A sweeping measure to offer state-subsidized healthcare coverage to people in the country illegally was significantly pared back Thursday in an effort to rein in costs as it cleared a key legislative hurdle.
Rather than extend Medi-Cal--California's healthcare coverage for the poor--to all eligible adults regardless of immigration status, as originally proposed, the amended bill by state Sen. Ricardo Lara would set up a limited enrollment healthcare program.
The board of Connecticut’s health insurance exchange approved a 22 percent hike in the fee it charges insurers to help fund its operations, a cost that’s likely to be passed on to insurance customers.
The fourth post, written in response to an interview he did with my colleague Harold Pollack over at healthinsurance.org, was a bit more forgiving, but still brought out my nasty snark.
WILLIAMSON: Where have you been, Shelly? Bruce and Harriet Nyborg?? Do you want to see the memos...? They're nuts... they used to call in every week. When I was with Webb. And we were selling Arizona...they're nuts...did you see how they were living? How can you delude yourself??
LEVENE: I've got the check...
WILLIAMSON: Forget it. Frame it. It's worthless.
LEVENE: The check is no good?
WILLIAMSON: You stick around; I'll pull the memo. I'm busy now.
LEVENE: Wait a minute...their check's no good? They're nuts...?
WILLIAMSON: You wanna call the bank, Shelly? I called them. I called them four months ago when we first got the lead. (pause) The people are insane. (pause) They just like talking...to salesmen.
In 2014, the overall average premium payment rate for those who selected a Qualified Health Plan (QHP) from the various ACA exchanges ended up being around 88% nationally. This varied from state to state and company to company, but in the end it was roughly 88%.
In 2014, the overall average net monthly attrition rate ended up being roughly 3% per month (by net, I mean after taking into account both new people enrolling during the off-season and existing enrollees dropping their coverage). Based on this, here's what the 2014 exchange enrollment looked like (click image for full-size version):
The whole fuss and bother at the heart of the King v. Burwell case centers around this subsection of the Patient Protection and Affordable Care Act:
(2) (a) the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer's spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311 [1] of the Patient Protection and Affordable Care Act
The short version of the plaintiff's argument, of course, is that supposedly this means that federal tax credits are kosher for individual states which "established" their ownexchanges (16 states plus the District of Columbia) but not for the remaining 34 states, since they're being run by the federally-"established" exchange.
The government's defense, of course, is that there's like a half-dozen other places throughout the law which make it pretty damned clear that tax credits should be kosher for states run through the federal exchange as well:
Every once in awhile I'm accused of being a little too blunt. As a blogger, I'm presumably not under the same "professional standards" of language and protocol as, say, the New York Times, the Associated Press or the U.S. Congress.
That's why it came as quite a relief to me to read this quote from an AP story in the New York Times this morning, which sums up the Republican Party's quandary pretty succinctly:
"If you win the case you actually have people who lost their insurance. You now share the responsibility for fixing it," said former Rep. Tom Davis, R-Va., who once led the House GOP campaign committee. "And you've got a lot of pissed off people. That hurts you."
Actually, the main angle of the AP story is that the King v. Burwell case has supposedly now turned into the old Life Cereal TV commercial. You know the one:
Whenever I post about King v. Burwell, I have a tendency to lump all 34 states together into collective numbers (around 6.5 million losing their tax credits, plus another couple million being priced out of the market due to the resulting premium spikes, plus another 4-5 million having to pay through the nose to keep theirs).
Next, I assume my standard 88% payment rate. Ironically, the higher this percentage is, the more people who could actually get royally shafted by a King plaintiff win.
NOTE I posted a partial version of this entry last night, then yanked it overnight in order to think about whether it was a valid concern or simply the same sort of click-bait headline hysteria that I've criticized other sites for posting.
After thinking it through, I"ve decided to go ahead and post a modified version with a bit of additional context and a less panicky headline. Think of it as more of a legal thinking exercise than anything else...but at this point, anything is conceivable.
For months now, I and many others have been sounding the warning bells re. the absurd King v. Burwell ACA case, currently awaiting a decision by the Supreme Court.
MNsure survived the legislative sessionwithout major changes. Some Republicans wanted to scrap the state's health insurance exchange altogether and some Democrats wanted to make it a state agency.
By some accounts, MNsure's performance has greatly improved since it's rocky 2013 roll out.
MNsure CEO Scott Leitz is leaving his position to work for a health care think tank. He took over the program after its first executive director resigned under fire.
The state Senate overwhelmingly adopted major health care changes Thursday in a bipartisan vote that reins in some facility fees, looks to development of a health information exchange to guarantee the sharing of patient data and aims to keep private physician practices in business.
But a new study casts doubt on that theory and suggests Obamacare’s bet may indeed pay off. The study, published in Health Affairs by John Romley, Dana Goldman and Neeraj Sood, found that hospitals’ productivity has grown more rapidly in recent years than in prior ones. Hospitals are providing better care at a faster rate than growth in the payments they receive from Medicare, according to the study.
A new healthcare reform debate may be on the horizon. Democrats refer to the issue at hand as the nation's "underinsured" population, reported the Associated Press.
Of course, when you throw in the missing tax season SEP / off-season enrollments, the actual total should be closer to 12.4 million or higher, and should finally reach my personal Open Enrollment Period target of 12.5 million by the end of May.
