a bit with states running their own exchanges

A week ago (Jan. 6), Theda Skocpol  crunched state-by-state ACA signup numbers tracked by Charles Gaba and concluded, not surprisingly, that takeup was far higher in states trying to make the law work than in states ignoring or actively impeding the exchanges (not to mention the Medicaid expansion).

That conclusion was not surprising, but the statistics were badly skewed by wide discrepancies in the timeliness of the states' reporting. was barely functional until early December, but the majority of states reliant on had posted signup figures only through 11/30 at the time of Skocpol's report.  Almost none had yet tallied the rush of signups immediately preceding and following the 12/23 deadline (later extended) for buyers seeking to obtain coverage effective January 1.  A much-reproduced chart accompanying Skocpol's report showed states relying on with anemic exchange takeup rates -- ranging, in various breakouts, from 3% to 6.3% of first-year CBO projections for each state. In contrast, Skocpol showed the 14 states running their own exchanges (and accepting the Medicaid expansion) with a collective exchange takeup rate of 37.2% of CBO projections. (Skocpol gave a rather unsatisfactory account of how the reporting gap should be handled on Charles Gaba's blog, here.)

In the intervening week, seven states relying on have updated their signup numbers at least through December 23: Delaware Idaho, Iowa, Nebraska, New Mexico, South Dakota, Wyoming.* Collectively, according to my tote-up, they have reached 16.9% of CBO projections -- 41,186 out of 244,000.

In contrast, the 14 states and District of Columbia running their own exchanges have by my count reached 32.9% of CBO projections -- 1,036,131 out of 3,143,000 projected. (I don't know where the discrepancy with Skocpol's 37.2% comes from; D.C., which she may have omitted, has a 36% takeup rate). Moreover, the states' reporting still chronologically lags that of the self-operating states: most of the latter have numbers updated into the first week of January, while most of the numbers I've cited date from the last week of December.

Perhaps, then, the total takeup for states relying on, measured as a percentage of CBO projections for the Oct. 1--March 31 open enrollment period, is at present a bit more than half that of states running their own exchanges. That crude comparison leaves out a lot of variables: the percent of uninsured in each state, a given state's acceptance or rejection of Medicaid expansion, the rate of Medicaid takeup in states accepting the expansion, the validity of CBO projections. The numbers also of course reflect the two month head start enjoyed by those state-run exchanges that have run reasonably well from the Oct. 1 start or close to it (state exchanges in Oregon, Massachusetts and Maryland have performed poorly).

Still, it seems plain that the positive efforts of state officials in states that are trying to make the law work have a strong impact. Leaving aside the Medicaid expansion, these would include efforts to attract insurers into the exchange, regulation of plans sold outside the exchanges, and marketing, education and outreach, as well as exchange design and functioning.

* Alaska and West Virginia are updated through 12/22. Alaska's takeup as of that date was an anemic 700, 3.5% of the CBO's first-year projection. West Virginia, in contrast, had signed up 2,201, 9.17% of its CBO projection -- plus  82,981 Medicaid enrollees.

P.S. Bleg to the numerate: I have no spreadsheet skills -- just tallied up the CBO projections vs. signups in my two categories on a calculator, checking them thrice.  If anyone can push the columns around and wants to check my machine-aided arithmetic, or comment on my categories (e.g., states reporting results from 12/23 or later), or add other context/criticism, please do, via comment, email or twitter. Thanks.

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