START OF 2018 OPEN ENROLLMENT PERIOD

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Trumpcare

I've spent the past two months painstakingly crunching the numbers in an attempt to project just how many people would likely lose their healthcare coverage if the ACA were to be: a) fully repealed; b) with immediate effect; and c) without any substantive replacement policy put into its place.

My conclusion, after much analysis, double-checking and updating, is that the grand total would be roughly 24 million people: Around 8.2 million current exchange enrollees, nearly 15 million via Medicaid (expansion or otherwise), and the 750,000+ people enrolled in BHP programs in Minnesota and New York.

 

I told the following story about two years ago. It bears repeating for a different reason:

When I was 18 years old, my father died of a brain tumor. 

A few weeks after the funeral, I left for college at Michigan State University. Freshmen were required to room blind, so I had no idea who my roommate would be. When I met him, a tall blonde guy named Brian, I was still wearing the Kriah ribbon--a small torn piece of black cloth.

We shook hands, introduced ourselves, and then Brian asked me what the torn ribbon was for. I explained that my father had recently passed away, and that Jewish custom was for mourners to wear torn black cloth as part of the mourning process.

His response?

"Oh, I'm sorry to hear that he's burning in hell right now."

I should note that this was less than 5 minutes after we had met. I was assigned to live in the same room as this guy for the next 9 months.

You may have noticed that I haven't been posting as many blog entries the past week or two. This has been partly due to our 5-day power outage, of course, as well as various other personal odds & ends. The main reason, however, is that I've been driving around the metro Detroit area giving a PowerPoint presentation about the ACA and Trumpcare to various groups. Last night was my 4th or 5th presentation, and while it was kind of sloppy and scattershot the first few times, I'm streamlining and modifying for each new event.

Even so, I'm cramming a lot of information into an hour or so, and several people at each event have asked if I could upload the slideshow to the website for easy download.

Therefore, I present: The Affordable Care Act and Repeal/Replace: Where Things Stand (pdf).

Me, February 3:

Of course, it's impossible to prove that the Trump executive-order/ad-kill combo was the cause of the numbers petering out at the end of the enrollment period...but I have some pretty strong evidence that it did.

How? Well, remember, the 12 state-based exchanges, which cover around 1/4 of all Qualified Health Plan (QHP) selections nationally, were not hurt by the ads being killed. The executive order might have had some impact, but the actual HC.gov ads being yanked shouldn't have hurt them much since these exchanges have their own, separate branding, marketing budgets and outreach programs.

I therefore decided to compare how the 39 HC.gov states performed relative to the 12 state exchanges...the results are pretty telling.

...UPDATE 3/16/17: I've updated the tables and chart below with the final, official 2017 Open Enrollment Period numbers from CMS.

As I noted earlier today, CMS has released the official 2017 Open Enrollment Period report, along with a whole mess of State, County and Zip Code-level breakouts and related demographic information, including APTC/CSR recipients, Metal Levels, Income Levels and so on.

This means I now have to dive back into my "How Many Could Lose Coverage?" project and update/revise the numbers for every state, county and Congressional district. Fun times!

On the one hand, this will take some time, so please bear with me. It took nearly 2 months to compile this data for all 50 states; it might take another week or so to update them with the latest numbers. Also note that it may only be the 39 states on the federal exchange which get updated, unless some of the state-based exchanges release their own updated reports.

On the other hand, it's important to note that for most counties/congressional districts, the numbers are likely to be fairly close to where they already are. For example, I've already completed Michigan; here's a before/after comparison:

Yesterday the CBO pretty much torpedoed the Trumpcare bill. Everyone from across the political spectrum now seems to agree that it's a complete disaster, with the exception of Paul Ryan and Tom Price (hell, even an internal Trump White House analysis apparently concluded that even more people would lose coverage than the CBO did...26 million vs. the CBO's 24 million).

However, there's one part of the AHCA which should be kept: The $100 billion that they currently have allocated to throw at the states to stabilize the individual market. As the CBO noted:

After five days, my power still hasn't been restored, and it's no fun typing with freezing fingers on a cold keyboard, but I had to make an exception for this: The CBO has officially scored the Trumpcare bill.

I'll be writing much more about it over the next few weeks, of course, but for the moment, my initial overview can be found in my latest article for healthinsurance.org. Take a look!

 

As noted this morning, our power is out and isn't expected to be back up for several days, so my posts will be spotty and brief while we deal with stuff like our kid being out of school, keeping the generator running, etc. However, I just had to post this one.

You've probably already seen this clip, but it's so staggeringly idiotic that I have to repost it here.

Do I even need to explain how gob-smackingly stupid this claim by Paul Ryan is?

 

(this is mostly a repost from last week, but there've been some additional developments since then):

Friday, January 20th:

Politically, the big unknown is whether or not Paul Ryan and Mitch McConnell will get away with trying to pin the blame for this on the Democrats/the law itself. That's why they've been pushing the "Obamacare is already in a death spiral!" claim hard for the past few weeks, even though it quite simply isn't.

...So, if this does end up in a worst-case scenario, Trump's "stop enforcing the mandate altogether!" order here could end up causing that death spiral even if the GOP doesn't technically end up repealing anything legislatively. The carriers would start announcing that they're bailing next year as soon as this spring (remember, the first paperwork for 2018 exchange participation has to be filed in April or May), and McConnell/Ryan would simply say, "See?? We told you it was collapsing all by itself! We didn't touch nuthin'!!"

UPDATE 3:00pm 1/27/17: 

HHS official tells @CitizenCohn that Ocare automatic phone calls and outreach tools will remain. but not tv ads https://t.co/jjYfReoylD

— Sam Stein (@samsteinhp) January 27, 2017

Huh. OK...that's directly opposed to what Demko's Politico story said last night (all media outreach including email reminders), but whatever.

UPDATE 11/28/17: OK, here's the latest:

The Trump administration apparently was unable to scrap all outreach efforts to enroll individuals in Obamacare, following widespread concern that its move Thursday to pull ads promoting enrollment could destabilize the insurance marketplace.

NOTE: I started writing this up as an update to an earlier post, but it was already pretty lengthy so I've broken it off onto a separate entry.

Last year, around 12.7 million people selected QHPs via the ACA exchanges nationally, including roughly 9.6 million via the federal exchange (HealthCare.Gov) and another 3.1 million via the 13 state-based exchanges.

This year, prior to the November election, both the HHS Dept. and I were projecting somewhere in the 13.5 - 14.0 million range.

UPDATE 7:00pm 1/26/17: Welp. This puts the nail in the coffin:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

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