Early state numbers: People aren’t signing up for ObamaCare, they’re signing up for Medicaid

posted at 2:41 pm on November 1, 2013 by Allahpundit

David Freddoso was issuing heads-ups about this weeks ago and now here’s Ezra Klein’s Wonkblog saying, yep, heads up. I understand the concern, what I don’t understand is why anyone thinks it’s “unexpected.” It stands to reason that the most voracious demand for expanded insurance would be among the people who can’t qualify for it or can’t afford it, i.e. the sick and the very poor. The latter are signing up and being steered into Medicaid. The former are surely signing up (or trying to sign up) and being steered into ObamaCare, where they’re going to create one hell of an adverse selection problem for insurers unless healthy people get cracking on enrolling en masse.

Long story short: Where are the enrollments from healthy middle-class people on whom so much depends?

The first month of the new health law’s rollout reveals an unexpected pattern in several states: a crush of people applying for an expansion of Medicaid and a trickle of sign-ups for private insurance.

This early imbalance — in some places, nine out of 10 enrollees are in Medicaid — has taken some experts by surprise. The Affordable Care Act, which expanded Medicaid to cover millions of the poorest Americans who couldn’t otherwise afford coverage, envisions a more even split with an expanded, robust private market.

“When we first saw the numbers, everyone’s eyes kind of bugged out,” said Matt Salo, who runs the National Association of Medicaid Directors. “Of the people walking through the door, 90 percent are on Medicaid. We’re thinking, what planet is this happening on?”…

The yawning gap between public and private enrollment is handing Republicans yet another line of criticism against President Obama’s health overhaul — that the law is primarily becoming an expansion of a costly entitlement program.

On top of the differing early demand for Medicaid versus private insurance, it’s easier to sign up for the former. As Wonkblog notes, there’s no choice of plans in Medicaid to dither over and no 404 catastrophe waiting for you online. Since states already have information on their lowest-income citizens are from food-stamp programs, they can either automatically enroll them in Medicaid or do it over the phone. None of this matters terribly if Healthcare.gov can be salvaged quickly and private-insurance purchases start to skyrocket: Granted, taxpayers are on the hook for all of these new Medicaid enrollments, but then they’re also on the hook for ObamaCare subsidies for lower-income people who don’t qualify for Medicaid. What makes this story worth flagging are two things. One: Like Guy Benson says, for all the Democratic blather this week about insurance plans getting canceled under O-Care because they’re “junk,” Medicaid itself is a junk plan. The instantly famous study of Medicaid recipients in Oregon earlier this year — conducted in part by none other than Jon Gruber, one of the architects of ObamaCare — showed that the program did little to improve the health of the poor.

Two: HHS has been, shall we say, imprecise in delineating the proportion of Medicaid applications to ObamaCare applications when talking about the demand for coverage since October 1. They’ve thrown around the number “700,000,” but how many of those are for one program versus the other? This was Freddoso’s whole point in initially flagging this issue. In order to tell if ObamaCare’s on track to form sustainable risk pools, only the number who are applying for private insurance matters — yet HHS has been coy in distinguishing that from the Medicaid applications. That fits a pattern of deception since the exchanges launched on October 1. Here’s Peter Suderman on last night’s report of six — six — total enrollments nationwide on ObamaCare day one:

On October 3, White House spokesperson Jay Carney, pressed for enrollment numbers, said, “No, we don’t have that data.” On October 7, in an appearance on the Daily Show, Health and Human Services Secretary Kathleen Sebelius repeated the claim when questioned about enrollment: “I can’t tell you,” she said, “because I don’t know.”

But that simply wasn’t true—at least not during the first few days…

It’s possible that Carney didn’t have the numbers at the time. And I suppose it’s even possible that, four days later, HHS Secretary Sebelius hadn’t seen the numbers either. But that explanation is not particularly believable, especially in the case of Sebelius, whose is the nation’s top health bureaucrat and is therefore expected to keep informed of such things. And on the vanishingly small chance that it is true that neither Sebelius nor Carney were at all aware of the enrollment numbers themselves, then that reveals that both remained, perhaps by choice, clueless and out of the loop regarding crucial details about Obamacare’s operations.

