END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Charles Gaba's blog

A couple of weeks ago, a joint letter was sent to all four Congressional leaders from AHIP (America's Health Insurance Plans), the BlueCross BlueShield Association, the American Academy of Family Physicians, the AMA, the American Hospital Association and the Federation of American Hospitalsm warning them, in no uncertain terms, of what the consequences of repealing the individual mandate would be:

We join together to urge Congress to maintain the individual mandate. There will be serious consequences if Congress simply repeals the mandate while leaving the insurance reforms in place: millions more will be uninsured or face higher premiums, challenging their ability to access the care they need. Let’s work together on solutions that deliver the access, care, and coverage that the American people deserve.

A week or so ago, the American Academy of Actuaries sent a similar letter to Republican Senate Majority Leader Mitch McConnell stating pretty muc the same thing, but in more vivid detail:

The following letter was sent to Rep. Carol Shea-Porter of New Hampshire a few days ago:

Dear Representative Shea-Porter:

Thank you for your letter regarding funding for the Navigator program. I appreciate hearing from you on this issue. The Patient Protection and Affordable Care Act requires each Health Insurance Exchange (whether Federally-facilitated or state-based) to have a Navigator program to, among other things, help facilitate enrollment of individuals in qualified health plans (QHPs) through the Exchange.

She goes on to rehash everything we already knew: That CMS slashed outreach grant funding by tens of millions of dollars. She obviously tries to make it sound like a reasonable, well thought-out process, even though, as I reported exclusively back in September, the decision was actually slapped together at the last minute, literally a few hours before the formal grant notices were actually sent out.

However, that's not what I'm focusing on here; this is:

This just in from the Washington Health Benefit Exchange...

The Washington Health Benefit Exchange today announced that nearly 18,000 new customers have used Washington Healthplanfinder to select 2018 health coverage through the first four weeks of open enrollment. The number of new customers who have signed up since Nov. 1 represents a 43 percent increase over the same period last year.

In addition to the 4,500 new sign-ups received on average each week, Washington Healthplanfinder has experienced an 18 percent increase in visits to the website, with more than 423,000 visitors reviewing their coverage options on www.wahealthplanfinder.org.

Additional data revealing increased consumer interest during open enrollment:

As I noted earlier, the price Maine GOP Senator Susan Collins appears to be demanding is passage of the Alexander-Murray stabilization bill and passage of her own Collins-Nelson reinsurance bill. I addressed Alexander-Murray in my last post, but let's take a look at Collins-Nelson:

Collins' bill with Nelson would set aside $4.5 billion over two years to help states establish reinsurance programs. Reinsurance directly compensates insurance carriers for their most expensive customers.

To the best of my knowledge, that's...pretty much all it does: $2.25 billion per year for two years, and then...that's it. If there's more to the bill than that, I'll revise this post, but in the meantime, that seems to be the whole bill.

All eyes are on the Godawful Tax Scam Bill this week, which once again lies mostly in the hands of a handful of Republican Senators including the usual suspects like John McCain, Lisa Murkwoski and Susan Collins.

McCain's biggest beef this year has been about "following regular order"; it's the reason he shot down the GOP's #BCRAP bill last summer. Of coruse, current tax bill most certainly isn't following regular order either. Will he stick to his guns on the issue or cave under pressure this time? Who knows?

Murkowski was a healthcare hero last summer as well...but she may have been bought off by the addition of a "Polar Payoff" in the form of the bill allowing oil drilling in the Arctic National Wildlife Refuge (ANWR). This is the only reason I can think of that would explain her rather disingenously defensive op-ed piece in the Anchorage Daily News last week.

Me, four days ago:

FWIW: By midnight tonight, I’m estimating ~2.8M QHP selections via HC.gov (4.6M nationally). My prior estimate forgot to account for Thanksgiving weekend: https://t.co/NoZrEE3eTK #ACA #Obamacare #GetCovered pic.twitter.com/mB1wKcWwQP

— Charles GetCoveredBa (@charles_gaba) November 25, 2017

CMS, moments ago:

In week four of Open Enrollment for 2018, 504,181 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

 

It's finally here, and just in the nick of time for the U.S. Senate's big vote on whether to scrap the Individual Mandate or not.

In around 15 minutes, I guarantee that you’ll understand how the ACA’s 3-legged stool works and why the Individual Mandate, while being about as popular as a root canal, still serves an important function. Don’t forget the popcorn!

