The short version is that she asked people to chime in with their "Obamacare Horror Stories" only to find that the response included a flood of "Obamacare is Awesome!!" stories.
Anyway, today she responded to the flood of positive tales by basically saying that those are mostly about the parts of the ACA which Republicans like, and therefore "don't count" for some reason or another:
Who can sign up?
The special enrollment period is for people who are uninsured now, have not had coverage at all in 2015, paid a tax penalty for not having coverage last year, and didn’t find out about that penalty until they did their taxes.
People in that situation can sign up for private insurance plans through Access Health CT, the state’s health insurance exchange, from April 1 through April 30. (People who qualify for Medicaid can sign up at any point in the year.)
When will the coverage start?
People who sign up by April 15 will receive coverage starting May 1. Those who sign up from April 16 through April 30 will receive coverage beginning June 1.
h/t to Charles Ornstein for the link to this amusing, if befuddling column in the Wall St. Journal today:
Two reports released in the past week demonstrate a potential bifurcation in state insurance exchanges: The insurance marketplaces appear to be attracting a disproportionate share of low-income individuals who qualify for generous federal subsidies, while middle- and higher-income filers have generally eschewed the exchanges.
And there we have it: The "Healthy Michigan" program, the Wolverine State's implementation of ACA Medicaid expansion, has broken the 600,000 enrollee mark:
Healthy Michigan Plan Enrollment Statistics
Beneficiaries with Healthy Michigan Plan Coverage: 603,681
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
*Statistics as of March 30, 2015
*Updated every Monday at 3 p.m.
Montana senators endorsed a Republican's compromise Medicaid expansion bill Friday after voting to blast it out of committee and onto the floor earlier in the week.
Senators endorsed the amended measure 28-22 on Friday after more than 90 minutes of debate.
If it makes it past the state House, the Governor will definitely sign it, which is great news for up to 70,000 Montanans.
No, not that anti-Obamacare SCOTUS case; the King v. Burwell decision won't be announced until June.
The U.S. Supreme Court on Monday declined to hear a new challenge to President Barack Obama's healthcare law that took aim at a bureaucratic board labeled by some Republicans as a "death panel" because it was designed to cut Medicare costs.
The high court left intact a ruling by the San Francisco-based 9th U.S. Circuit Court of Appeals that threw out the lawsuit.
As you'll recall, after over a month of radio silence since the end of Open Enrollment, a couple of weeks ago the HHS Dept. finally stated, when asked directly about it by CNBC's Dan Mangan(although they didn't bother responding to me about it over the previous few weeks), that yes, they would be releasing post-OE2 enrollment data last week.
Well, last week came and went...and nothing. When called out for this publicly by Mangan on Friday afternoon, HHS responded by claiming that they'll do so this week.
While there's a few somewhat plausible ideas tossed in here and there, and a few even voluntarily participated in the ACA's Medicaid expansion program (ironically the most "socialized medicine-ish" provision of the law), on the whole their "policies" are pretty much big nothingburgers.
The most telling (and amusing/depressing, depending on your POV) entries are the ones for Rand Paul, Jeb Bush, Chris Christie, Rick Perry, Lindsey Graham and particularly Carly Fiorina:
UPDATE 3/30/15: I wasn't planning on "tweet-spamming" this one, seriously. However, given that this survey is starting to get traction among mainstream news outlets, I thought it was important to take a serious look at the methodology and what the survey is really saying.
So, some outfit called the Foundation for Government Accountability released a Big Survey which claims that Americans hate Obamacare, that they "don’t expect or want states to bail out Congress or the Obama administration" and that they're "prepared to vote against their state lawmakers the next time they’re up for re-election if they set up a state exchange."
First of all, who the heck is the Foundation for Government Accountability? Well, according to Wikipedia:
Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:
Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.
An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.
Look, I'm not trying to be an obnoxious pain in the ass, but I've been asking for weeks now whether or not the HHS Dept. will or won't be releasing off-season enrollment data for HealthCare.gov, at least during the #ACATaxTime special enrollment period, with nary a peep in response.
Last year, they didn't provide any off-season enrollment reports, but at least they announced as much. I was upset about it, but at least I knew.
Since things are a bit slow at the moment (and inspired by this post (on Facebook, natch) from dKos Sr. Campaign Director Chris Bowers), I figured this would be a good time to ask for some love for the ACA Signups Facebook Page.
As for Twitter, while my personal account is the best known, If you'd prefer just the ACA posts without my personal garbage posts, don't forget to follow the officialACA Signups Twitter Feed.
In the midst of a pretty quiet week data-wise, the Washingotn HealthPlanFinder had a pleasant surprise: An extremely comprehensive enrollment report which breaks down their 2015 numbers every which way possible and, of particular importance to me, also includes data up through March 9th (as opposed to the Feb. 21st cut-off of most of the other state exchanges).
As an additional bonus, the accompanying press release also brings the QHP enrollment numbers even further up to date...right up through March 25th, I think (the PR doesn't specify the exact date of that number, but it's a few thousand higher than the enrollment report so I'm assuming it includes the 16 extra days).
You know, in the year and a half that I've been running this site, I've had a couple of "hit pieces" written about me online (the two which come to mind are the "Online Majority/Newsbusters" incident and the "Investor's Business Daily" piece) and have received plenty of email/comments from critics. However, I've never received a full-on, completely-disconnected-from-reality, frothing-at-the-mouth, speaking-in-tongues rant before...until now.
