N.C. Obamacare numbers remain elusive

Participation in the health insurance marketplace created by the Affordable Care Act has dropped by about 700,000 people,  from 8 million when enrollment closed March 31 to 7.3 million as of Aug. 15, the nation's top Medicare/Medicaid administrator said Thursday.

That partially answers questions many have posed this summer about developments on the insurance exchange,  which includes subsidies for low- and moderate-income people buying individual policies.

Medicare/Medicaid administrator Marilyn Tavenner (AP photo)

It still doesn't offer details on how many have failed to pay premiums,  how many have left the marketplace for other reasons  and how many have been added during special enrollment.  Nor have the state tallies posted in May been updated.

Update: The feds did post a zip code map of enrollments as of April 19; read a report from John Murawski of the News & Observer here.

North Carolina had the nation's fifth-highest enrollment after open enrollment,  with 357,584 enrollments as of March 31.  If the state's numbers reflect the 8.75 percent drop the nation has seen,  we'd have lost about 31,300.

As the Department of Health and Human Services notes,  enrollment changes on a daily basis.  People may sign up,  then lose coverage if they fail to pay premiums.  They move from one state to another.  They gain or lose jobs and go through family changes that affect their health insurance.

Earlier this week,  DHHS announced that 115,000 people nationwide will lose their coverage because they failed to provide immigration documents required to verify their citizenship or immigration status.  The department initially flagged 966,000 people whose applications didn't match data on file.  In July,  after repeated attempts to reach those people,  they sent warning letters to 310,000 saying they'd lose coverage if they didn't verify their status by Sept. 5.  That included 12,300 in North Carolina.

The update on people who will lose coverage because of immigration status didn't include state breakdowns;  a DHHS official said that would come later.

In a conference call with reporters,  Andy Slavitt of the Centers for Medicare and Medicaid Services proudly noted that the overwhelming majority the immigration cases that were initially flagged had been resolved.  But he didn't have answers when a reporter asked whether "resolved" included people who kept their coverage and people who lost it,  and if so,  what the mix was.

Insurance exchange: Where are new numbers?

Two Republican senators have posed a good question:  What has happened to enrollment in the Affordable Care Act's insurance exchanges since March?

Barrasso

Sens. John Barrasso of Wyoming and Lamar Alexander of Tennessee sent an open letter to the U.S. Department of Health and Human Services seeking an update on enrollment numbers,  which were last reported as of the end of open enrollment March 31.  They want to know who has joined since then and who has fallen off the roster for reasons such as failure to pay premiums or provide documentation of their immigration status.

"With the next open enrollment period set to begin on November 15,  2014,  it is imperative that (the Centers for Medicare and Medicaid Services) provide Congress and the public with accurate information about the number of people who are enrolled in exchange coverage as well as the number of people who have cancelled coverage,"  their letter says.

Alexander

That seems like a reasonable request.  I went looking for updates this summer when I wrote about special enrollment and hit the same wall.

During the 2014 open enrollment period,  HHS provided monthly updates on the number of people who had bought insurance through the federal and state exchanges set up to provide subsidized health insurance.  The most recent tally, posted May 1, showed just over 8 million enrolled through the exchanges and 4.8 million through Medicaid and the Children's Health Insurance Program.

After reading about Alexander's and Barrasso's request,  I went back to the department spokesperson Friday to see when we could expect an update.  The statement I got in reply:  "HHS issued monthly enrollment reports during the first marketplace open enrollment period in order to provide the best understanding of enrollment activities as it was taking place. Now that this time period has ended,  we will look at future opportunities to share information about the marketplace that is reliable and accurate over time as further analysis can be done but we do not anticipate monthly reports."

That,  of course,  is a non-answer.

I'm new to coverage of the Affordable Care Act,  but I've been reporting on public agencies for most of the last 33 years.  I can't think of an instance where withholding or delaying information is wise.  If the numbers show a problem,  it only delays the reckoning.  The perception of hiding something gives critics room to speculate and assume the worst.

So here's hoping the federal government provides a real answer soon.

Connecticut exec named CEO of federal marketplace

Kevin Counihan,  CEO of Connecticut's insurance exchange,  will take the same post managing the federal exchange set up under the Affordable Care Act,  the U.S. Department of Health and Human Services announced Tuesday.

That puts him in charge of North and South Carolina's subsidized health insurance programs as well,  since state officials declined to set up their own marketplaces.

Counihan

Open enrollment for 2015 begins Nov. 15.  The new leadership team is charged with making this year's process work better than the notoriously glitchy startup last fall.

Counihan has worked in health care and insurance for three decades.  He oversaw Connecticut's creation of an exchange that signed up about 79,000 people.

The challenges of his new job are plentiful,  Jeff Cohen of WNPR and Diane Webber of Kaiser Health News report:  "Healthcare.gov serves states that are actively hostile to the law in the Deep South, states that are embracing the law to some minimal degree and states that are active partners in running the exchange."