Bottom line: If only because of the ongoing Medicaid/private insurance sleight of hand, you shouldn’t trust what anyone in the White House says about applications or enrollments until we have the official numbers later this month. To hit their target, they need 494,000+ newbies in the private insurance market alone. Otherwise they’re at risk of an adverse selection problem, which means next year will be worse than it’s already shaping up to be. Via BuzzFeed, here’s OFA’s latest solution to the ambivalence from “young healthies” towards the law so far. Merry Christmas?


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Obamacare related…

Federal Appeals Court Strikes Down Obamacare Contraception Mandate…

How will Sandra Fluke pay for her $9-per-month birth control pills now?

WASHINGTON (AP) – A divided appeals court panel is siding with Ohio business owners who challenged the birth control mandate under the new federal health care law.

The business owners are two brothers who say the mandate to provide contraceptive coverage would make them violate their Roman Catholic beliefs.

The ruling Friday by the U.S. Court of Appeals for the District of Columbia Circuit is one of many on the birth control issue, which likely will be resolved by the Supreme Court.

The appeals court panel says the mandate limits the right of free exercise of religion.

The brothers are Francis and Philip M. Gilardi. They say they don’t want to provide contraceptives like the Plan B pill for their employees. The Gilardis own Freshway Foods and Freshway Logistics of Sidney, Ohio.

The DC Circuit Court of Appeals is generally a fairly accurate predictor of how the Supreme Court will rule in the event it takes the case.

Resist We Much on November 1, 2013 at 2:43 PM

Wow, who could have seen this coming?

Chris of Rights on November 1, 2013 at 2:44 PM

Sophie, for you

Schadenfreude on November 1, 2013 at 2:46 PM

May it all go the way of obama…deep into a latrine.

Schadenfreude on November 1, 2013 at 2:46 PM

Where are the enrollments from healthy middle-class people on whom so much depends?

Math is hard.

Good Lt on November 1, 2013 at 2:48 PM

I’ve been saying for years– of the “35 million” uninsured, over 20 million who were getting covered were just getting added to Medicaid

We and many Dims fought hard against the “public option” in Obamacare– well Medicaid is now the de facto public option

It speaks volumes about our society that anywhere from 45-55% of ALL pregnant women are now covered by Medicaid primarily

It will be interesting to see how this plays out in the 25 or whatever states that wisely didn’t take the Medicaid expansion– what happens in those states now?

thurman on November 1, 2013 at 2:48 PM

Going according to plan
-obama

cmsinaz on November 1, 2013 at 2:48 PM

I think the total healthy enrollment is up to 7…that should help pay for it all…

PatriotRider on November 1, 2013 at 2:49 PM

Cloward-Piven strategy proceeding according to plan.

cool breeze on November 1, 2013 at 2:49 PM

I will not comply because I am a free citizen of the United States, not a subject of its government. I consider non-compliance with this monstrosity and the tens of thousands of pages of regulations that are to be enforced by an unelected bureaucracy, and that have left a gigantic carbon footprint on our environment and the United States Constitution, a duty.

Non-compliance is my executive order, and that order reads in part that I do not recognize any government’s claim on my action or inaction in the marketplace, nor upon any personal information I am unwilling to divulge.

Schadenfreude on November 1, 2013 at 2:52 PM

Since states already have information on their lowest-income citizens are from food-stamp programs, they can either automatically enroll them in Medicaid or do it over the phone.

Yes, because we know that the screening process to determine food-stamp eligibility is so rigorous.

slickwillie2001 on November 1, 2013 at 2:53 PM

“We do know that there is a debate over the roll of government and the size of government,” former Congressional Budget Office director Doug Holtz-Eakin said. “This will unmistakably make government bigger. This is one thing we know in politics that animates voters.”

Wake up, or NEVER be free again, America!!!

Schadenfreude on November 1, 2013 at 2:54 PM

The DC Circuit Court of Appeals is generally a fairly accurate predictor of how the Supreme Court will rule in the event it takes the case.