With that in mind, I present to you the email I received last night from one "Richard Frates" (I am, however, posting it as a series of images rather than the actual text since the last thing I need is for Google searches about this gibberish to bring up my site):
CLARIFICATION: A few folks have inquired whether this is simply an auto-generated spambot thing not directed at me personally (especially since there's nary a peep about the ACA in the blathering). This may be the case...except it was actually sent as a series of 4 contact form submissions in a row, over a 10 minute period. In other words, if it was a random submission, I'm pretty sure it was still done manually, not via auto-script.
“If you just do simple multiplication, 12 million [insured individuals] into $108 billion, we are talking literally every single [Obamacare] recipient would be costing this government more than $5 million per person for their insurance. It’s staggering….$108 billion for 12 million people is immoral. It’s unconscionable. ”
– Rep. Pete Sessions (R-Tex.), statement on the House floor, March 24, 2015
Glenn Kessler corrects his math, but...really, is it now necessary to do the arithmetic that my 3rd grade son was able to do in his head a year ago?
One day after announcing his plan to run for president and “repeal every word of Obamacare,” Ted Cruz confirmed that he plans on using Obamacare’s new state-level marketplace to enroll in coverage himself.
Because Cruz’s wife Heidi is joining his campaign full-time, she’s going on unpaid leave from her current job at Goldman Sachs. Earlier this week, CNN reported that the couple will lose the employer-sponsored plan through the company, and speculated that Cruz would likely be in the market for a new health care plan.
“We will presumably go on the exchange and sign up for health care and we’re in the process of transitioning over to do that,” Cruz told The Des Moines Register on Tuesday.
Gov. Peter Shumlin on Friday announced contingency plans for a federal government takeover of the state's troubled health insurance exchange and an alternative hybrid federal-state system.
Vermont Health Connect still isn't meeting its goals, and if it doesn't meet two key ones in the coming months, Vermont could scale back its handling of the project in favor of the federal government, Shumlin said. Those goals include:
One is about Ted "Joseph McCarthy Lookalike/Soundalike" Cruz being "hypocritical" by enrolling the ACA himself (this is mildly amusing, but people comply with laws they personally oppose all the time, so I'm not really making hay out of this one).
In any event, there you have it. IF the other 2/3 of the states follow similar retention patterns to the 1/3 I have data for, the current number enrolled in exchange QHPs as of this writing should be somewhere between 6.8 - 7.0 million people.
Remember how I made 6.8 million the low end of that range in the interest of caution because HHS had previously insisted that the August effectuated enrollment number was 7.3 million?
So, the big ACA data report of the day is the Kaiser Family Foundation's report about 2014 federal tax credit reconciliation--that is, they've issued a big report filled with number-crunchy goodness regarding how many people qualified for "Advanced Premium Tax Credits" last year (aka APTC, aka "Federal Tax Subsidies"), how much they overpaid, how much they underpaid and so on. Lots of good stuff here.
The major takeaway (judging from my Twitter feed, anyway) seems to be one particular point: About 50% of those who received the tax credits underestimated their incomes to the point that they have to pay back an average of $794 per household (important: That's per household, not per individual enrollee).
Now, the other major news here is that 45% of APTC recipients overestimated their incomes by a similar amount, meaning that they'll receive an additional little windfall of around $773 per household, which is awesome for those folks.
OK, it's important to stress that this may not mean anything. Perhaps Justice Kennedy was just in a crabby mood at the time, or perhaps it's an indication of his thinking at the moment but he'll change his mind between now and the June decision announcement (the way that Justice Roberts supposedly did a few years ago in the NFIB case (the one where they upheld the law but shot down mandatory Medicaid expansion). Or, perhaps Kennedy will side with the plaintiffs, but Justice Roberts will "play the savior" like he did 3 years ago.
Michigan continues to astound. Remember, the official estimates of how many Michiganders are eligible for ACA Medicaid expansion ranged from 477K - 500K.
Healthy Michigan Plan Enrollment Statistics
Beneficiaries with Healthy Michigan Plan Coverage: 596,246
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
*Statistics as of March 23, 2015
*Updated every Monday at 3 p.m.
That's as much as 25% higher than the number supposedly eligible for the program.
This article is a bit outdated (it's from March 3rd); thanks to Andrew Sprung for finding it for me. Apparently over 200,000 people are now enrolled in Pennsylvania's "Healthy PA" program, which is the "alternative" Medicaid expansion plan set up by GOP Governor Tom Corbett prior to new Democratic Governor Tom Wolf taking charge. Wolf is in the process of flipping the program back to "standard" Medicaid expansion, but is running into a few snags:
Under former Gov. Tom Corbett's Healthy Pennsylvania program, the state built a second Medicaid managed-care system, separate from its HealthChoices Medicaid system that serves about 1.6 million residents. About 600,000 residents are eligible for the expanded coverage and about 200,000 have enrolled.
Among the more amusing tidbits surrounding Texas Senator and Joseph McCarthy Impersonator* Ted Cruz is the revelation that he foolishly never bothered registering TedCruz.com, with hilarious consequences.
Of course, he also failed to register other domains such as TedCruzForAmerica.com or (for those who don't know how to spell his name) TedCruze.com.
A new competitor entered the Idaho market this year, with a different business model. The Mountain Health CO-OP is Idaho's first Consumer Operated and Oriented Plan - a type of nonprofit organization authorized by the Affordable Care Act and supported with federal seed money.
The co-op's first year in Idaho yielded about 19,000 members by mid-March, with an additional 2,700 who hadn't yet paid their premiums. Most enrolled through the state exchange.
Mountain Health CO-OP expects to charge premiums high enough to allow it to avoid losing money, said spokeswoman Karen Early. "We are trying to have the lowest administrative cost we can," she said. The co-op expects its overhead and profits to be "well under" the 20 percent allowed by the law.
