Charles Gaba's blog

Of all the state-based exchanges, the one in DC has gone the longest without a formal enrollment update; the last one only included data through December 5th, a whopping 5 weeks ago. Fortunately, the DC board of directors held their monthly meeting last night and produced the following update.

As shown, the tally as of 1/8/18 is 21,352 QHP selections, slightly below last year's 21,437 as of the same date. Since DC (along with California and New York) are sticking with the full 3-month Open Enrollment Period, it should provide a good apples-to-apples comparison (and the fact that very few DC enrollees have CSR assistance also means there's a nominal CSR loading impact, either).

The final, official DC ACA exchange tally last year was 21,248, so technically speaking they've already surpassed that figure...but again, it was 21,437 as of 1/8/17, which means there were at least a few hundred people who were dropped off at the tail end due to cancelling or non-payment of their first premium.

Last week the Congressional Budget Office reported that funding the CHIP program for 5 years, which they had previously estimated would increase the federal deficit by about $8 billion over the next decade, would instead only increase it by about 1/10th as much: Roughly $800 million, a rounding error when it comes to the federal budget. The reason for this isn't that funding CHIP had suddenly become less expensive, it was instead, ironically, because due to the GOP repealing the ACA's individual mandate starting in 2019, NOT funding CHIP has suddenly become more expensive.

OK, first of all, here's the actual press release from CMS about it:

CMS announces new policy guidance for states to test community engagement for able-bodied adults
Will support states helping Medicaid beneficiaries improve well-being and achieve self-sufficiency

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.

In other words, work requirements for Medicaid expansion enrollees are now officially on the table.

Over at Politico, reporter Jennifer Haberkorn has a pretty impressive scoop about an internal Trump Administration memo from last March which lays out a list of 10 different executive measures Trump planned on taking to muck around with the ACA exchanges and the 2018 Open Enrollment Period:

Trump’s secret plan to scrap Obamacare

Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.

The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.

MNsure, Minnesota's ACA exchange, has just posted their latest official enrollment numbers. It's only a minor update from this unofficial 110K figure a week ago, but every enrollment counts.

111,667 QHP selections bumps them up another 1,667, with 5 days left to go for Minnesota residents to #GetCovered for 2018. It's worth noting that enrollment in MinnesotaCare, MN's name for the ACA's Basic Health Program, has actually dropped slightly since the last hard number update I confirmed back in mid-November (93,049).

Michael Bertaut is a conservative healthcare economist in Louisiana. He and I disagree on most political issues, and he's obviously not a fan of the ACA, but he seems to be intellectually honest about his positions, and he and I have found some common ground over ACA-related stuff in the past.

Case in point: The individual mandate. Bertaut may not care for the ACA overall, but he does recognize, as I do, that if you're going to utilize the "3-legged stool" model for individual market enrollment, it has to include both a positive and negative inducement to encourage (or goad) people into enrolling...aka the Carrot and the Stick. More to the point, if you're going to have a Stick (i.e., the Individual Mandate), it has to be large enough and well-enforced enough to be effective.

Presented without comment because I don't really have much to add aside from yes, this is a good idea which should happen for EVERY state, really:

Kreidler proposes bill to stabilize individual market, reduce premium costs
Contact Public Affairs: 360-725-7055

January 8, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is proposing legislation to help provide stability and confidence that over 300,000 people are able to maintain coverage in Washington’s individual health insurance market.

Kreidler’s proposed reinsurance program would encourage more health plan options in the 2019 individual market and lower premium increases by up to 10 percent.

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

UPDATE 01/15/18: Since I originally posted this, the deadlines for 2 more states have passed (CO & MN), and I have minor, non-final enrollment updates for MA, MN, DC & WA. Everything in this post has been updated accordingly, including the table below.

UPDATE 01/16/18: Updated table and writeup to include final Colorado numbers, which just came out today.

UPDATE 01/17/18: Updated table & writeup to include final Maryland numbers, which just came out today.

As I keep stressing, the 2018 Open Enrollment Period is still going on across 6 states 4 states 3 states (+DC). Colorado's deadline is Friday night. Minnesota's is Sunday, followed immediately by Washington State on Monday. Eight days later, Massachusetts closes the books on the 23rd. Finally, eight days after that, OE5 officially ends for the last three state-based exchanges in California, DC and New York State.

I'm a little late with this one (spent pretty much the entire day dealing with cleaning up the aftermath of my Terrible, Horrible, No Good Very Bad Day), but Connect for Health Colorado, the CO ACA exchange, issued their first update since December 17th with 3 days left to go before Open Enrollment ends for 2018:

Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Deadline is Friday
Posted on Tuesday, January 9, 2018

DENVER — More than 158,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through January 8, 2018, a rate 2 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, days ahead of the enrollment deadline.

Note: Obviously none of this remotely compares to, say, being without electricity for over three months or being deported to El Salvador after living here legally for over a decade for no reason, but I think I'm entitled to vent a bit once in awhile...

Yesterday morning I was using the snowblower when I hit a rolled-up newspaper buried under the snow (in a plastic sleeve) which promptly got jammed in the impeller and likely burned out the auger belt.

Then, I noticed my front driver's side tire was really low, but I had to pick up my kid from school so didn't have time to fill it with our air pump before doing so. I figured I could get there and back, but also turned out to be really low on gas, so on the way back, we stopped at a nearby gas station where I figured I'd use their air pump as well. Got gas but the air pump was broken.

No official press release yet but AccessHealthCT just released a series of tweets with their official final numbers...

114,134 CT residents have enrolled in a health plan for 2018 - 2.3% more than last year! #AHCT

— Access Health CT (@AccessHealthCT) January 8, 2018

Happen to be in the Birmingham/Bloomfield area of Michigan on Monday, Jan. 8th? Swing by the Bloomfield Township Public Library at 1099 Lone Pine Road, Bloomfield Hills, MI 48302 from 7pm - 9pm, where I'll be giving the Birmingham/Bloomfield Democratic Club an overview of the ACA/healthcare landscape situation now that the dust has mostly settled on the 2018 Open Enrollment Period.

A new letter from the Congressional Budget Office to Sen. Orrin Hatch says:

Re: Updated Cost Estimate for S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017

Dear Mr. Chairman:

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have updated their estimate of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017, to account for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and to account for administrative action. The agencies now estimate that enacting this legislation would increase the deficit by $0.8 billion over the 2018-2027 period.

This one is quite a head-scratcher, but let me see if I can peel the onion.

(yes, I know everyone else was posting writeups about this yesterday; I was a little swamped with some personal issues)

The original announcement was made last fall:

A week or so ago, there was some confusing news about how Donald Trump may or may not be planning on signing a new healthcare-related executive order. I didn't write about it earlier because at first it sounded like he was talking about a meaningless "sell across state lines" decree...meaningless because the ACA already allows carriers to sell ACA-compliant policies across state lines, as long as the states in question sign onto an interstate compact.

More recently, however, it became clear that the executive order in question is more dangerous than I thought:

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