Resist We Much on November 1, 2013 at 2:43 PM

Which, not surprisingly, Obama is trying to pack that court – and his buddies are threatening the nuclear option again.

Jeff Weimer on November 1, 2013 at 2:54 PM

In NO land of the world does obama’care’ exist.

Not even in Russia and China are there mandates.

obama is a communist. He said so in Boston. But, he took obama’care’ further than any commie in the world. Period.

Schadenfreude on November 1, 2013 at 2:55 PM

They’re herding up the sheep.

faraway on November 1, 2013 at 2:55 PM

This early imbalance — in some places, nine out of 10 enrollees are in Medicaid — has taken some experts by surprise.

I don’t think that word means what they think it means. Can we revoke their “expert” cards? I haven’t seen an “expert” make an accurate prediction in years. Perhaps “braindead Obamazombies” might be more accurate.

dominigan on November 1, 2013 at 2:56 PM

It’s just another f*&cked up Ponzi scheme.

If we, as private citizens, were trying to perpetrate this bullshit, we’d be facing felony fraud counts.

I get so f*&cking mad, I can hardly see straight.

OhEssYouCowboys on November 1, 2013 at 2:56 PM

To hit their target, they need 494,000+ newbies in the private insurance market alone. Otherwise they’re at risk of an adverse selection problem, which means next year will be worse than it’s already shaping up to be.

Uhmmmmmmmm ….

They are going to need a LOT more than 494,000 ‘newbies’, AP !!

At least an order of magnitude MORE, prefereably with a multiplier of 4 or 5

Or this beast never makes takeoff.

PolAgnostic on November 1, 2013 at 3:00 PM

Uhmmmmmmmm ….

They are going to need a LOT more than 494,000 ‘newbies’, AP !!

At least an order of magnitude MORE, prefereably with a multiplier of 4 or 5

Or this beast never makes takeoff.

PolAgnostic on November 1, 2013 at 3:00 PM

He forgot to indicate that was their target for October. Their overall target is 7 million.

NotCoach on November 1, 2013 at 3:02 PM

You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…
You won’t know until mid-November…

right2bright on November 1, 2013 at 3:02 PM

man the Cloward-Piven thing…where does it cover lack of participation?

So I guess they have to somehow make the transition from Obamacare to Medicaid to get that single payer to work. That will require the paycheck deduction to be huuuuuuge in order to fund it. Even a burger flipper will feel that and hard.

With O-care out of the way private insurance can work again as dems lose every person that draws a check.

DanMan on November 1, 2013 at 3:03 PM

There is a glitch that automatically signs people up for Medicare if they don’t sign up for Obamacare. There was post here on HA a few days ago about it.

I’d guess that the vast majority of new Medicare enrollees are completely unaware that they’ve signed up for it.

BobMbx on November 1, 2013 at 3:03 PM

This early imbalance — in some places, nine out of 10 enrollees are in Medicaid

 
But that’s exactly opposite of what our resident high-info (D)s told us would happen. According to them, the working poor were going to spend thousands of dollars a year on private insurance premiums and deductibles instead of getting it at zero or low cost.
 
Gosh, who could’ve foreseen such unpredictable and unorthodox economic decisions at the personal level?

rogerb on November 1, 2013 at 3:03 PM

right2bright on November 1, 2013 at 3:02 PM

That’s my Friday laugh – thanks r2b.

OhEssYouCowboys on November 1, 2013 at 3:03 PM

Early state numbers: People aren’t signing up for ObamaCare, they’re signing up for Medicaid

I’ve been warning since the beginning that the insane expansion of MediCAID (taken out of MediCare, at that) was the most dangerous part of this un-Constitutional, un-American, idiotic expansion of the feral government into every nook and cranny of society.

This un-Constitutional law needs to be stopped, killed, and buried under 1000 tons of rubble any way possible. There is no excuse for not using every weapon in the arsenal to kill this anti-American feral takeover of society. None. This is why the GOP surrender on that pathetic feral government 17% “shut-down” was so stupid and destructive.

ThePrimordialOrderedPair on November 1, 2013 at 3:09 PM

This early imbalance — in some places, nine out of 10 enrollees are in Medicaid — has taken some experts by surprise.