Thanks to HonestyinGov for giving me a heads up (via Twitter) to this Wall St. Journal article by Stephanie Armour the other day regarding a new survey (and several interviews with tax preparers) which claims that overall, those who will owe a tax penalty for not being insured last year and are still uninsured this year are not likely to go ahead and enroll during the 2015 tax filing season currently ongoing:
Major tax-preparation firms say many customers are paying the penalty and not getting health insurance. It is still early, since the special enrollment period launched Sunday, but research also suggests that many people who lack health insurance will pay the penalty and not get covered this year.
Only 12% of uninsured people would buy policies if informed of the penalty, according to a survey of 3,000 adults polled through Feb. 24 by McKinsey & Co.’s Center for U.S. Health System Reform.
Over on another comment thread, one ACA Signups regular is trying to parse out the question of "newly insured" vs. "previously insured" enrollees as they relate to both the ACA exchanges as well as Medicaid expansion. He admits to being surprised that I'm comfortable stating that "only" about 5-6 million of the current exchange enrollees are "newly insured" as opposed to "previously insured". I tried to explain both the numbers as well as the methodology headaches, but also decided this issue is worthy of a full entry, so here goes:
Meet Bob. Bob is married with 2 kids. In 2013, Bob was 64, his 2nd wife was 42, their son from Bob's first marriage was 24 and their daughter together was 15.
Bob had quite a year in 2014.
In December 2013, Bob and his wife, who had been uninsured for the past year, discovered that they qualified for Medicaid thanks to the ACA's expansion provision in their state. Their 15-year old daughter was already enrolled in the CHIP program, and their son was scrimping by on a junk "policy". Bob and his wife enrolled in Medicaid, effective January 1st.
Here's another one of the "A-list" talking points that ACA critics have been lobbing for several years now: Supposedly, egregious regulations for employer-basd healthcare coverage would "force" thousands of large/medium-sized companies to drop their coverage entirely, throwing their employees over to the heatlhcare exchanges and taking the $2,000 per head tax hit for not providing coverage instead.
Hmmm...looks like I overshot the mark a bit this time around, but still impressive growth in Medicaid/CHIP enrollment:
From the report:
The 51 states (including the District of Columbia) that provided enrollment data for January 2015 reported nearly 70 million individuals were enrolled in Medicaid and CHIP.6 This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.
394,023 additional people were enrolled in January 2015 as compared to December 2014 in the 51 states that reported comparable January 2015 and December 2014 data.7
(And yes, the "51 states" wording is CMS's, not mine)
Ways and means chairman says GOP is moving ahead on alternative to health law
WASHINGTON—Rep. Paul Ryan urged state lawmakers to resist setting up state insurance exchanges if the Supreme Court rules that key parts of the Affordable Care Act can only continue if they do so.
“Oh God, no…The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law,” the Wisconsin Republican told state legislators Thursday during a conference call organized by the...
Earlier today, the CMS/HHS Dept. held a press call to discuss the #ACATaxTime Special Enrollment Period for people who missed the open enrollment deadline this year, had to pay the non-coverage tax penalty last year and "didn't know" about the penalty until it was too late. They also discussed the exciting world of the 1095-A tax form. That's the one you fill out if you received federal ACA exchange policy tax credits for 2014; you have to reconcile what you thought your income would be with your actual income to see whether you have to pay anything back or receive a higher credit.
As you may recall, there was a bit of a problem with roughly 820,000 of the 1095-A forms; they had the wrong benchmark plan listed, which screwed up the formula used to calculate the subsidy for the tax filer, so they originally told those folks to hang tight until they received the corrected form.
Over at The Huffington Post, Jonathan Cohn lays out the potential carnage if the King v. Burwell plaintiffs receive a favorable ruling from the Supreme Court...and why it would be far, far worse than the 2 million or so people whose noncompliant policies were cancelled at the end of 2013 & 2014.
This is the first time I've updated The Graph in awhile, for an obvious reason: Since the end of Open Enrollment (including the "Waiting in Line" extension period) there's only been a tiny smattering of data updates, from Colorado, DC, Maryland, Massachusetts, Minnesota and Rhode Island...and only 2 of those include any of March. Slim pickings indeed. Of course, the #ACATaxTime Special Enrollment Period kicked off on the 15th in most states, so things should have picked up, but unless the HHS Dept. surprises me, you're not likely to hear anything official about it until after April 30th (and possibly not even then). (Update: Yay! They'll issue some sort of enrollment update next week after all!)
Still, based on the snippets of data I do have since 2/22, along with last year's off-season pattern and some educated guesswork for the tax season SEP, here's where I think things should stand as of Monday, March 23rd, 2015...otherwise known as the 5 year anniversary of the Affordable Care Act being signed into law by President Obama (make sure to click the image for a higher-resolution version):
The domain name for D.C. Health Link's website was allowed to expire for 49 minutes earlier this week.
A D.C. website development company discovered the problem Tuesday morning as it tried to use D.C. Health Link's web page for its own employees' coverage. D.C. Health Link, the District's Affordable Care Act exchange, is operated by the D.C. Health Benefit Exchange Authority and has come under fire recently for technical and usability issues.
I can't even...
(sigh) For those who aren't familiar with how domain name registrations work, renewing one takes literally seconds to do, only has to be done once per year, costs a whopping $10 or so per year, and can easily be set up to either autorenew every year or you can register the domain for up to 10 years at a time.
Fox News cited an unnamed "independent expert" to cast doubt on the veracity of recent Affordable Care Act enrollment numbers, which have exceeded 16 million Americans and are reported to have driven the largest reduction in uninsured persons in 40 years.
