2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Now that the Democrats have officially retaken control of the U.S. House of Representatives, everyone's expecting them to try and save and improve the ACA. I stress "try", of course, because without the Senate, it's unlikely that any bill to protect or improve the law will get passed...and even if it did somehow, the odds are high that it would then be vetoed by Donald Trump (or Mike Pence, in the unlikely-but-still-conceivable event that Trump is removed from office before January 20, 2021).

HOWEVER...they can certainly at least try. With a likely 235:200 advantage in the House and a caucus which is far more progressive on healthcare issues than it was a decade ago, the Dems shouldn't have too much trouble passing a fairly robust healthcare reform package even knowing that it's unlikely to go anywhere in the Senate. The question is how robust?

#1: The 2019 Open Enrollment Period runs from November 1st - December 15th...in most states.

  • In California, open enrollment already started on Oct. 15th, and will run through Jan. 15, 2019.
    • If you enroll by Dec. 15th, your coverage will start Jan. 1st, 2019.
    • If you enroll between Dec. 16th - Jan. 15th, coverage will start Feb. 1st, 2019.
  • In Colorado, open enrollment runs through Jan. 15, 2019.
    • If you enroll by Dec. 15th, your coverage will start Jan. 1st, 2019.
    • If you enroll between Dec. 16th - Jan. 15th, coverage will start Feb. 1st, 2019.

So, my wife and I finally got around to renewing our own ACA exchange plan the other day (yes, I'm realize how ironic it is that I've spent the past 41 days screaming at everyone else to #GetCovered while waiting until the last week to do so myself. We're a bit busy this month. Don't @ me.)

Anyway, we went through a lot of research and discussion (including assistance from fantastic folks who know more about this stuff than me like Louise Norris and David Anderson) about whether to stick with our existing Gold HMO (we have some pricey issues to deal with) or to switch to a Bronze HMO...but with a Health Savings Account.

I know very little about HSAs, but Dave and Louise suggested I look into one so we did. In our particular case, we decided to stick with the Gold plan in the end for reasons I'd rather not get into...but along the way, while researching our actual 2018 medical claims and expenses, I noticed something rather important. See if you can figure out what it is:

I've written a lot about how the clever Silver Loading and Silver Switcharoo pricing workarounds have managed to result in millions of people becoming eligible for dirt-cheap or even free Bronze ACA exchange healthcare policies, or bargain-priced Gold plans for millions more. Last year, in fact, the Kaiser Family Foundation determined that roughly 4.5 million uninsured Americans qualified for FREE Bronze plans nationally.

Well, they've done it again for 2019. The total number eligible for FREE Bronze plans has dropped a bit to 4.2 million, but that's still a TON of people:

The midterms are over, and the Democrats won back the U.S. House, so the ACA is (mostly) safe at last, right?

Well...maybe. In addition to the ongoing regulatory sabotage by the Trump Administration to undermine, weaken and generally piss all over the law as much as possible, there's also still a little thing called Texas vs. Azar, aka the #TexasFoldEm federal lawsuit. Oral arguments were held way back in early September, and right-wing Judge O'Connor claimed that he'd rule on a preliminary injunction "quickly" afterwards.

As a reminder, here's the #TexasFoldEm case in a single image:

OK, this "news" isn't remotely worth a full blog entry, but what the heck; Idaho has been radio silent since Open Enrollment started, so any news out of the Great Potato state is welcome:

Deadline to Apply for Health Insurance for the 2019 Plan Year is Dec. 15

  • Nine in 10 Idahoans Qualify for a Tax Credit to Help Lower Monthly Premiums

BOISE, Idaho – Idahoans wanting health insurance coverage starting on January 1, only have a few days left to enroll in a plan for 2019 with Your Health Idaho, the state’s health insurance exchange. Idahoans must complete their application by midnight, December 15 in order to have coverage at the start of the new year. In response to high demand, Your Health Idaho is extending its support center hours to help customers enroll or answer any questions.

Again, I realize that doesn't mean much of anything on its own; I haven't a clue what counts as "high demand" in Idaho or how it differs from prior years. Still, it does suggest that things are running smoothly at the Idaho exchange.

Minnesota's ACA exchange, MNsure, released a mid-period enrollment report a few weeks back, putting their total at over 97,000 QHP selections through November 14th.

They just updated that tally for me: 104,162 signups as of EOD 12/6.

Last year, MNsure broke 100,000 enrollments as of 11/23 and 101,626 as of 12/15, which should have put them at right around 100,900 QHP selections as of 12/06/17. That means the current total is around 3.2% ahead of the same point last year.

It's important to note that unlike most states, Minnesota's 2019 Open Enrollment Period doesn't end on the 15th (although you do have to sign up by then in order to have coverage start on January 1st); Minnesotans still have until January 13th to enroll (anyone who enrolls after 12/15 will have their coverage kick in on February 1st instead).

 

With major enrollment updates from California, New York, DC and Massachusetts and especially the Week 5 update from HC.gov all rolling in over the past couple of days, I thought this would be a good point to put it all together and see where things stand just ahead of the big final push (for most states).

Here's a state-by-state breakout of confirmed QHP selections. All 39 HC.gov states as well as New York are as of 12/01, while California, Colorado and Connecticut are all as of 11/30; Rhode Island and Washington State are as of 11/28. The outliers are DC and MN (11/13 and 11/14) and Massachusetts (thru 12/04). I don't have any enrollment data from Idaho, Maryland or Vermont as of yet.

When comparing the year over year numbers, I have not corrected the HC.gov states for the missing day below, but I did add a column noting how many days worth of data are missing in each state.

As you can see, all of the HC.gov states are running behind last year as of roughly the same point in time (Florida is slightly ahead if you adjust for the missing day). As a whole, the 39 HC.gov states are down 11.3% so far.

Week 5 via CMS:

Week 5, Nov 25 - Dec 01, 2018

In week three of the 2019 Open Enrollment, 773,250 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

This Just In from the New York State of Health exchange...

Press Release: NY State of Health Announces 2019 Enrollment is Up in First Month of Open Enrollment Period
Dec 5, 2018

  • More than 930,000 Consumers Enroll in a Qualified Health Plan or the Essential Plan
  • December 15 is the Deadline to Enroll for January 1, 2019 Coverage

ALBANY, N.Y. (December 5, 2018) - NY State of Health, the official health plan Marketplace, today announced in the first four weeks of the 2019 open enrollment period, enrollment is outpacing last year. More than 930,000 consumers have enrolled or renewed coverage in a Qualified Health Plan or the Essential Plan for 2019. Consumers must enroll or renew by December 15, for coverage beginning January 1, 2019.

The numbers are several weeks out of date, but it's better than nothing: Here's the DC Health Link's official 2019 ACA Open Enrollment report through November 13.

Things weren't looking great as of two weeks in: Total enrollments were down 6.8% (1,202 people) year over year as of the same date. We'll have to see whether things have picked up since then.

As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC had already reached 85% of that as of 11/13.

DC's report also includes all sorts of wonky demographic breakout data, and even closes with currently effectuated numbers for both the individual and small business (SHOP) markets. Remember, DC's SHOP market is unusually high (especially compared to the individual market) because the ACA requires all members of Congress and their staff to enroll using it if they want their 72% FEHB subsidy.

I just received another official update from the MA Health Connector...

On enrollment, as of today, we have 261,619 enrolled members for January. We have an additional 14,368 plan selections made (but unpaid) for a total of 275,994 under the CMS definitions. New enrollments for 2019 continue to trend slightly ahead of last year.

A week or so ago I noted that Massachusetts had enrolled just over 264,000 people (10,000 of whom hadn't actually paid their January premium yet...MA's exchange is one of the only states which is able to actually track payment data live, since they handle it themselves). They were up 10K over the same date in 2017, or up around 4% year over year.

I don't have a hard "thru 12/05" number for 2017 this week, but they did confirm the 276K number is still "slightly ahead", which is good.

Michigan was pretty much Ground Zero for the 2018 Blue Wave midterm elections. In addition to Democrats flipping the Governor's seat (and holding onto Debbie Stabenow's U.S. Senate seat), they also flipped the Attorney General, Secretary of State, one of two state Supreme Court seats, both of the state Board of Education seats which were up and all six state University Board seats which were up. In addition, they picked up two U.S. House seats, five state Senate seats and five state House seats.

It was a complete and utter repudiation of both Republican governance and their agenda.

You might expect the Michigan GOP to accept the clear will of the voters. You would be very, very wrong.

As Democratic candidates prepare to take three statewide offices on Jan. 1 — governor, attorney general and secretary of state — Republican lawmakers introduced bills Thursday to challenge their authority.

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

"But the whole point of the doomsday machine is lost if you keep it a secret! Why didn't you tell the world, eh?

--Dr. Strangelove, 1964

No one applauded the New Jersey legislature and Governor Phil Murphy louder than I did when they swiftly passed several laws this past spring which cancelled out much of the Trump Administration's sabotage of the Affordable Care Act. As a reminder, the laws and waivers they put into effect included:

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