And what value do ‘experts’ bring us these days?

Good grief.

Midas on November 1, 2013 at 3:09 PM

If you qualify for Medicaid the site will not ALLOW you to purchase an alternate health care plan. The site will not allow you to buy a plan even if you feel you can afford it and do not want to go on Medicaid. Daughter, who owns a home, has a full-time job and does not feel she is “poor” or in need of an entitlement, was not allowed to purchase a plan because she “qualified” for Medicaid.

Un-frickin-believable…

Fallon on November 1, 2013 at 3:12 PM

Repub governors, like nitwit RINO brewer in Arizona and nitwit kasich in Ohio, sold their taxpayers down the river by stupidly signing up for the OBOZO bait-and-switch gimmick of medicaid expansion. The massive bill for this massive medicaid expansion will come due in about three years. If you live in one of these states, be prepared to get the biggest tax shafting you’ve ever gotten – and it will be a fault of these incompetent, ignorant Repubs !!!!

TeaPartyNation on November 1, 2013 at 3:12 PM

By mid-November… new policies created or saved

faraway on November 1, 2013 at 3:16 PM

To hit their target, they need 494,000+ newbies in the private insurance market alone.

Hmmm, by my math at the rate of 56,000 per day the early leaked documents stated needed to be enrolled in non Medicaid private insurance plans by the end of November (60 days), they would need to have 3,360,000 enrolled in Private Insurance to meet their target. They said they needed 14,000,000 enrolled in private insurance by the end of February to make the thing work.

*All of the above assumes no goal posts have been motorized and moved out of the stadium.

Johnnyreb on November 1, 2013 at 3:16 PM

“but mom & dad I am still covered under your insurance for a couple more years, so I don’t need to sign up.”

tommer74 on November 1, 2013 at 3:16 PM

I feel so sorry for lonely ObamaCare that I wish I could sign up just to cheer it up. But I can’t because the FREAKING WEBSITE STILL DOESN’T WORK!

Tsar of Earth on November 1, 2013 at 3:18 PM

“Daddy, why can’t I keep my doctor?”

faraway on November 1, 2013 at 3:19 PM

I think the total healthy enrollment is up to 7…that should help pay for it all…

PatriotRider on November 1, 2013 at 2:49 PM

Or, in Progressive speak/alternate universe, i.e. MSM : ObamaCare Enrollments Up Over 16%, Fixes Are Working, Program Is Gaining Significant Popularity

parke on November 1, 2013 at 3:21 PM

What is Robert’s take now?

Schadenfreude on November 1, 2013 at 3:23 PM

To hit their target, they need 494,000+ newbies in the private insurance market alone.

Well, that’s no problem at all. They can just go to the same folks that gave them their millions and millions of fake facebook followers. Done deal! 500,000 new ObamaGlitch subscribers is EASY.

Meople on November 1, 2013 at 3:25 PM

I’m wondering about those non-Medicaid expanding states too. Do those new Medicaid enrollees get insurance for 3 years and then get dumped because those states are protecting its taxpayers from the moochers?

txhsmom on November 1, 2013 at 3:27 PM

“…has taken some experts by surprise…”

unexpectedly?

Tsar of Earth on November 1, 2013 at 3:27 PM

Commie methodology for enhanced sign-ups:

Free turnips.

Free vodka.

Staples of Utopia.

OhEssYouCowboys on November 1, 2013 at 3:28 PM

its=their

txhsmom on November 1, 2013 at 3:28 PM

I’m wondering about those non-Medicaid expanding states too. Do those new Medicaid enrollees get insurance for 3 years and then get dumped because those states are protecting its taxpayers from the moochers?

txhsmom on November 1, 2013 at 3:27 PM

I looked at the chart for Kentucky this morning. Almost 70% of the KYnect enrollees are getting signed up for Medicaid. My understanding is the Fed will cover the difference for the first two years and after that we are on our own. There is no way Kentucky can afford that kind of an increase in Medicaid. It simply is not going to happen.

Thank you Louisville and Lexington.