...On the March 16 edition of Special Report with Bret Baier, host Bret Baier briefly reported on the enrollment numbers, offering the unevidenced claim that "an independent expert says the reality is fewer than 10 million people have signed up."
I suppose I could write a lengthy screed explaining 8 ways from Sunday how utterly full of garbage that is (i.e., if you don't include Medicaid, don't include sub26ers on their parent's plan, don't include off-exchange enrollments and don't bother including the 14 states running their own exchanges), but really...why bother? FOX has literally pulled a number out of their ass here. I can do the same thing:
"FOX News claims that none of their on-air personalities have molested goats. But an independent expert says that at least 40% of them have."
As open enrollment for the second year of the Affordable Care Act’s health coverage expansion begins, a clearer picture of 2015 health insurance rates has emerged. As of November 4, 2014, seven states—Colorado, Maryland, New York, Ohio, Oregon, Rhode Island, and Vermont—as well as the District of Columbia announced approved rates for both on-exchange and off-exchange health plans on the individual market. In total, HRI has collected premium data from 43 states and the District of Columbia.
Among the seven states and DC with final rate announcements, the average premium (across metal tiers and ages) is about $344, andthe average premium increase from 2014 is 3.5%. By contrast, the average premium increase across all reporting states is 5.6%, and the average premium is $381.
The Kaiser Family Foundation has posted a very handy table listing how many people in each state are receiving federal tax credits for ACA exchange-purchased healthcare policies this year, how much those policies would cost (on average) at full price, and what the average tax credit in each state is.
I'm using their data to take this info one step further: If the Supreme Court does tear away the tax credits in states operating on the federal marketplace, just how many people would be screwed by the ruling as a result, both on and off the exchanges? Remember, studies by both the Urban Institute and the RAND Corporation agree that average individual market premiums would rise by at least 35% in those states (and potentially as high as 45% in all states) as a result of such a ruling. The American Academy of Actuaries is taking these projections very, very seriously.
PEMBROKE, Maine — Jeremy Brown has made a living hunting scallops in unforgiving waters off the state’s far eastern tip, where doctor visits are often construed as signs of weakness.
But sometimes his back hurts. His son got sick. Like many in Maine’s coastal fishing communities, he begrudgingly accepted insurance offered to his family through the Affordable Care Act and has come to rely on a federal discount to keep it.
Now, that support may disappear for tens of thousands of families in Maine and New Hampshire.
...The Affordable Care Act, President Obama’s signature legislative achievement, was enacted in 2010 and GOP lawmakers have worked to kill it since. They object to the cost and consider it governmental overreach. But if the law gets uprooted without a viable replacement, Republicans could face a backlash.
Yeah, I know, not exactly an earth-shattering development, but it's a fairly slow news day ACA-wise, and everyone's spazzing out about Hillary Clinton's a) email brouhaha and/or b) her (supposedly) imminent official announcement about whether or not she's gonna run for President next year, so I figured this was worth a post:
Repeal of the ACA would let insurers write their own rules again, and wipe out coverage for 16 million Americans.
But luckily the Constitution supplies a contingency plan, even if the administration doesn’t know it yet: If the administration loses in King, it can announce that it is complying with the Supreme Court’s judgment — but only with respect to the four plaintiffs who brought the suit.
This announcement would not defy a Supreme Court order, since the court has the formal power to order a remedy only for the four people actually before it. The administration would simply be refusing to extend the Supreme Court’s reasoning to the millions of people who, like the plaintiffs, may be eligible for tax credits but, unlike the plaintiffs, did not sue.
Beneficiaries with Healthy Michigan Plan Coverage: 588,641
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
*Statistics as of March 16, 2015
*Updated every Monday at 3 p.m.
So, for a year and a half now, I've been plugging raw data into spreadsheets and meticulously tallying the health insurance comings & goings of pretty much every person outside of Medicare, traditional Medicaid, ESI and the Indian Health Service.
I've learned more about the different types of health insurance polices than I ever wanted to. Small group. Large group. Off-exchange. "Grandfathered" plans. "Transitional" plans. The Child Health Plus (CHP) program in New York (not to be confused with the Children's Health Insurance Program (CHIP). The Basic Health Plan in Minnesota (MinnesotaCare). HMOs. PPOs. EMOs. "Sub26ers". Different Metal Levels.
Pharmspective is a company that specializes in healthcare industry data visualization/management apps. Most recently, they've announced a new app called "ACO Tracker" which basically does just that: Unscrambles information about Accountable Care Organizations, which are a Big Deal® these days.
Full disclosure: While they're not paying me to promote this particular app for them, they did pay me to help out with some data issues last fall, so take that for what you will (as an aside, in the process of helping them answer some questions which aren't directly related to this site last year, I also stumbled upon some info which is directly related, so that worked out nicely).
Anyway, I don't know much about ACOs myself, but as a data nerd it seems like a pretty cool app for those interested in this area, so what the heck: Check it out.
Wyoming Gov. Matt Mead (R) is no fan of the Affordable Care Act. He supported the first Supreme Court case seeking to repeal the law, and he claimed that the law is “unconstitutional.” And yet, at a news conference last week, Mead echoed many of the Justice Department’s warnings regarding what will happen if the justices side with a new case seeking to gut the law. Indeed, according to the Wyoming Tribune Eagle, Mead “hopes the court will reject the case and uphold the law.”
...In his press conference, Mead worried about the chaos that would result from a decision that allowed all of this to happen. “If on June 30, if that’s when the case comes down, and they say no more subsidies for federal exchanges … it is going to cause a lot of turmoil,” he warned, adding that his home state of Wyoming “will be scrambling” if the King plaintiffs win their case.