(Oh, and if you'd like to help support my work, please feel free to do so via either my Patreon or GoFundMe accounts, thanks!)

A week or so ago, Connect for Health Colorado reported that they'd enrolled 22,650 people in ACA exchange plans as of November 14th, up a full third over last year by the same date. Today they've posted their third week numbers, and while things have started to slow down, they're still running 25% ahead of last year.

Given the whole Silver Load/Silver Switcharoo craziness, I was mildly surprised to see that the ratio between Bronze, Silver and Gold have barely changed year over year, and in fact Silver has inched upward by a few points...until I remembered that Colorado is among the few states which went with the "broad load" model, spreading the additional CSR cost across all metal levels both on and off the exchange. This makes the similar metal level spread more understandable, but it also makes the 25% enrollment increase even more surprising, since subsidized enrollees will pay pretty much the same (no more or less) than this year, but unsubsidized enrollees are seeing their rates shoot up no matter where they go. As you can see below, the average premiums for unsubsidized enrollees ("NFA" = "Non-Financial Assistance) is 36.6% higher this year than last.

Not an official update, but I just saw this from KXRA's Voice of Alexandria:

(St. Paul, MN) -- More than 100-thousand Minnesota residents have enrolled in the state's MNSure health insurance purchasing exchange. And about 50-thousand families are expected to get average tax credits of 72-hundred dollars to help pay for their coverage. Credits are higher in southeast and southwest areas. MNSure C-E-O Allison O'Toole says they can make the difference between "unhealthy and healthy" for thousands of people -- and yet, she says too many residents are not taking advantage. The open enrollment for MNSure runs through January 14th -- and O'Toole says that for at least a couple years, the tax credits will remain in place regardless of what happens to Obamacare in Congress.

That's the enitre article...it's dated yesterday (11/24), so I'm assuming the 100K figure was as of Thursday evening (Thanksgiving, Nov. 23rd).

 

(h/t to former CCIIO Director Gary Cohen for the reminder)

You've probably never heard of the Center for Consumer Information & Insurance Oversight (CCIIO)...

The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), part of the Department of Health & Human Services (DHHS), provides national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure that affordable, quality health coverage is available to all Americans. The center also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.

...but among other things, they're the folks who actually implement the ACA, including, among other things, HealthCare.Gov (I'm not sure if it's the same team that operates HC.gov or not...probably a lot of overlap between the two?).

Consumer Information and Insurance Oversight

Ensuring the Affordable Care Act Serves the American People

As I keep noting, early enrollment numbers can be extremely misleading, especially given the half-length Open Enrollment Period this year. Yes, enrollments via the federal exchange are up around 38% year over year so far, as well as being up 40% in Massachusetts, 3% (including auto-renewals) in Maryland, 33% in Colorado and so forth...but the shorter period could simply mean that more enrollments are being "front-loaded" this year. It's still all about how big the 12/15 surge is, along with how many NEW enrollees are added.

On the one hand, I nailed the Week Three HC.gov number almost perfectly (I projected 2.3 million, the actual number is 2,277,079). Yay, me! Only off by 1%! On the other hand, I seriously underestimated the first two weeks, so I'm not patting myself on the back too much. It's an insane year with too many unknowns for me to do much more than throw darts at the board. Still, I'll take credit where I can.

In addition, CMS has also started breaking the numbers out by state, which helps analysts look for trends and cause/effect relationships, so let's jump in!

First, the main numbers:

I used to track the monthly Medicaid/CHIP enrollment reports issued by CMS, watching as the numbers rose dramatically thanks to ACA Medicaid expansion.

I pretty much stopped doing that about a year ago, however, since the expansion numbers have mostly petered out. ACA Medicaid expansion actually has continued to climb a bit more since January, and is likely somewhere around 16 million people as of now, but it's also been partly cancelled out by a slight drop in standard Medicaid enrollment as the economy has continued to improve in general. In short, there's little reason to keep writing the same update every month.

 

(h/t to nmbrmnstr via Twitter for the heads up)

As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").

It's my understanding that if they can't keep it below that threshold, the bill won't go through for some obscure Senate rule reason or another (although apparently White House budget director Mick Mulvaney also stated that they really don't give a crap whether the mandate is repealed or not as long as the larger bill gets passed, so perhaps I'm mistaken about this? Need clarification on this point...)

Press release from the Massachusetts Health Connector...

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

Pages