Well, it's a week later, and I'm feeling confident enough (especially with the support of new data out of California) to state that the actual total number should indeed have passed the 12.5 million mark nationally sometime over Memorial Day weekend (or today at the latest, since most exchanges were closed for the holiday).
One of the Big ACA Stories today is Robert Pear's piece in the New York Times about the origin/history of the infamous "...established by the state" wording in the Affordable Care Act which is at the heart of the impending King v. Burwell Supreme Court decision (now just 1 month away from the expected announcement):
...The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. Some described the words as “inadvertent,” “inartful” or “a drafting error.” But none supported the contention of the plaintiffs, who are from Virginia.
Pear goes on to interview and quote various former/current members of Congress and their staff--both Democrats and Republicans alike--all of whom give the same response:
It appears that after the tragic Amtrak derailment a couple of weeks ago, a Philadelphia-based personal injury attorney named Chad Boonswang (allegedly) decided to send out hand-written "sympathy cards" to the families of not just one, but at least two different victims. The "sympathy cards" actually contain no words of sympathy, but instead are crass ads pushing his litigation services at a discounted rate. What a bargain!!
Adding insult to injury, at least one of the victims and their families happen to be Jewish, making the embossed cross on the outside of the card doubly tacky.
In other words, every one of the following states--along with the other 2 dozen not already running their own exchanges--should be running, not walking towards at least getting their ducks in a row in case SCOTUS lowers the boom...and instead, every damned one of them appears to have decided to twiddle their thumbs for the next 6 months or so.
Anyway, let's suppose that #1 and #2 are squared away. Against all odds, the Republican governors and legislators of these states get their heads out of their asses and actually approve all of the above.
That leaves #3: Time. Even if everything was streamlined and fast-tracked (and lord knows that's unlikely), it would still take substantial amounts of time to do all of this.
5. Does the rate change reflect how many people switched policies and/or companies?
Number 4 is easy: NO. None of the requested rate changes that you're seeing flying around right now (and will continue to for the next few weeks) have been approved yet. This could dramatically change some of the final rates.
As I’ve noted before, Republicans may try to pass a temporary patch for the subsidies, packaged with something like the repeal of the individual mandate, in hopes of drawing a presidential veto — so Republicans can then try to blame Obama for failing to fix the problem.
A few days ago, in my latest exclusive for healthinsurance.org, I listed 4 important questions to ask before freaking out about the Scary Rate Increase Headlines® which have started popping up in the news for some states. However, I forgot about a fifth one, which I hinted at yesterday in my analysis of the new Kaiser Family Foundation survey:
Bear in mind that "shopping around" doesn't necessarily mean that you switch policies, it just means that you at least looked around to see what was available.
The whole theory behind the "invisible hand of the free market = lower prices for all" mindset is that competition allows the consumer to shop around and compare pricing and other factors. However, the "competition = lower prices" theory only works if the customers actually do shop around. This year only 30% did, which is either unimpressive or impressive depending on your perspective.
Jeffrey Toobin is a very smart man. He's a staff writer at The New Yorker and has been CNN's legal analyst for many years.
That doesn't mean he's correct about everything, however...and in fact, he made a very obvious, very significant factual error in his King v. Burwell opinion piece this morning, "Obama's Game of Chicken with the Supreme Court".
The main thrust of the piece is that if the Supreme Court does rule in favor of the plaintiffs in King v. Burwell and does make the IRS stop issuing federal tax credits to millions of people enrolled in private healthcare policies via the federal exchange, most people will blame President Obama and the Democratic Party for the fallout rather than the Republicans in Congress and their conservative think tank allies who brought the lawsuit, financed the lawsuit, cheered on the lawsuit and, most importantly, are refusing to take 5 minutes out of their day to "fix" the supposed "problem" in the language of the law.
According to the new report, they've had a total of 117,024 QHP selections since then (through May 10th), including #ACATaxTime enrollments:
Add them together and you get 1,529,224 total QHP selections to date (well, as of 5/10, anyway).
One interesting side note: CA's final #ACATaxTime tally turned out to be nearly 10,000 higher than expected (they previously reported around 33K with just a couple of days to go in the special enrollment period; apparently a lot of people jumped in at the last second after all)
On the surface, aside from the extra 10K for #ACATaxTime, that doesn't sound too interesting...I already had CA down with 1,503,200 QHPs, so this is just 26,024 higher. Big deal, right?
Except for one thing: I've confirmed that the number below represents actual paid, effectuated enrollments as of March 2015:
Holy smokes. The Kaiser Family Foundation, without which running this site would be much harder, has released their 2nd annual (I assume it'll be done every year) Survey of Non-Group Health Insurance Enrollees.
There's a heck of a lot of findings to absorb here, almost all of which overlaps with the areas I cover here at ACASignups.net, so it'll take some time to go over it all. However, here's my initial thoughts:
The survey, conducted February 18 – April 5, 2015, after the close of the second open enrollment period, includes individuals who purchased ACA-compliant coverage inside or outside of a Marketplace, as well as those who are currently enrolled in “non-ACA compliant” plans.
These are really important points to keep in mind when looking at their findings. It does include off-exchange enrollments, whether ACA-compliant or not (and in fact those distinctions are the focus of some of KFF's findings).