OK, I lied; I do have one comment which Gov. Mead might want to pass along to his Republican colleagues in Congress:
OK, this one came out of nowhere, but it's helpful: The Assistant Secretary for Planning and Evaluation (ASPE, the source of the official monthly ACA exchange enrollment reports) and the Director of the Office of Health Reform at the Health & Human Services Dept. just released a new report which states that:
Since several of the Affordable Care Act’s March coverage provisions took effect, about 16.4 million uninsured people have gained health insurance coverage. That includes:
Remember all the fuss and bother back in 2013 over OMG!!! ELEVENTYGAZILLION POLICIES CANCELLED DUE TO OBAMACARE!!!?
Remember how the number of people having their policies cancelled due to not being compliant with minimum Affordable Care Act standards supposedly totalled anywhere from a somewhat reasonable 4-5 million to an absurd 17 million, depending on whether the rightwing source screaming about it was of the rational or batsh*t insane variety?
Well, in the end, it appears that it was only 2.6 million people at most, according to a study by the Urban Institute at the time. However, even that number may be too high, because it also turns out that a lot of people whose policies were originally cancelled were later reinstated after the backlash caused President Obama and the HHS Dept. to allow states to extend those non-compliant policies by 1, 2 or even 3 years.
OK...technically speaking, 6 states had already kicked off their Tax Filing Season Special Enrollment Period starting as early as February 17th (Washington State), but for 40 states (plus DC) states, the "encore" edition of 2015 ACA Enrollment officially began today. Connecticut doesn't start theirs for another 2 weeks, and 3 states (CO, ID & MA) are not offering a "tax filing season" SEP. However, those three, like every state, still have the "normal" off-season SEP for people who have significant life changes such as getting married, divorced, giving birth, adopting a child, losing their other coverage or moving to a new state.
Just as a few states starting this SEP early, 2 (Vermont and Washington State) are also ending their Tax Season SEP later than the rest. However, for 46 states, the cut-off is April 30th.
U.S. Senators Barbara Boxer and Dianne Feinstein are calling on California’s health insurance marketplace, Covered California, to allow women to sign up for coverage when they become pregnant.
Under the current rules of the Affordable Care Act, uninsured women who discover they’re pregnant outside of open enrollment periods can only sign up for coverage once the baby is born. The senators sent a letter to Covered California on Wednesday urging the agency to change the policy to make pregnancy a “qualifying life event” that allows women to enroll in coverage at that time.
I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:
MICHIGAN:
For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.
The good news is that MNsure is continuing to provide off-season enrollment reports. The only bummer is that they appear to have switched to monthly reports, but I guess I can live with that:
Latest Enrollment Numbers
March 12, 2015
MNsure provides a robust enrollment metrics summary to the MNsure Board of Directors at each regularly-scheduled board meeting. This page will be updated on board meeting days.
Health Coverage Type Cumulative Enrollments
Medical Assistance 90,839
MinnesotaCare 31,070 Qualified Health Plan (QHP) 61,109
TOTAL 183,018
Unlike today's DC update, which seems highly questionable due to the "...since Oct. 2013" wording, MNsure's report only includes 2015 enrollments, and the numbers, while still impressive, are much more reasonable.
From October 1, 2013 to March 8, 2015, 89,852 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
21,784 people enrolled in a private qualified health plan,
52,115 people have been determined eligible for Medicaid, and
15,953 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment).
Hmmmm...that "From 10/1/13" clarification is a bit concerning, especially since the official 2015 QHP total as of 2/21/15 was just 18,465. I find it difficult to believe that DC would have increased their QHP enrollment by 18% in just 19 off-season days, but perhaps there was a clerical error or something. I'll likely have to correct this later on, but I'll leave it be for now.
It's also noteworthy that they're officially acknowledging the huge impact that Congressional staffers have on their SHOP enrollments.
UPDATED 3/20/15: Yay! The HHS Dept. has confirmed that yes, they'll release "some enrollment data" the week of March 23rd...but it's still not a full response; see my post about it.
Dear Andy Slavitt, Kevin Counihan and Sec. Burwell:
Don't get me wrong, I was thrilled when you started breaking HC.gov enrollments down weekly, and was especially happy when the state-by-state breakdowns were provided! Awesome! That's the main reason I started this project in the first place, because of the lack of data transparency during the 2014 enrollment period!
We're in a bit of an in-between phase this week. Open Enrollment is officially over, and the Tax Season special enrollment period doesn't start until Sunday in most states.
However, the Massachusetts Health Connector has provided me with a handy report which gives some interesting drill-down data. Most of it is stuff I don't really track anyway, but some of it I do and the rest may be of interest to some. I'm only focusing on a few items, the PDF itself has a bunch more:
CLARIFICATION 3/15/15: No, I don't have any hard proof that anyone has done this or that anyone will do so. For all I know, not a single person has done this. I'm just saying that it's a) easy to do, b) perfectly legal (how do you know for certain what your expected income will be in the future?) and furthermore, c) not unethical, as you'd have to be in pretty dire straits to do this, as shown below.
There's not a huge amount of position shifting here (other than Hawaii), but with today's final official ASPE enrollment report for 2015 Open Enrollment having been released, it seems appropriate to do this one more time:
2015 vs. 2014:
The biggest change here is that Hawaii is no longer near the top of the list due to the confusing report from the HI exchange a few weeks back. Otherwise, aside from Massachusetts (special case) and Maryland (these are the only 2 exchanges to overhaul their prior tech platform with new ones while remaining self-contained), DC is the only "state" exchange in the top third. The other state exchanges are all down at the bottom.
