I haven't written anything about the developments in the #TexasFoldEm anti-ACA lawsuit in awhile, partly because I was out of the country for a couple of weeks and got backlogged. Then again, things are kind of at a standstill at the moment anyway, so perhaps that omission on my part isn't quite as big of a deal as I had feared.

Anyway, here's some of what's happened since Judge O'Connor's lousy ruling on December 14th:

A federal judge in Texas who recently declared the Affordable Care Act unconstitutional has stayed his ruling to allow for appeals.

That means “Obamacare” remains in effect while litigation continues.

REMINDER from MNsure.org...

Last chance: MNsure Open Enrollment Period Ends this Sunday, January 13
January 10, 2019

ST. PAUL, Minn.—Minnesotans have until midnight on Sunday, January 13, to secure health insurance coverage through MNsure for 2019. Those who enroll by the deadline will have coverage that begins February 1.

"MNsure is the only place to get financial help to save money on your monthly premium," said MNsure CEO Nate Clark. "More than half of all MNsure enrollees are receiving tax credits."

Minnesotans can see if they qualify for financial help, while also comparing medical plans side by side, by using MNsure's plan comparison tool.

MNsure has extended Contact Center hours in the days leading up to the final deadline:

Earlier this week, newly-sworn-in Governor Gavin Newsom announced several proposals for improvements to California's implementation of the Affordable Care Act along with some other important healthcare-related measures. The most important ACA-specific ones were:

  • Reinstating the individual mandate penalty at the state level, as New Jersey, the District of Columbia, Vermont and Massachusetts have (VT's doesn't kick in until next year, and MA simply reverted back to their own pre-ACA mandate penalty), and
  • Enhancing ACA subsidies and expanding them to those earning 400-600% of the Federal Poverty Level

Newsom didn't include any details on either proposal, but I assumed that the mandate would simply reinstate what it was under the ACA before being repealed by Congressional Republicans in December 2017 ($695 per person or 2.5% of household income), and that the expanded subsidies would simply take the existing ACA formula (which limits the cost of benchmark Silver plans to no more than 9.86% of household income and provides subsidies to cover the difference after that), and raise the cut-off point from 400% FPL to 600% FPL.

ACASignups.net, February 11, 2018:

That should mean that the average HC.gov premium is around $600 or so per month in 2018. The 3.5% surcharge hasn't changed for 2018, which means the federal exchange should take in something like $252/year per enrollee. Total enrollment in HC.gov plans was down 5% this year, so I'll assume average effectuated enrollment will be as well...somewhere around7.13 million per month. That means ~$1.8 billion in HC.gov revenue directly from the premium surcharge.

All of this brings me to my question:

In the midst of the ongoing #TrumpShutdown, where hundreds of thousands of federal employees are either off the job altogether or having to work without being paid and hundreds of federal contractors are being stiffed for the work they've done in good faith, I just wanted to remind folks that Donald Trump also screwed over several hundred insurance carriers in October 2017 when he cut off contractually-owed Cost Sharing Reduction reimbursement payments to insurance carriers nationwide.

Once again, the very short version is this:

Something is definitely in the water this week, and I believe it's called "Democrats hitting their stride on healthcare reform":

And now, this:

Gov. Jay Inslee and Democratic lawmakers Tuesday announced proposed legislation for a new “public option” health-care plan under Washington’s health-insurance exchange.

The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act.

“We are proposing to the state Legislature that we have a public option that is available throughout the state of Washington so that we can increase the ability to move forward on the road to universal health care in the state of Washington,” said the governor, who is considering a run for president in 2020.

I...really don't know what to do with this announcement:

New York City will begin guaranteeing comprehensive health care to every single resident regardless of someone's ability to pay or immigration status, an unprecedented plan that will protect the more than half-a-million New Yorkers currently using the ER as a primary provider, Mayor Bill de Blasio said.

It's not health insurance, his spokesman clarified after the surprise announcement on MSNBC Tuesday morning.

"This is the city paying for direct comprehensive care (not just ERs) for people who can't afford it, or can't get comprehensive Medicaid — including 300,000 undocumented New Yorkers," spokesman Eric Phillips tweeted.

At a press conference Tuesday, de Blasio said the plan will provide primary and specialty care, from pediatrics to OBGYN, geriatric, mental health and other services, to the city's roughly 600,000 uninsured.

This Just In from Covered California...

California’s Open Enrollment for Individuals Ends Jan. 15; Consumers Have One Week to Sign Up for Health Care Coverage

  • Consumers have through Jan. 15 to sign up and select a plan through Covered California or directly with health plans for coverage that will begin on Feb. 1.
  • The final week of open enrollment comes on the heels of Gov. Newsom’s announcing sweeping proposals, including a new requirement for having coverage and expanded subsidies.
  • While open enrollment ended for much of the nation in December, California’s final deadline is about two weeks earlier than it was in previous years, when open enrollment ran through the end of the month.
  • More than 238,000 consumers had selected a plan through Dec. 31.

Some awesome news out of the Golden State today:

Gov. Gavin Newson announced sweeping proposals to tackle the state’s healthcare needs shortly after taking office on Monday, outlining a dramatic Medi-Cal expansion that would cover young undocumented adults, a requirement that all consumers in the state carry health insurance and increased subsidies for middle-class families to help those who need it.

...Newsom campaigned on a universal healthcare platform and has said the issue would be among his top priorities. His announcement on Monday stopped short of the single-payer system demanded by activists that would cover all residents’ healthcare costs, but was characterized as the first step down that path.

According to the article, Newsom, who just took office a few hours ago, already plans on rolling out his proposed state budget on Thursday, which is expected to include, among other things:

This just in from Connect for Health Colorado...

Rural Counties Lead Connect for Health Colorado® 2019 Health Coverage Sign Ups; Many Have Already Passed 2018 Totals

DENVER – Rural counties are leading the way in Connect for Health Colorado® sign ups as the state health insurance marketplace heads to the last week of the 2019 Open Enrollment period.

Overall, 2019 health plan selections through Connect for Health Colorado are running about 3 percent ahead of the comparable period a year ago but many rural counties have already exceeded the number of plan selections made in the entire two-and-a-half-month Open Enrollment period in 2018.

By January 3, 2019, 30 of the state’s 64 counties had matched or exceeded the number of plan selections made during all of last year’s Open Enrollment. This year’s Open Enrollment runs through January 15.

When I last checked on Access Health CT, Connecticut's ACA exchange, their 2019 Open Enrollment Period tally was about 10% short of their final number from 2018, by around 11,700 people. However, they still had a solid month left to make up the gap, with the enrollment deadline extended out until January 15th, 2019.

CT still has another week to go, but I just received a partial update, as of January 4th.

That's a net increase of 6,286 QHP selections between 12/15/18 - 1/04/19, or around 300 per day on average. At that rate, they'd add around 3,300 more by the final 1/15 deadline, putting them 112,000...still around 2,100 shy of last year. On the other hand, that timeframe included both Christmas and New Year's Eve, when enrollment tends to drop through the floor, so there's still a chance of Access Health CT at least matching 2018, though exceeding the 114,134 tally would be a pretty tall order at this point.

For years now, I (and many other healthcare wonks) have been arguing that one of the most important fixes/improvements that the ACA needs regardless of the Next Big Thing® is to #KillTheCliff...that is, to eliminate the infamous "subsidy cliff" which hits those who earn just over the 400% Federal Poverty Level income cap for Advance Premium Tax Credit (APTC) assistance.

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

This happened while I was out of town, but it's welcome news nonetheless...

Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year

RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.

“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”

OK, with the FINAL HC.gov Report having been released, I can now fill in even more blanks in the 2019 Open Enrollment Period: A grand total of 11.24 million 11.3 million QHP selections nationally so far. That includes 8.41 million on the federal exchange, plus another 2.82 million 2.9 million on the 12 state-based exchanges.

If the counting were to stop right here, the total would be 3.9% 3.8% lower than last year nationally, which would actually be pretty good all things considered.

HOWEVER, it isn't over yet. Deadlines in several state-based exchanges haven't expired yet. New York and DC are open for business until January 31st, and many people in Alaska, Georgia and Florida still have time to enroll due to last fall's earthquake and hurricanes.

Here's what it looks like as of right now:

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