In which Reason asks some questions which are quite Reasonable
2018 MIDTERM ELECTION
Time: D H M S
Reason.com is a pretty conservative outlet, but Peter Suderman has an entry which asks some refreshingly valid questions. He starts with an overview of the report released yesterday by the CDC, which noted an overall drop in the uninsured number by about 3.8 million as of the end of March. To his credit, he follows up by calling attention to the fact that this doesn't include over half of the total QHP enrollments (as well as a lot of Medicaid additions):
But this survey probably doesn’t measure the full impact of the law. That’s because the survey was conducted from January through March of this year, when Obamacare’s open enrollment period was still ongoing. So it wouldn’t capture much of the last-minute enrollment surge that accounted for a significant portion of the sign-ups under the law. People who signed-up at the end of March, or in the extended enrollment period in early April, wouldn’t have technically been insured for another month or more.
He then turns to the heart of the matter: The CMS press release from Monday in which they updated the status of about 966K QHP enrollees with inconsistencies in their immigration/citizenship data, and another 1.6 million with inconsistencies in their income data. The good news is that CMS reported having resolved 88% of the citizenship issues and 77% of the income level issues.
The bad news, which I've already noted, is that there's still about 115K citizenship/immigration cases to resolve and 363K income cases. Presumably the vast majority of these will be cleared up before the Sept. 30 deadline.
However, as Suderman notes:
The CMS memo notes how many cases have been closed, and how many are being resolved. But it doesn’t provide any information at all about how those cases were resolved. That’s a departure from when the discrepancies were first revealed in June. At the time, as CBS News reported, federal health officials stressed that consumers were coming out ahead in the “vast majority” of resolved cases. It seems probable some portion of the resolutions since, and perhaps even a significant fraction, were resolved with the subsidies being taken away.
In other words, while it's good that they've "resolved" a huge percentage of the data issues, the results of those resolutions aren't known. Presumably "vast majority" means that, say, 80% of the 1.23 million income levels straightened out to date were in the enrollees favor, which is awesome, and even if the other 20% worked out against the enrollee, that could mean just by a few dollars in some case. However, it's also possible that a couple hundred thousand people are losing their tax credits because their income was higher than they reported.
While unfortunate, this isn't really a major issue for this website, since I'm primarily concerned with how many people are enrolled, not their economic status. The enrollment numbers could be impacted by this since some people might drop their coverage if they lose the tax credits...but my guess is that this is already reflected in the overall "net attrition rate" anyway.
What's more concerning to me are the immigration/citizenship cases. Again, CMS reported having "resolved" 851,000 of these...but didn't say what the results of those resolutions are. Let's suppose that, again 80% of those resulted in the enrollees legal status being A-OK. That would still mean a good 170,000 who may be kicked off their exchange QHP completely, since undocumented immigrants aren't legally allowed to purchase via the exchanges (nor are they eligible for Medicaid). There's also the 115,000 who haven't been resolved yet.
In the above scenario, this could potentially mean having to lop off up to 285,000 people from my current tally of 8.07 million paid out of 9.3 million total.
Of course, it's also likely that some of these folks have already been purged from the tally; perhaps they're more likely not to bother paying their premiums than someone whose paperwork is all in order (or to drop it after the first month)? Who knows?
Certainly I don't...because no one at CMS was willing to give out that information, any more than they're willing to release an updated enrollment report at all.
None of which increases my confidence level.