Johnnyreb on November 1, 2013 at 3:32 PM

Where are the enrollments from healthy middle-class people on whom so much depends?

Right here , this from CNN linky:

Organized by “Siouxsie Q,” a Bay Area sex worker, the event was meant to encourage other sex workers to enroll in the new insurance exchanges. It was a rousing success: Nearly 40 men and women attended and almost all of them filed enrollment paperwork.
In the all-cash, off-the-books sex industry, workers can be particularly high risk and insurance is often out of reach. Many sex workers — a broad term that can refer to a number of services, including sexual massage, prostitution, and escort and dominatrix work — consider themselves self-employed entrepreneurs who can’t afford to purchase healthcare. But that could all change with the Affordable Care Act.

Siouxsie, 28, has shopped for plans countless times since 2008, coming up empty each time. She and her partner recently reviewed their healthcare options and found that a joint plan would have cost between $400 and $500 a month — an unaffordably large chunk of their incomes.

“We just couldn’t swing [insurance] in the Bay Area — we’re lower middle class, recent college graduates, in Startup Land trying to make our way,” she said.

But come January 1, when the new law goes into effect, she and her partner will be looking at a monthly bill of between $175 and $200. They’re deciding between two plans on the California exchange and will receive a tax credit of about $275 a month (without the credit it would have cost nearly $500). California’s exchange site was down the first few times Siouxsie tried to navigate it, but she was able to successfully browse policies several times. (She nevertheless arrived at the party with stacks of paper applications so the night could continue even if the website was disrupted.)

Volunteers from Siouxsie’s weekly podcast, The WhoreCast, staffed the event. “Jolene,” another sex worker who had already enrolled through the California exchange, was also on hand to talk users through the process. A key detail for the crowd: Enrollment doesn’t require users to report their employment.

“I am here mostly to put my skill at filling out bureaucratic forms to use,” Jolene joked.

Through the California exchange, Jolene will receive a $211 monthly tax credit, which will bring her payments to just $36 a month.
Individuals making less than $46,000 are eligible for a tax credit to offset their monthly costs. Many of the sex workers at the event file W-2s for their legal work, whether it be a part-time job or sex work that falls within the law. Sex workers interviewed by CNNMoney estimated this income to be less than $45,000 a year.

The Affordable Care Act will cover contraception, screening for sexually transmitted infections, and violence counseling at no additional charge, which the sex workers said would make a big difference in their community. The legislation will also make it more difficult for insurance companies to deny coverage based on gender identity and HIV status.

For Jolene and others in her line of work, it’s cause for celebration.

“I really do think access to healthcare should be a human right, and I’ve been so brainwashed to think it’s such a privilege,” a sex worker and activist known as “Maxine Holloway” said.

burrata on November 1, 2013 at 3:33 PM

txhsmom on November 1, 2013 at 3:27 PM

I’m not sure, but I think those states do not have to enroll them on their Medicaid rolls. I guess the Federal government will be responsible for them.

Barred on November 1, 2013 at 3:34 PM

Johnnyreb on November 1, 2013 at 3:32 PM

Yep. I remember when TX number crunchers said the Medicaid expansion would cost TX 80 times what DC was projecting. It will bankrupt the states that went for the expansion.

txhsmom on November 1, 2013 at 3:35 PM

Love the woman in the screen cap—- “Honey, this is some effed up shit coming down.”

arnold ziffel on November 1, 2013 at 3:38 PM

There is no way I can imagine a young person sitting down with their parents having a stupid conversation like this one. Maybe if they were a dork like this guy…..

Barred on November 1, 2013 at 3:43 PM

If you qualify for Medicaid the site will not ALLOW you to purchase an alternate health care plan. The site will not allow you to buy a plan even if you feel you can afford it and do not want to go on Medicaid. Daughter, who owns a home, has a full-time job and does not feel she is “poor” or in need of an entitlement, was not allowed to purchase a plan because she “qualified” for Medicaid.

Un-frickin-believable…

Fallon on November 1, 2013 at 3:12 PM

I expect she will receive a SNAP card in the mail shortly as well, since it appears they are linking all the freebie programs.