Throughout the long, tortured life of the Affordable Care Act over the past 5+ years, one of the easiest attack points has been to go after the sheer bulk and complexity of the law itself. Whether you're referring to the actual wording of the law (supposedly a whopping 2,700 pages long) or, even worse, the 8-foot tall stack of 10,000 - 20,000 pages of regulations related to "Obamacare", Republican politicians, pundits and talk show hosts have used the immense size of the ACA itself to go after it.
I'm bringing this up now because my big project the past week or two has been to track down the various 2016 policy premium rate change requests for the companies operating both on and off the ACA exchanges in all 50 states (+DC, of course).
So far I've done a pretty good job with OR, WA, CT, MI, DC and VT...and I have partial data for MD & IA.
Yesterday I estimated that total #ACATaxTime-specific enrollments were likely around 200,000. Today, thanks in part to CNBC's Dan Mangan, I can pin this down even further. The bold-faced states are the ones where the number is provided by Mangan's report:
But there’s another potential twist to the tale: Just as he is now seeking to get on Obamacare, he could very well find himself unable to sign up for coverage, if the Supreme Court rules for the challengers in King v. Burwell next month.
...an HHS official tells me that if he can get his income up a bit — it reportedly fluctuates — he could probably qualify for a category that would allow him to apply for Obamacare again before next year’s open enrollment period.
But if the Court strikes subsidies in three dozen states on the federal exchange — one of which includes South Carolina — it could put Obamacare even further out of reach for Lang.
Of course, if the Supreme Court decides to blow up the entire system with an adverse King v. Burwell decision, all bets are off, as none of the “requested” rate changes will have any meaning whatsoever in the 34 states without their own exchange.
...In short, if the King plaintiffs win, prepare for one heck of a mess next year.
Yesterday I noted that a seemingly minor announcement (HHS tweeting that the final #ACATaxTime tally for the federal exchange from 3/15 - 4/30 ended up being 147,000 people) had a greater significance than that, because tacking that onto the grand national total brought the official tally up to the 12 million milestone.
Personally, this didn't mean much to me because I estimate that the actual total (including unreported numbers from various exchanges) is more like 12.4 million or higher anyway...and on the flip side, the number of people actually paid up with effectuated enrollments is more like 10.1 million, and has been for a month or so now. Still, officially hitting the 12 million mark seemed worth noting, so I did so.
An hour or so ago, Luis Lang, who earlier today announced his support of Single Payer healthcareand his decision to leave the Republican Party (specifically over their obstruction of the Affordable Care Act) posted the following update on his GoFundMe account:
Lifelong Republican Turns On His Party, Embraces Obamacare
Luis Lang, who is currently crowdfunding for medical expenses that he can’t afford because he didn’t sign up for insurance under Obamacare, has become a viral sensation. However, the 49-year-old South Carolina resident says he doesn’t want to be the poster child for the Republican Party’s opposition to health care reform anymore.
Many people both here and over at Daily Kos have criticized me, either for donating a few bucks ot Mr. Lang in the first place or alternately, for coming down so hard on the guy in my blog posts. Some thought it was a waste of time (and money) to help the guy out, while others thought it was an equal waste of time/breath to chastize him, figuring that it'd fall on deaf ears. Still others thought that it's inappropriate to donate money with one hand while berating him with the other. Well, guess what?
After all the fuss and bother made over the #ACATaxTime Special Enrollment Period by myself and others, the final number of QHP selections was announced in the most understated way possible:
From March 15 to April 30, 147,000 consumers signed up for coverage through http://t.co/eTfU7hSMWR using the tax special enrollment period.
Hot off the presses, the Minnesota ACA exchange, MNsure, just held their monthly board meeting and released some new enrollment numbers:
That precise 64,000 QHP number is up 2,126 since April 13, while Medicaid and MinnesotaCare are (combined) up a whopping 34,538 people, which is pretty impressive.
As you may have noticed, I've been posting a bunch of 2016 Rate Change Request posts over the past week or so. Last week I wrote about Oregon, Washington State, Iowa and Connecticut. This week I've added Michigan and the District of Columbia, and just this morning I added Vermont and Maryland. Other state numbers will be popping up left and right over the next couple of weeks.
To try and avoid confusion, my latest exclusive piece over at healthinsurance.org is a primer of sorts on what to be on the lookout for when you start seeing scary-sounding newspaper headlines about "massive rate hikes!" for 2016.
Spoiler: They may be accurate, or they may be full of hot air. Check it out!
Maryland's rate request website is an exercise in frustration. At first glance, it looks very cut and dried: A full table of each health insurance company, broken out by either individual or small group market, whether the filing is for policies sold on or off the ACA exchange, and the "average % change requested", along with direct links to the actual filing documents (where, presumably, I can dig up the crucial enrollment numbers, which are vital to determining the weighted average rate requests).
Unfortunately, once you get into the actual documents...they're completely scattershot. Some companies list the number of enrollees who would be impacted by the requested rate changes; some don't. That makes it impossible to determine the market share, which in turn means there's no way of weighting the average.
The 2016 rate requests are popping up all over the place now...here's Vermont:
Blue Cross Blue Shield of VT is requesting avg. 8.38% increase for 31,147 individual exchange enrollees and 35,903 small business (small group) enrollees.