Why? Two reasons: First, 3 of the states (CO, RI & WA) are only listing paid enrollments (or at least are purging past-due unpaid selections before submitting their data to HHS). Secondly, because HC.gov has simply caught up this year after being smoked the last time around.
HAWAII: I was assured 8 ways from Sunday that Hawaii's23,000 enrollee figure was specifically for 2015 enrollment. This made no sense to me given their tiny enrollment last year, but I was assured of it. Well, apparently my original instincts were correct, because they're showing up with only 12,625 in the end.
IDAHO: This is the only state which hasn't given their own enrollment update in forever. According to the prior ASPE report, they were at around 90.5K as of January 17th...yet somehow they only managed to rack up another 6,500 enrollees over the entire final month of Open Enrollment?? I was expecting upwards of 30K or so. This makes zero sense to me...am I missing something here?
In addition, there are a few states where their most recent official enrollment reports had some confusing data, which the ASPE report pretty much trumps regardless of anything else (at least, this is the official number which will be tossed around no matter what anyway):
Pennsylvania's newly elected Democratic Gov. Tom Wolf is working with the federal government to set up a state-based insurance exchange, but GOP-controlled state Legislature would need to approve any funding.
Gov. Rick Snyder said Monday he would ask the Republican-controlled Legislature to create a state-run health exchange if a key part of the Affordable Care Act does not survive a legal challenge.
There was a lot of fuss yesterday about the new CBO report which now projects ACA federal tax credits to end up costing about 20% less than previously estimated over the next decade. This is great news, although the reasons for it can be seen as either good or bad depending on your POV:
The Congressional Budget Office previously projected that 12 million people would be covered by insurance policies obtained via an exchange this year. But it has reduced that prediction to 11 million, in part based on the expectation that a significant number of enrollees will give up this coverage, either to obtain insurance elsewhere or to become uninsured.
Over the past few years, there's been what seems to be a huge increase in incidents of police officers harrassing, arresting, beating up, tasing and/or flat-out shooting black people (and, admittedly, the occasional mentally-troubled white person, as if that makes the situation any better) for no particular reason. Michael Brown. Tamir Rice. John Crawford III. Eric Garner. The list goes on and on.
Anyway. My mom and stepfather are snowbirds, spending the winter in a condo down south. My mom called me this afternoon because she had received a call from the alarm company: The alarm at their house in Michigan had gone off, the police had been notified and were en route to check it out. I know the alarm code and have a spare key, so she needed me to swing by to disable the alarm and see what was going on.
Yup, Michigan's ACA Medicaid expansion is still continuing to grow, although it does seem to be slowing down at last:
Healthy Michigan Plan Enrollment Statistics
Beneficiaries with Healthy Michigan Plan Coverage: 579,115
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
*Statistics as of March 9, 2015
*Updated every Monday at 3 p.m.
Again, for the record, the prior estimates of how many Michiganders are even eligible for the program ranged from 477K - 500K. We're 16 - 21% above that now.
Nearly 11.7 million people were enrolled in an Obamacare plan through Feb. 22, Department of Health and Human Services Secretary Sylvia Burwell said Monday.
That number will continue to increase due to extended enrollment periods through April for those who learn of the penalties for not having healthcare while they are doing their taxes. But as of now, Burwell said more than half of those who signed up were new customers.
The Colorado ACA exchange has just released their latest official enrollment report, and while it's chock full of useful data, it's also bit hard to read (physically...it's a low-res version, will swap it out with a higher-res PDF once they post it), and the numbers also require a bit of parsing...and are a bit confusing.
UPDATE: OK, I've found the actual high-res Dashboard report and have swapped out the low-res one below.
the grand total of "submitted enrollments" is just shy of 154,000. However, that appears to include 3,716 SHOP enrollees (the precise SHOP number is a bit fuzzy due to the footnote regarding this being "currently covered lives, regardless of date of enrollment").
So, separate SHOP out and you have 150,229 QHP selections.
This Just In...Maryland has announced their official final QHP selection tally for 2015 Open Enrollment (including the 2-week "wait in line" extension period):
289,131 Marylanders enrolled through Maryland Health Connection from Nov. 15, 2014 to Feb. 28, 2015. That includes 122,778 people enrolled in private Qualified Health Plans (QHPs) and 166,353 enrolled in Medicaid. Due to high demand during the final weekend of open enrollment, Maryland Health Benefit Exchange allowed people who started an application at MarylandHealthConnection.gov or contacted the Consumer Support Center by Feb. 15 to complete the process by Feb. 28.
Now that the King v. Burwell Supreme Court oral arguments are out of the way (with radio silence expected until they announce the decision sometime in June) , the next Big Development to keep an eye on ACA-wise is...Tax Season! There will be plenty of stories about how many people have to pay back some/all of their 2014 tax credits, how many will receive additional tax credits...and, most germane to this site, how many additional people enroll via the exchanges to avoid having to pay (most) of the higher tax penalty next year for not being covered in 2015 during the Tax Filing Season Special Enrollment Period (SEP), or #ACATaxTime as I prefer to call it.
If the Supreme Court does rule in favor of the government, then all of this will be moot (until the next BS, frivolous legal challenge to the law, of course). Healthcare.Gov will presumably be full-steam ahead, the tax credits will flow to all 50 states (+DC), and all will be (relatively) well. In fact, I wouldn't be at all surprised to see some of the smaller states such as Rhode Island, Vermont and Hawaii scrap their own exchanges and move to HC.gov the way Nevada and Oregon did (although in the case of RI, VT & HI, it would be more about funding issues than technical problems).
