Estimated Exchange QHPs as of 8/26/14: 7.96M PAID (9.18M Total)

Estimated Total, all sources: (24 Million - 29 Million)

Exchange + Off-Exchange QHPs: 15.9M  •  Medicaid/CHIP (6.9M - 9.8M)

ESIs (155K confirmed; up to 8M more possible)  •  Sub26ers (1.6M - 3.1M)

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The big news ACA yesterday was that Kevin Counihan, the guy who ran AccessHealthCT (one of the best-run state exchanges) has left that post to become the new "CEO" of Healthcare.Gov, just in time to prepare things for the 2nd open enrollment period.

By all accounts, this is excellent news all around. Counihan has been widely praised for his work in Connecticut--as well as in Massachusetts prior to that (he was one of the guys in charge of the original "RomneyCare" initiative).

So. We now have a new HHS Secretary (Sylvia Burwell, who's been in charge since early summer), a new Healthcare.Gov CEO (the first, actually), and a new Communications Director for CMS (Centers for Medicare & Medicaid Services), Lori Lodes.

The Maryland Health Connection just issued their latest monthly enrollment report (running from 7/27 - 8/23). On the one hand, the QHP tally includes both new additions and dropped/cancelled enrollments this time around, making it useless for adding to my off-season enrollment projection chart...

Enrollment Data
As of August 23, 78,666 individuals have enrolled in qualified health plans.1

As of August 27, 2014, 355,281 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage. We have begun reporting the net changes in Medicaid enrollment. This figure takes into account that individuals lose Medicaid coverage because of changes in household, age and income, as well as redeterminations. Compared to December 31, 2013, the net change in Medicaid enrollment as of August 27, 2014 is +262,737. 

A little while ago I posted about the failed Florida "Health Choices" website, the Florida GOP response to the Affordable Care Act. Over a 6 month period, they've only managed to enroll 30 people, total. That's Three-Zero.

So, how does this compare to the cost-per-enrollee of other "failed" Obamacare exchanges?

Well, Healthcare.Gov itself, which enrolled over 5.4 million people and covers 36 states, spent $647 per enrollee.

Nevada's ACA exchange was botched by Xerox to the tune of $51 million, and enrolled 38,000, or $1,342 apiece.

Maryland spent $118 million and had enrolled 78,930 people in private plans as of the end of June. That's $1,495 per person.

File this one under "Not From The Onion":

TALLAHASSEE — Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

Six months after the launch of the state's effort, called Florida Health Choices (, just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services.

Huh. OK, exactly 1 day after I snarkily speculated that Cover Oregon is unlikely to release an enrollment update anytime soon due to their increasingly-ugly legal (and technical) battles with Oracle Corp., take a guess what just happened this morning...

August 25, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 340,621
Total private medical insurance enrollments through Cover Oregon: 100,013   

Oregon Health Plan enrollments through Cover Oregon: 240,608*

*OHP enrollment data is current as of August 6, 2014. An updated number will be posted soon.

Dental enrollments 
Total private dental insurance enrollments through CoverOregon 1: 20,018

Net enrollments 
Net private medical: 78,714
Net private dental: 14,299

On the one hand, the total QHP number has jumped an impressive 3,103 over a 19 day period, or 163/day, so good on them.

Sarah Kliff at Vox broke the news a few hours ago, but I just received the official press release from CMS; there seems to be some discrepancy about the total number eligible, but it's fantastic news no matter what:

Pennsylvania has apparently struck a deal with the Obama administration to expand its Medicaid program to more than 300,000 poor residents, Joan Alker at Georgetown University tweets:

Pennsylvania would be the 27th state (not including the District of Columbia) to participate in Obamacare's Medicaid expansion, and Gov. Tom Corbett would be the ninth Republican governor to sign on.

According to the CMS Dept, however, the actual number eligible in Pennsylvania could top 500,000:

FOR IMMEDIATE RELEASE Contact: CMS Media Relations

August 28, 2014
(202) 690-6145 or

CMS Statement on Approval of Medicaid Expansion in Pennsylvania

I post guest entries once in a blue moon, and this one could be huge, if his conclusions are accurate (and still well worth discussion even if they aren't). Recently, both Sarah Kliff over at Vox and Margot Sanger-Katz & Kevin Quealy at the NY Times Upshot have delved into some fascinating and unexpected news regarding Medicare & Medicaid spending in the U.S. over the past few years.

Well, an ACASignups supporter named Jim Stuart (all I really know about him is that he's a retired executive and educator who attended Princeton and lives in Illinois) has gone even deeper into the weeds on this and, well, I'll let those who know more about such things than I do decide how much of a Big Deal this is.

With Jim's request/permission, I'm reposting his piece verbatim, but I'd also advise checking out his own blog.