HOWEVER, it's important to bear in mind that this average a) ranges from 4.7% to 14.3% depending on the type of policy, and they seem to have mixed both individual and small group enrollments together (first time I've seen that so far). Here's the distribution; I'm not sure I understand the 2,964-enrollee difference between the totals:
As you can see, about 1.6% of enrollees would see an increase of 5% or less, while 32% would see a 10-15% increase, with the remaining 66% between 5-10%.
The 2016 Rate Request Train continues to chug along; in addition to Oregon, Washington State, Connecticut and Michigan, I can now add the District of Columbia to the list.
The first thing to note about the DC market is that one of only two (the other is Vermont) in which all individual and small group enrollments are done through the ACA exchange; no off-exchange enrollees here. That makes things a bit simpler.
In addition, the DC Dept. of Insurance, Securities & Banking has also provided a handy table showing the year over year changes on both markets:
As you can see, DC has a pretty simple setup; 4 insurance companies operating in the Small Business (SHOP) exchange, only 2 of which are operating on the Individual exchange (and one of those, Kaiser, is only offering HMOs, not PPOs). An unweighted average of each gives the following:
I was poring over a bunch of ACA-related stories last night, many of which have to do with last week's announcement that the Hawaii ACA exchange is very close to having to shut down in 2016 just as both Oregon's and Nevada's already did in 2015.
Don't get me wrong, there's no putting a positive spin on this development (other than to say that it's not a done deal; HI Gov. Ige is still negotiating with the Federal government and a way to save the exchange may come through at the last minute). However, one curious thing jumped out at me in not one, but two different stories about the Hawaii exchange.
Hawaii’s move to the federal exchange would leave only 13 states with state-based marketplaces. Already, about a half-dozen states, including Oregon and Nevada, have had to scrap their exchanges and move to the federal system because of funding and technological issues.
Over at Politico this morning, Rachana Pradhan has an excellent article about the real-world impact of the ACA's Medicaid enrollment expansion program on, well, the expansion of Medicaid enrollment. The gist of it is that, as I've been noting for months now, additional enrollment in the Medicaid and/or CHIP programs have far exceeded "expectations" to date, with a net increase of over 12.6 million people since the ACA was passed into law (over 11.7 million of which has happened since the expansion provision officially went into effect a year and a half ago).
As far as I can tell, there are four reasons why enrollment in Medicaid/CHIP is higher than "expected":
Lawmakers and the governor reached a deal to pass a health care package that, as one senator put it, will “keep the lights on” for health care reform.
The package contains $3.2 million in new state health care spending, which is eligible for roughly another $3 million in federal match. The money will be used to level-fund exchange subsidies for out-of-pocket costs, target increases to Medicaid rates and invest in initiatives to strengthen the primary care system.
I know I said I was done writing about Luis Lang, the guy in South Carolina who's going blind and is uninsured due to a combination of his own decisions and the SC administration. However, my colleague Harold Pollack over at healthinsurance.org just posted a lengthy interview with the guy to get his take on things. Since I'm one of those who tore him to shreds, it behooves me to let him say his piece.
For a few hours yesterday, the top link on the Drudge Report led to a YouTube video in which an Ohio woman said she's going to vote for President Obama because he gave her a phone. The woman is inarticulate and she speaks loudly, and on top of those things she's black. Basically, she is exactly the kind of person many on the right envision—wrongly, it should be said—when they think of who is guzzling from the government teat these days. That she was bragging about Obama giving "every minority in Cleveland" luxuries like cell phones was just the icing on the cake.
Of course, it turns out that the "Obamaphone" brouhaha was, to put it mildly, a wee bit exaggerated (and the program was actually started by Ronald Reagan):
However, I also noted that the graph included by Gallup makes the drop look more dramatic than it really is, by not including the entire picture. I whipped up my own version which starts at 0% to give a more accurate representation; here they are again:
Nearly 12 million people signed up for health coverage plans on exchanges created under Obamacare, according to the website ACAsignups.net. [ed: hey, that's me!!]
But more than half of the adults who bought such plans had deductibles of $1,500 or more, Families USA, a Washington nonprofit organization focused on health care, found. Adeductible is the cumulative amount a person has to spend on health care before his or her insurance company starts to pay. Despite receiving tax credits to help offset the cost of coverage, these deductibles were prohibitively expensive.
In addition, NJ FamilyCare – the state’s primary Medicaid coverage program -- has added 463,463 residents to its rolls since December 2013, including 42,947 in April.
The fact that 9% of the net increase happend 16 months after the Medicaid expansion provision started is surprising to me, consideirng that according to the Kaiser Family Foundation, only around 390,000 uninsured NJ residents were even eligible for the program as of last fall to begin with. In other states, like Michigan, things have pretty much plateaued as every eligible resident has pretty much been enrolled already.
I don't post about the state of Maine very often, and given that their Governor is an utter nutbag that's usually a good thing. Tonight, however, I'm happy to report that at least 2 of the 34 states at risk of losing their federal tax credits in the event of a King v. Burwell plaintiff win next month are seriously prepping to "establish" a state-based exchange if need be (Pennsylvania is the other one):
In a unanimous vote, the Legislature’s Insurance and Financial Services Committee endorsed the effort to maintain the health insurance premium subsidies that are offered as tax credits through the Affordable Care Act. Those credits are being challenged in a federal lawsuit known as King v. Burwell, which the U.S. Supreme Court is expected to decide next month.