However, I've laid out a number of potential workaround/solutions in the event that the SCOTUS does rule for the plaintiffs...the massive catch being that all of them would require some amount of cooperation on the part of a) Conservatives on the Supreme Court; b) Republicans in Congress and/or c) Republicans in the 34 states in question.
(title corrected...everyone knows it was "licks", not "bites"...d'oh!!)
Last night I got embroiled in a Twitter discussion with Ken Kelly and Seth Trueger about the various categories of policies available (on exchange, off exchange, grandfathered, etc). I got to thinking about it; believe it or not, there are over a dozen that I've tried to track over the past year and a half:
1. ACA Exchange-Based Qualified Health Plans (QHPs) Current Paid Enrollment: Around 10.3 Million
2. OFF-Exchange (direct) Qualified Health Plans (no tax credits) Current Paid Enrollment: Around 8.1 Million (including #3 below)
3. Off-Exchange ACA-Compliant (but not QHPs)...believe it or not, there are policies available directly via the insurance companies which are compliant with ACA requirements, but which aren't defined as "QHPs" (that is, they still couldn't be sold on the exchanges even if the insurance company wanted them to be).
The following is an actual email exchange from last spring between someone working at a private, for-profit insurance company and myself. I've blocked all personally identifiable information as a courtesy, even though I probably shouldn't have. I had completely forgotten about this incident until the Huffington Post's Jeffrey Young tweeted something which reminded me of it.
Hello Charles,
I work for an insurance organization in (city, state) and have been following your information as it relates to enrollment. I have been tracking competitor information manually as our state insurance department has not, up to this point, provided any enrollment information.
We are extremely interested in enrollment numbers for (competitor) and (competitor) in the state of (state). Here is a link to some more enrollment numbers for (competitor) - (link), however, they are old because we currently got some information that they are now up to (number) total enrollment members. Please, if you do report these numbers, I wish to keep my identity confidential.
When you're deep in the weeds on this stuff, you tend to take things for granted. Case in point: I kind of figured that it was obvious that everyone who purchases private insurance coverage in the 34 Federal Exchange states will be utterly screwed in the event of the plaintiffs in King v. Burwell winning (assuming, of course, that the GOP Congress doesn't show a lick of decency for once and none of those states slap together an exchange-in-a-box, that is).
Apparently I was mistaken about this, so to review:
Under King premiums for subsidized enrollees would ↑ 256%. As the risk pool deteriorates, premiums for all in the individual market also ↑.
UPDATED w/explanation (although this really isn't a serious analysis, just trying to make a larger point:
The conventional thinking now seems to be that Roberts and Kennedy are likely to side with the 4 liberal/Dem-appointed Justices to rule against the plaintiffs, 6 to 3.
This translates to roughly, say, a 75% chance of the federal exchange subsidies continuing, 25% chance of them being cut off:
A couple of weeks back, CoveredCA reported that they had renewed 944,000 2014 QHP enrollees, and added another 474,000 new enrollees for 2015, for a grand total of around 1,418,000 private policy enrollees (payments pending, of course). Like every other state, CA tacked on an "overtime" period for people who were waiting "in line" by the 2/15 deadline but hadn't completed the process. I was assuming this might push their grand total up to perhaps 1.5 million or so.
Today, CoveredCA released their final official numbers, and they're...underwhelming:
Obamacare: @CoveredCA says newly enrolled 2015 was 495K, total enrollment including renewals is 1.41M #ACA
Some people were disappointed (and others no doubt relieved) that after flapping my gums about it for the past 9 months, I didn't have anything to say about the actual King v. Burwell oral arguments yesterday. As I noted, I'm neither an attorney nor a SCOTUS or Constitutional scholar. I really don't know much about the actual mechanics of Supreme Court procedures--heck, until yesterday evening, I didn't even realize that the 2-3 hours of lawyers and Justices chit-chatting was the whole ball of wax:
@onceupona@nicholas_bagley Stupid question: Was today IT? that is, was the whole #King thing a 1-day deal, followed by 3 mo of waiting?
The Silver Lining: Medical Tax Breaks Can Offset Health Care Costs
Everyone needs medical services at some point in their lives. Yet, annual expenses rise every year: health care costs increased 22% from 2010 to 2013 alone. Now that health insurance has become mandatory, many fear that their health expenses will increase even more. Luckily, Americans may be able to offset some of their health care costs by by deducting applicable medical expenses.
Long-time followers of this site know that I attempt to track every person who gets enrolled in healthcare coverage through the Affordable Care Act, whether it's via individual/family exchanges, Medicaid expansion, off-exchange QHP enrollments...or the SHOP (Small Business) exchanges. They'll also recall that last year, due to the massive technical problems which most of the exchange websites faced, only a handful of SHOP exchanges were even usable, much less actually signing people up. The exchanges were, for the most part, so busy scrambling to get the individual enrollment side working properly that they pretty much put the SHOP exchanges on the back burner. Only about a half-dozen states had theirs running at all, and the total enrollment topped out at only around 83,000 people nationally.
A couple of weeks ago, Gallup released a massive Health Insurance Survey which noted that the uninsured rate nationally fell from 17.3% to 13.8%. On the one hand, yay Obamacare! On the other hand, this drop in the uninsured was far less impressive-sounding than earlier surveys put out by the Urban Institute, Commonwealth Fund, RAND Corporation...and even Gallup itself.
There was an obvious reason for this, however:
In other words, they surveyed a mountain of people, but the polling was spread out over the full course of each year. These are full-year averages. There's nothing wrong with this, and 10 years from now it will be more practical to look at historical data from a year-to-year perspective. At the moment, however, things are changing very rapidly as enrollments/expansion/policy implementation goes into effect, and a month-to-month or quarter-to-quarter perspective is far more telling.
Today is his birthday. In honor of Chris, I'd like to ask visitors to consider making a donation to him today. Just visit Eclectablog, scroll all the way down and look for this PayPal area in the lower-right corner:
P.S. I'll have plenty to say about today's King v. Burwell developments this afternoon or tomorrow, I'm sure, but for the moment there's not much more I can add. I'm neither a lawyer nor a Constitutional scholar; others are far more knowledgable about the particulars of the Supreme Court as well as the personalities/idiosyncracies of the individual Justices.
The first reason why he is wrong is that the June numbers are preliminary numbers. Those numbers are not set in stone. The second reason is if the subsidies are upheld, any uncertainty costs that appear on the 2016 Exchange gets eaten by the subsidy. For the subset of people who are buying on Exchange without financial assistance and all people buying off Exchange, they could pay slightly higher rates but on-Exchange subsidized buyers are protected by the subsidy structure.
Back in December, I noted that Michigan's implementation of the ACA's Medicaid expansion provision had achieved an impressive 99.4% of it's theoretical maximum enrollment. Official state administration estimates pegged the number of Michiganders eligible for the program at around 477,000, and as of 12/08/14, enrollment had hit 474K.
Other estimates had Michigan's eligible population as being higher--perhaps 500,000, so I didn't think too much of it at the time. Besides, population shifts, changes in the economy and so forth could mean that an estimate from last spring had shifted up or down a bit.
Even so, as the official enrollment total broke 500K, then 510K, then 530K, I noted each increase, with increasing curiosity about the discrepancy.
Ever since I first wrote about the Halbig v. Sebelius case (later Halbig v. Burwell, then shifted over to King v. Burwell shortly thereafter), the one question I've never been able to get a straight answer on is whether Oregon, Nevada and/or New Mexico would be legally defined as "exchanges established by the state" in the even that the Supreme Court does end up ruling in favor of the King plaintiffs.
Ironically, three states that experienced monumental failures when they initially tried to create exchanges might hold the closest thing to a golden ticket.
This is about as minor of an update as I can post; the actual hard enrollment number is slightly lower than the 160K figure that I already had, but it's still good to have specific data, plus it's broken out into more detail. Plus, the SHOP data is here as well (such as it is):
Open Enrollment Numbers (All Numbers Effective as of February 15, 2015)
A few weeks back I posted a wildly speculative look at what the rest of 2015 might look like (assuming, that is, that the Supreme Court doesn't blow all of my enrollment models out of the water this June with a horrible King v. Burwell ruling).
At the time, I made a pretty ambitious assumption about how many people might enroll during the special 2015 Tax Filing Season enrollment period...I figured a good 1.8 million might do so.
Since then, I've thought it over and decided to be more cautious--I honestly have no clue how many people will follow through and enroll during this period (all I know for sure is that the total number eligible to enroll is somewhere between 0 and 6 million nationally). In the interest of caution, I'm lopping this down to just 1 million even today (it could be higher or lower, of course).
My other assumptions remain the same: An 88% payment rate (for the 1st month) and a roughly 2% net monthly attrition rate, plus about 9K/day enrolling during the "truly" off-season (ie, no special enrollment periods, major life events only).
Since the 2015 Open Enrollment Period began, in addition to the weekly HC.gov "snapshot" reports which gave state-by-state breakouts of exchange-based private policy enrollments, the Oregon Insurance Division has also been tracking and reporting the number at their site...along with off-exchange (direct) QHP policies. As the only state reporting the off-exchange data on a regular basis, OR has become the only hard source I have for this number (other states like Washington, Florida and Louisiana report off-exchange data as well, but only on a quarterly or annual basis).
Their exchange-based data has always lagged slightly behind the HC.gov number, partly because the thru-dates don't match up and partly because at least one of the insurance companies in Oregon only reports paid enrollments instead of plans selected. Still, with the final week or two of HC.gov data missing at the moment, this is a handy estimate of how things played out in the final "overtime" enrollment week:
Members enrolled, Nov. 15-Feb. 22
On Healthcare.gov 113,219
Outside of Healthcare.gov 102,232
Total 215,451
Last July, I came up with a rather idiotic-sounding "solution" to the "problem" caused by the infamous King v. Burwell court case:
So, the question becomes, just how much of the "establishment" has to be done by the state, and how much is allowed for by the Feds? For that matter, if "the state" contracts out the actual site development work to a private corporation, that's technically not being done by "the state" or "the Feds"...it's being done by a private company which is simply paid for their services by one or the other (ie, the Oracle debacle in Oregon; CGI Federal at the Federal level; Deloitte or Accenture in other states, etc).
In other words, what do "established by" and "facilitates participation" actually mean?
Depending on the answer to those and related questions, there could be an incredibly stupid-sounding solution.
I'm referring to domain names.
Yes, that's right: For just $9.95 apiece (or less, if you shop around), the United States Federal Government could simply ask the health departments of the 36 states in question to snap up a domain name along the lines of:
OK...technically speaking, 6 states had already kicked off their Tax Filing Season Special Enrollment Period starting as early as February 17th (Washington State), but for 40 states (plus DC) states, the "encore" edition of 2015 ACA Enrollment officially began today. Connecticut doesn't start theirs for another 2 weeks, and 3 states (CO, ID & MA) are not offering a "tax filing season" SEP. However, those three, like every state, still have the "normal" off-season SEP for people who have significant life changes such as getting married, divorced, giving birth, adopting a child, losing their other coverage or moving to a new state.
2015 vs. 2014:
