Here's one more way Trump/Price could screw w/enrollment this fall

I've noted before that even if the Trump Administration does ensure CSR reimbursement payments and does enforce the individual mandate in 2018, there are literally dozens of other ways that Trump and HHS Secretary Tom Price could sabotage the 2018 Open Enrollment Period. Here's just a few, several of which they've already been caught doing:

• Minimal or non-existent advertising/outreach/promotional efforts
• Understaffing of call centers/support staff, leading to absurdly long hold times
• Deliberately underthrottled server bandwidth, slowing HC.gov down or even taking it offline, especially during peak hours
• "Accidentally" misentered enrollment instructions or policy specifications
• Confusing or missing confirmation/status notification messages either on the site, via email or both
• Incorrect APTC/CSR subsidy formulas giving incorrect tax credit/financial assistance details to enrollees
• Burying/completely removing the "Window Shopping" tool on the site

Here's another one for you, courtesy of Abby Goodnough of the New York Times:

Mr. Slonaker also said that at a conference that C.M.S. held for navigators in June, employees of the agency said the federal government would not run any ads to promote open enrollment this year. A spokeswoman for the agency would not confirm whether that was true or answer other questions about the administration’s plans.

Other open questions include whether the Trump administration will automatically re-enroll people who did not actively cancel or change their plan, as Mr. Obama’s did, and whether it will increase staffing at call centers that help people sign up, given the compressed enrollment time frame.

I was actually philosophically opposed to the auto-renewal when it was first announced back in the summer of 2014. My reasoning was simple: With so many changes to the policy offerings, premiums/deductibles and the way that the APTC subsidy formula can shift and change from year to year, it made more sense to me to require current enrollees to visit the ACA exchange at least once every enrollment period to review their options. I figured HC.gov and the other state-based exchanges could add a "Quick Renew" button where the enrollee would load the site, log into their account, poke around to see what had changed that year, and then, if they wanted to renew their existing policy after all, just do so using one click.

As it happens, HC.gov did add something similar to that starting in 2015, but it's still an optional thing. The policy still remains the same for current enrollees: If your current policy is being offered the following year and you take no action whatsoever, the system will automatically renew you anyway around mid-December unless you actively log in and tell it not to do so. Your other options are to actively renew the same policy, switch to a different one or actively cancel your coverage at the end of the year. If your current policy isn't still being offered (i.e., your carrier pulls out of your county/state or drops that particular plan), you'll either be automatically "mapped" to a similar policy or you'll have to actively shop around, depending on the situation and plans which are still available.

In the fall of 2014, about 2/3 of all renewing enrollees did so passively...that is, they were automatically renewed without taking any action on their part, while only about 1/3 actively renewed their policies or shopped around for a different one. By 2017, that ratio had reversed, at least on the federal exchange at HealthCare.Gov:

Biweekly Enrollment Snapshot • WEEKS 8 AND 9, DEC 18 – DEC 31, 2016

8.8 million Americans have signed up for coverage through HealthCare.gov since Open Enrollment began on November 1st. This compares to about 8.6 million plan selections last year at this time, demonstrating Americans’ strong and growing demand for affordable, quality coverage. Total plan selections as of December 31st, which include auto reenrollments, consist of 2.2 million new consumers and 6.6 million returning consumers. Among returning consumers, two thirds, or 4.4 million, actively selected a plan, an increase from last year’s already high levels of consumer engagement.

“With 8.8 million Americans signed up for coverage through HealthCare.gov, more than last year at this time, it is clear that Americans want and need this vital coverage,” said U.S. Department of Health and Human Services Secretary Sylvia M. Burwell. “As we enter the New Year, Americans who are still uninsured should sign up by January 15th to have coverage starting February 1.”

Today’s report covers the period from December 18 through December 31, 2016. This snapshot does not include plan selections from the 12 State-Based Marketplaces that use their own enrollment platforms. Those numbers will be included in the upcoming Mid-Open Enrollment report.

To be fair, a big part of the reason why so many more people are actively shopping/renewing these days as opposed to letting themselves be passively renewed is because, frankly, a lot of carriers have either dropped out of the exchanges or terminated many of their existing policies (keeping HMOs while eliminating PPOs, for instance), which pretty much forces those enrollees to shop around whether they wanted to or not. Regardless, it's still a good thing in general that more people are paying attention to the process and their options.

In any event, I may have been opposed to the autorenewal policy at first, but I've since realized that as a website developer and a blogger, I'm more comfortable than some people with logging into websites and monkeying around with settings and options. There are millions of folks who'd rather not bother, even if it means they end up missing out on a potentially better deal.

On the one hand, that 2.2 million figure only refers to people signed up on the federal exchange (HC.gov), not the state exchanges. On the other hand, HC.gov is precisely where the potential for mischief is; the state-based exchanges are all, to my knowledge, doing their best to actually enroll as many people as possible.

So, what would happen if Tom Price announced that the HHS Dept. has decided not to automatically renew anyone for 2018, and instead requires everyone to actively renew/shop around or be dropped? Well, that 2.2 million figure gives a pretty good place to start. Total OE4 enrollment on the federal exchange was around 5% lower this year than last, so under normal circumstances I'd expect roughly 2.1 million people who'd otherwise be autorenewed to instead have to take action.

How many of those folks would go ahead and actively do so, and how many either wouldn't realize they have to until it's too late or would get confused by the process (even though it's been streamlined tremendously since the ugly early days of the exchange site)? Normally I'd assume perhaps 3/4 would grudgingly go ahead and log onto HC.gov to do so, meaning only perhaps half a million enrollees would be lost in the shuffle.

However, there's another factor to consider, and this isn't hypothetical: The 2018 open enrollment period will only be half as long as usual.

So instead of only having to contend with new enrollees and 1/3 of the current enrollees, the HC.gov team would instead have to handle all enrollees (new or renewals)...in half the time.

Even without any other active sabotage measures, I could easily see "no autorenewals" on HC.gov being responsible for depressing total enrollment by perhaps 1-1.5 million people by itself.

For that matter, consider this:

I am also worried about https://t.co/ruGOtKUHS9. making everybody get new passwords. That would be awful.

— Millard Fillmore (@MillardFillmor1) August 21, 2017

Again, as a website developer, I actually encourage people to reset their passwords on occasion as a security measure...but again, there's a big difference between encouraging it as a safety protocol and requiring people to do so purely to screw with them and put obstacles in front of them. The point isn't whether they will do this, but the fact that a) they could and b) with this crew, it's highly likely that they'd do that sort of thing.

Once again: When you elect someone President of the United States, you're also effectively "electing" everyone they put in charge of every department of the federal government.

63 million people chose, whether they realized it or not, to put the most incompetent, reckless, unqualified person in the country in charge of our nuclear arsenal. Just what sort of people did they think he was gonna put in charge of all those departments?