Right off the bat, I want to clarify that I might have misread some of the numbers here; while some states provide the per-company average rate change requests in a nice, simple table format, I had to wade through a mountain of forms at the SERFF Filing Access Database to hunt all of these down, and there seems to be little consistency from company to company about the formatting of the documentation, etc etc. It's possible that I've confused a Small Group filing for an Individual one, for instance, and I may have misunderstood the current enrollment number for one or two companies. Finally, in one case (Physicians Health Plan), their 2016 rate request seems to have been redacted for some reason. Fortunately, they only appear to have around 600 enrollees anyway, which means any change in their rates would barely move the state-wide needle at all anyway.
With those caveats out of the way, assuming I have these numbers straight, here's what it looks like...and remember, these are requested changes only; they still have to be approved:
The California ACA exchange, CoveredCA, released their 2016 budget today, and the outlook is...well, kind of underwhelming, frankly:
After using most of $1 billion in federal start-up money, California's Obamacare exchange is preparing to go on a diet.
That financial reality is reflected in Covered California's proposed budget, released Wednesday, as well as a reduced forecast calling for 2016 enrollment of fewer than 1.5 million people.
The recalibration comes after tepid enrollment growth for California during the second year of the Affordable Care Act. The state ended open enrollment in February with 1.4 million people signed up, far short of its goal of 1.7 million.
A number of factors contributed to the shortfall, but health policy experts said that some uninsured folks still find health insurance unaffordable despite the health law's premium subsidies.
Yesterday I posted a rather scathing entry about Mr. Luis Lang of South Carolina, followed by another one about the hundreds of almost entirely liberal / progressive-leaning donors (including myself) who have, as of this writing, ponied up over $12,000 to save him from going blind due to a combination of his own irresponsibility and his political party's decision to throw nearly 180,000 SC residents--including himself--under the bus.
Today, Mr. Lang has responded to all the hubbub...mostly (emphasis mine):
First of all I would like to thank ALL of the wonderful people that have donated to help me in my time of need. And I do mean everybody. When I started this I never meant it to became a political war. I am a honest person and I have to give a big thumbs up to the liberal side. Even though you have crucified me in your comments but you spoke with your heart with the donations. I respect everybody opinion whether I agree with you or not. That is why we live in the U.S.A. home of the free and free speech. As far as the conservative side I wish they would step up to the plate and do there part. Again thank you all and i will be posting updates with my condition.
sorry one last thing I have to hand it to the liberal side you sure do know how to get the word out when you dislike something. I say shame on the conservative bloggers for resting on there laurels.
As one of those who coughed up a few bucks to bail him out of his self-created mess, here's what I have to say to Mr. Lang:
(ok, not much of an article here, I mainly linked to it as an excuse to jot down a note: The exchange market share breakout in Wyoming is roughly 9,500 via WINHealth & 10,500 via BCBSWY).
The Connect for Health Colorado staff has recommended more than doubling the fee that insurers pay on each policy purchased on the exchange — a charge that is passed on to consumers.
The state marketplace would increase the carrier fee from 1.4 percent to at least 3.5 percent of the premium charged on exchange health plans — the same rate charged through the federal exchange, under the recommendation made Monday.
For a consumer holding a $4,000-a-year health plan, the increase would be $84 a year. The estimated increase in revenue for the exchange would be about $5.8 million.
Yeah, that's right, I'll say it: Luis Lang is a hypocrite.
Over at Talking Points Memo, Josh Marshall has a story about a guy in South Carolina named Luis Lang who's in a nasty situation due to a combination of bad timing, Republican cold-heartedness and, to be blunt, his own stupidity.
First, the backstory:
As the Charlotte Observer explains, Lang is a self-employed handyman who works as a contractor with banks and the federal government to maintain foreclosed properties. He was making a decent living, enough to be the sole breadwinner in the family. As the Observer puts it, Lang "he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills."
There's good news and bad news out of Iowa tonight. For 2015, there were originally only 2 insurance companies to choose from on Healthcare.gov: Coventry and CoOportunity. Unfortunately, the latter of these went belly-up for a variety of reasons, leaving Coventry the sole provider available on the exchange.
Moderate-income Iowans who want to use Affordable Care Act subsidies to purchase health insurance will still not be able to choose policies from Wellmark Blue Cross & Blue Shield next year, but they should be offered policies from at least two competitors.
Roughly a million Texans with government-subsidized health coverage could see a new label on their health insurance cards, and critics say the designation is akin to a “scarlet letter.”
But instead of Hester Prynne’s infamous “A,” insurance cards for Texans with coverage under the federal Affordable Care Act would bear the letter “S,” for subsidy.
Supporters of House Bill 1514 by state Rep. J.D. Sheffield, R-Gatesville, say it’s necessary to standardize insurance cards and clarify the type of health coverage a patient has.
For months now, the ACA state exchanges in small states like Rhode Island, Vermont and Hawaii have been struggling mightily with either funding issues (RI) or both funding and technical problems (VT & HI). Most of my own focus has been on the 2 northeastern states.