Ditto a voter registration card.

slickwillie2001 on November 1, 2013 at 3:44 PM

See cause making a lame Teevee commercial makes the pain go away or something…

workingclass artist on November 1, 2013 at 3:49 PM

Yep. I remember when TX number crunchers said the Medicaid expansion would cost TX 80 times what DC was projecting. It will bankrupt the states that went for the expansion.

txhsmom on November 1, 2013 at 3:35 PM

And we moved here this year from Connecticut to escape the ever increasing taxes in that state. We just got our annual City tax bill for our house this week. $82.37, vice the $3,800 we were paying in Connecticut…….

Johnnyreb on November 1, 2013 at 3:49 PM

MeanWhile, ……..

Doctor who charged $5 per visit for 58 years retires, closes clinic in Rushville, Ill. – @NBCNews

18 mins ago from usnews.nbcnews.com by editor
=============================================

http://www.breakingnews.com/

canopfor on November 1, 2013 at 3:56 PM

canopfor on November 1, 2013 at 3:58 PM

To hit their target, they need 494,000+ newbies in the private insurance market alone.


…Annnddd along comes Sean Trende with mathematical analysis and observations

The numbers vary by a fair amount. If exchanges had functioned and attracted customers nationally at the same rate as Minnesota, they would have attracted some 53,000 customers. On the other hand, if they had functioned like Kentucky’s, they would have attracted around 450,000, which would be close to the administration’s low-end estimate. On average, it works out to about 280,000 customers nationally.

Now, we need some caveats here, and they cut both ways. First, different states have different risk pools, different insurance rates, and different numbers of uninsured. You can’t literally extrapolate from a state to the nation as a whole. The above is meant as an estimate. That said, we have a decent cross-section of states, if perhaps a bit skewed to the Northeast. Second, there is a high degree of variance in the performance of state exchanges; some are functioning okay, some are terrible, and some are doing well. Third, these numbers might be depressed due to the negative publicity surrounding the national exchanges.

Fourth, and perhaps most importantly, we need to remember that 400,000 to 500,000 enrollees represented a bare minimum for what the administration expected at the start. The fact that only two states prorate into that range (and Vermont’s website is having problems now), the picture isn’t particularly encouraging.

The bottom line is this: If the national exchanges were functioning as well as the best-functioning state exchange — and encountering the same demand — we’d probably be on the low end of the administration’s acceptable enrollment range. If the middle state were representative of the country as a whole, we’d be below it, but not by an overwhelming amount. That’s not much, but it’s probably the best news supporters of the law have received in a while.

Just one tiny, itsy-bitsy problem Sean tried to completely ignore:

Somehow (perhaps because RCP is a left leaning website?) Sean FORGOT not everyone is signing up for Obamacare.

Somehow (because RCP is rumored to benefit from politically partisan “click” generation automations?) Sean FORGOT in his analysis of the preliminary data that the early reports are the BULK of enrollees are signing up for Medicaid.

He is getting his azz handed to him in the Comments section.

http://www.realclearpolitics.com/articles/2013/11/01/projecting_obamacares_early_enrollment_numbers_120540.html

PolAgnostic on November 1, 2013 at 4:03 PM

burrata on November 1, 2013 at 3:33 PM

These must be those “artists” and such that Nanzi Pelosi was talking about.

lfwest on November 1, 2013 at 4:27 PM

Mom and Dad should be telling son to swallow the penalty. Make sure he’s not entitled to a refund, because the IRS can use a refund to pay the penalty.

BuckeyeSam on November 1, 2013 at 5:09 PM

“When we first saw the numbers, everyone’s eyes kind of bugged out,” said Matt Salo, who runs the National Association of Medicaid Directors. “Of the people walking through the door, 90 percent are on Medicaid. We’re thinking, what planet is this happening on?”…

On Earth. What planet are you on? Obamaanus?

VorDaj on November 1, 2013 at 6:14 PM

Early state numbers: People aren’t signing up for ObamaCare, they’re signing up for Medicaid

..oh oh!…so the feds can still fudge the numbers!

KOOLAID2 on November 1, 2013 at 8:37 PM