Today, however (thanks to Sabrina Corlette for the heads' up), the HI Health Connector has apparently skipped ahead a few chapters and concluded that due to their inability to convince the state legislature to pony up more cash (they were originally seeking $10 million but only $2 million was approved), they're gonna have to close up shop:
May 09--The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat.
The looming case of King v. Burwell threatens subsidies that help 7.5 million people* afford health coverage in the roughly three dozen states using the Affordable Care Act’s federally run marketplace.
*(Note: As I've stated repeatedly, the actual number who would lose tax subsidies is "only" about 6.5 million, but the number who would lose their insurance as a result is likely a couple million more, plus another 4-5 million who'd pay through the nose to keep their coverage).
The Associated Press-GfK poll released Monday finds 56 percent wants the justices to rule to continue the subsidies, while 39 percent wants them invalidated for the federally run marketplaces.
There's also some interesting numbers about the politicization of the Supreme Court (y'know, the one which isn't supposed to be politicized):
In the latest update to The Graph, in addition to simply updating both the currently confirmed and estimated exchange-based QHP totals, I've also made one significant addition: The estimated number of HC.gov-based enrollees who are currently receiving federal tax credits from the IRS, and how many of those I expect to lose those credits in the event that the Supreme Court rules for the plaintiffs in the King v. Burwell case.
The total numbers nationally are notable mainly because of the milestones which have now been passed: Over 11.9 million QHP selections have been confirmed as of today, and I estimate that the actual total should have passed the 12.4 million mark by now. I now expect to hit my official "Open Enrollment Period" QHP selection target of 12.5 million in another couple of weeks (hey, look at that!--I was right after all, just early by...um....3 months...ok, never mind...).
Colorado just released an updated enrollment report bringing things all the way up through April 30th...and as always, CO's report is both extremely comprehensive and extremely confusing at the same time.
A week or so ago, U of Michigan assistant law professor Nicholas Bagley and his associate, Boston U. public health asst. professor David K. Jones) posted a lengthy, comprehensive analysis of potential post-King v. Burwell options for the HHS Dept. and/or the impacted states in the event that the Supreme Court rules in favor of the plaintiffs. As I noted at the time, several of their points were very close to my own last July...except that I was just shooting off at the mouth, whereas they actually know what they're talking about, legally speaking.
What if HHS declared that any state that performs substantial, ongoing, and essential exchange functions has established an exchange, even if the state never formally elected to do so?
Last year, Connecticut was a perfect example of how the initial requested insurance policy rate changes from the companies involved in a given state can end up changing dramatically after the approval process (and in CT's case, change even more when the actual Open Enrollment period actually arrives). The original requested average increas in CT was 12.8%, but the approved changes ended up only being around 4.5%...and in the end they were far lower: Less than a 1% overall weighted average increase!
With that in mind, here's the story on 2016 requested changes in CT:
Four major health care providers that offer plans on Connecticut's health insurance marketplace have filed for rate increases for the upcoming open enrollment period that begins Nov. 1, 2015.
...The following increases have been proposed: 2 percent for ConnectiCare, 6.7 percent for Anthem, 12.4 percent for United Healthcare and 13.96 percent for Healthy CT.
Assuming this ratio hasn't shifted much over the past 6 years, around 28% of the total U.S. population are mothers
Obviously women over 64 (mostly on Medicare) are much more likely than the general population to be mothers...but girls under 18 are far less likely to be (well...under 16, anyway...the birth rate varies from state to state, of course), so I'm assuming that these cancel each other out, resulting in that 28% rate hopefully being roughly accurate.
On the one hand, Washington State, like Oregon, has a nifty, easy-to-use web-based searchable database for their 2016 rate request filings, yay!
On the other hand, when you get into the details, some of it can be pretty confusing stuff. In 2014, there were 8 companies approved for the WA exchange. For 2015, there were 10 companies, plus 2 more which didn't make the cut. For 2016, a total of 17 companies/subsidiaries have requested approval to sell on the individual market. There's no guarantee that all 17 will be approved to sell in the state, but I'm assuming they all will be for the time being.
There's actually 18 listings, however, because Lifewise split their policies into two entries...one of which is "grandfathered" policies only, and is therefore not relevant for the table below...although this does answer the question "how many people are sill enrolled in Grandfathered policies in Washington State?" The answer appears to be just 15,677 people...out of 343,348 total in the individual market, or only 4.5% of the total.
Since I made such a fuss over Colbeck's jaw-dropping laundry list of factual errors and omissions, I figure it behooves me to give the same scrutiny to the follow-up from a "union boss". Let's take a look:
They said it wouldn’t work.
They said no one wanted it.
They said it would destroy the economy.
They said it would create chaos in the healthcare industry and cause masses of people to lose their insurance.
They said no one would sign up for it; especially healthy and young people.
They even said it would lead to “death panels” deciding who will live or die under Obamacare.
From "It'll Destroy America!!" to "It Doesn't Suck But It Will Someday!" in 10 Easy Steps
1. October 2013: "No one can enroll!!"
(ok, this one is a gimme; the technical mess at HC.gov and some of the state exchanges did make it almost impossible for anyone to sign up the first month.)
Just as House lawmakers were putting together their annual “trains” — cramming multiple, tangentially related bills into hundreds of pages of amendments so they could pass them all at the 11th hour — a funny thing happened. They upped and quit.
On April 27, House Speaker Steve Crisafulli prematurely banged his gavel, ending the session, leaving the Senate holding the bag on this year’s biggest, most contentious issue: Medicaid expansion under the Affordable Care Act. Now a group of Senate Democrats has sued the GOP-dominated House, and as of this writing, the Florida Supreme Court says the lower chamber must explain its abrupt adjournment.
In a nutshell, the House doesn’t want Medicaid expansion but the Senate does. The upper chamber has a nifty non-Medicaid name for it, too. The Florida Health Insurance Exchange (or FHIX) is, in name, an attempt to help GOP senators get past the program’s unpalatable association with “Obamacare.”
OK, I just got this and it just went live, so I'm just now reading it as I'm typing this...call it "liveblogging" if you will...(Update 6:00pm: OK, pretty much done now)
4 p.m., ET, Wednesday
May 6, 2015
STUDY FINDS HEALTH COVERAGE GROWS UNDER AFFORDABLE CARE ACT
Insurance coverage has increased across all types of insurance since the major provisions of the federal Affordable Care Act took effect, with a total of 16.9 million people becoming newly enrolled through February 2015, according to a new RAND Corporation study.
Researchers estimate that from September 2013 to February 2015, 22.8 million Americans became newly insured and 5.9 million lost coverage, for a net of 16.9 million newly insured Americans.
Among those newly gaining coverage, 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid (6.5 million), the individual marketplaces (4.1 million), nonmarketplace individual plans (1.2 million) and other insurance sources (1.5 million).
...it could actually be several hundred dollars lower.
A week ago I posted a story in which I busted Michigan State Senator Patrick Colbeck for blatantly spewing nonsense numbers about the ACA in an Op-Ed in the Detroit News.
Yesterday, my follow-up story, about the Detroit News allowing Colbeck to go back in and correct some (but not all) of his insanely false factual garbage a solid 10 days later (while failing to give any indication about just how absurdly wrong he had been in the first place) went viral, generating more visitors than any other story I've posted in months.
After an all-day saga, the end result was that the Detroit News finally posted a "correction" notice...except they did so in such a disingenous way (and so long after the original editorial was publshed) as to be nearly meaningless.
I actually missed this report a few days ago, partially because I thought the February report had already been released a few weeks back; it turns out I was thinking of January's.
For January I overshot the mark a bit, but for February my projections were pretty much bang-on target, with an net incrase of 12.65 million Medicaid/CHIP enrollees to date thanks to the ACA. But wait, you're saying: The report says the net gain is only 11.7 million!
Yes, that's true...except that the 11.7 million figure only includes ACA-enabled Medicaid/CHIP additions since expansion started on 1/1/14:
Hartford, Conn. (May 5, 2015) – Access Health CT (AHCT) today announced that they enrolled 1,429 Connecticut residents during the Special Open Enrollment Period which began April 1, 2015 and ended April 30, 2015. The special enrollment period was open to individuals who did not have health care coverage in 2014 and were subject to a penalty on their 2014 federal taxes.
It's important to bear in mind that this number specifically does not include "normal" off-season QHP enrollees via marriage, birth, job loss and so forth.
1,429 over 30 days = about 48 per day. My final estimate of 3,000/day nationally would scale down to just 28/day for Connecticut specifically based on their Open Enrollment Period percentage, so this is actually pretty good.
NOTE: A few days ago there were 2 ACA-related stories which caused me some concern: The initial 2016 rate request filings out of Oregon and a new report from Standard & Poors which seems to indicate troubled waters ahead for ACA-compliant policy premiums. Unfortunately, a lot of this stuff goes way over my head. Fortunately, actuary Rebecca Stob has offered to explain why there's more (or possibly less) than meets the eye in the S&P report:
Disclaimer: I am an actuary at Group Health Cooperative in Seattle WA - this represents my personal opinion and not that of Group Health.
Just over 1 year ago I posted a long, rambling entry which boiled down to: A bunch of thank-yous to those who helped get me through Year One; a reminder that I never intended this project to continue past the 2014 Open Enrollment period; and a committment to keeping the site, blog, graph and spreadsheets cranking along through Year Two as well.
Now that we're past the official 2015 Open Enrollment period (#OE2), the "In Line by Midnight" overtime period (#ACAOvertime and the Tax Filing Season Special Enrollment Period (#ACATaxTime), it's time for me to finally let folks know what my plans are for the site for Year Three.
One week ago I posted en entry titled "Color me shocked: Michigan GOP State Senator spewing nonsense", which documented an appallingly erroneous Op-Ed by Republican State Senator Patrick Colbeck riddled with basic mathematical errors about the Affordable Care Act.
Among the many factual errors included in Colbeck's essay were such gems as:
He claimed that the ACA is costing $1.35 trillion per year. It's actually priced at less than 1/10th that price ($120 billion per year).
He claimed that the ACA has insured an additional 19 million people, which is oddly generous as compared with my own estimate of 14 million or even the Obama administration's estimate of 16.1 million.
He claimed that the ACA is "still leaving 36 million people" without insurance, while failing to acknowledge that 4 million of those are stuck in the Medicaid Gap created by Republican-run states, while another 6.3 million are undocumented immigrants who aren't legally eligible for coverage under the law.
He claimed that the ACA is costing over $71,000 per enrollee per year, when the actual number is closer to $5,000 per person.
He claimed that a "high quality policy" can be purchased on the non-ACA market for $6,000/year, which may or may not be true depending on the person.
He claimed that "159 organizations" which stand "between a patient and a doctor" were created by the ACA, which is utter nonsense.
He claimed that the state of Washington launched a program which magically cut both costs and hospitalization rates in half, without citing any source or providing any information about what this mystery program might be.
So, in my piece I carefully debunked all of these lies (or misstatements, assuming he was just ignorant). My response garnered quite a few retweets and a generally positive response...so positive that several people suggested that I write up a simplified version and submit it to the Detroit News Op-Ed page myself as a rebuttal.
Analysts at Standard & Poor's Ratings Services say the effects of funding restrictions on the Patient Protection and Affordable Care Act (PPACA) risk corridors program may cause the program to hurt small and midsize health insurers.
Drafters of PPACA created the risk corridors program in an effort to make selling health insurance under PPACA rules less risky, by using cash from health insurers with good underwriting results for 2014, 2015 and 2016 to help insurers that get poor results for those years.
When Talking Points Memo, The Wall Street Journal and The Washington Post needed data on how often police officers are charged with on-duty killings, they all turned to the same guy: Bowling Green State University criminologist Philip M. Stinson.
Stinson, 50, has become an indispensable source for researchers and reporters looking into alleged crimes and acts of violence by police officers because he has built a database tracking thousands of incidents in which officers were arrested since 2005. His data has shown that even the few police officers who are arrested for drunken driving are rarely convictedand that arrests spike for cops who have been on the force 18 years or longer, contrary to prior research showing it was mostly new officers who were acting out.
I haven't actually done Short Cuts in awhile, letting dozens of significant ACA-related stories disappear into the Memory Hole. Will try to be better about this going forward:
Normally this is exactly the sort of story which I'd post a full point-by-point debunking of (see McConnell, Mitch), but frankly I've had a lousy weekend and am just too damned tired to bother. It's like playing whack-a-mole, anyway; sometimes it's just not worth the effort.
Fortunately, Jason Easley of PoliticsUSA clears up at least a couple of the whoppers John Boehner spewed this morning:
So, the good news is that new Democratic Pennsylvania Governor Tom Wolf, who has already scrapped his predecessor's unnecessarily confusing "alternative" Medicaid expansion plan in favor of regular expansion, has officially submitted a latter to the HHS Dept. stating that yes, if the Supreme Court does rule against the government in the King v. Burwell case, PA will indeed establish their own ACA healthcare exchange.
HARRISBURG, Pa. (AP) - Gov. Tom Wolf's administration advanced plans Friday to maintain federal health insurance subsidies for nearly 400,000 Pennsylvanians ahead of a U.S. Supreme Court decision that could wipe out the aid to insurance buyers in some states.
The Democrat wrote to U.S. Health and Human Services Secretary Sylvia Burwell to declare his administration's intent to take over operation of the insurance marketplace in 2016. The federal government currently operates the marketplace, which is a prominent feature of the 2010 federal health care law designed to extend insurance coverage to 35 million Americans.
However, there's still no enrollment data since late February for about 10 states, and only fractional data for the other 40. Based on my best estimates, the actual total QHP selections to date should beslightly over 12.3 million as of yesterday (click image below for the full-size version).
As for the tax filing season Special Enrollment Period specifically, there have been over 110,500 confirmed enrollments to date (68,000 via Healthcare.Gov, 33,000 in California, around 4,800 in Washington State and over 4,700 in Maryland). My best estimate is that #ACATaxTime QHPs will end up being roughly 140,000 in the end.
BALTIMORE (May 1, 2015) — More than 4,700 Marylanders took advantage of a special six week enrollment period that allowed them to enroll for health insurance to avoid an additional federal tax penalty for 2015 if they had already owed a tax penalty for lacking health coverage in 2014.
Marylanders who applied for the special enrollment period, which ran from March 15 through yesterday, attested that they owe the penalty for lacking health insurance in 2014 and that they became aware of this after the Feb. 15 close of open enrollment for 2015 coverage.
"One of the things Ford had always found hardest to understand about humans was their habit of continually stating and repeating the very very obvious, as in ‘It’s a nice day’, 'You’re very tall’, or 'You seem to have fallen down a thirty-foot well, are you alright?’
At first Ford had formed a theory to account for this strange behaviour. If human beings don’t keep exercising their lips, he thought, their mouths probably seize up.
--Douglas Adams, The Hitchhiker's Guide to the Galaxy
Sarah Ferris at The Hill has a story this morning about the Republican Party's "list of demands" in the event that the Supreme Court rules against the federal government in the King v. Burwell case.
I was tempted to point out the obvious terrorist/hostage theme in the headline, but instead I'm gonna just focus on one snippet from the article:
But, in the event the justices rule against ObamaCare, Democrats will offer a simpler solution — passing a bill to fix the few sentences of the statute that are under scrutiny.
“The president can say, here’s our one-page bill,” Louisiana Gov. Bobby Jindal (R), who opposes the current congressional strategy, told a D.C. audience on Thursday.
Why yes...yes, that sounds about right. In fact, I seem to recall posting this several months ago:
