On the one hand, this isn't nearly as big of a shock to me as it wsa when Michigan hit 600,000 enrollees (a full 100K higher than earlier eligibility estimates).
On the other hand, 36,000 more people covered than you expected is still 36,000 more people covered!
As you can see from the NM Medicaid enrollment report below (click on it to see the full-size version), as of the end of March, New Mexico was up to 205,901 people enrolled specifically in the ACA expansion program. According to the NM Human Services Dept., the state was only expecting around 170,000 people total to even be eligible.
Of course, that was in March. According to their latest projections from May, they estimate expansion enrollment has reached around 222,000 as of today...and are now projecting it to reach over 241,000 by next June. If that proves accurate, they'll have enrolled nearly 42% more people than expected.
Here's your chance to explain whether this is Good or Bad news.
You may recall that in early May, Rebecca Stob, an actuary iin Washington State, wrote a guest post explaining why a new Standard & Poors report which had just come out was a bit troubling but no cause for major alarm (yet). It basically has to do with the "Three R's" put in place by the ACA (Risk Adjustment, Reinsurance and Risk Corridors) for insurance companies to help smooth the transition from the pre-ACA world over the first few years.
In her post, Stob referred to the fact that:
2014 results are still uncertain for the other 2Rs. What is reported in insurer's financial statements are still estimates and insurers won't know the results from risk adjustment and reinsurance until they get the final report in June.
Well, it's the last day of June, and sure enough, look what was just released...
As regular readers know, I repeatedly mentioned my presentation to the Society of Actuaries annual conference in Atlanta, GA a cuople of weeks ago. This was a Big Deal® for me for a couple of reasons: First, it was my first out-of-town speaking engagement; second, it's the first time I've flown anywhere in nearly a decade; and third, the event happened to take place smack in the middle of KingvBurwell-apalooza. Considering that this is the Society of Actuaries, that meant a hell of a lot; it was on everyone's mind throughout the event, especially since there was a good chance at the time that the Supreme Court decision would be announced the very next day (that Thursday).
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:
Between all the craziness surrounding the King v. Burwell decision and the indirectly-related Obergefell v. Hodges decision and it being my birthday weekend and all, a whole mess of ACA/healthcare stories piled up over the past week...
If I'm reading this correctly, it looks like a whole lot of poor people in non-expansion states were effectively forced into padding their official income in order to qualify for federal tax credits due to their GOP overlords being jackasses. I'm not sure whether that's a problem legally (as opposed to deliberately cutting your official income), but it seems to me that this will only work for so long before it catches up with them recordkeeping-wise?
I originally used this headline after the dust settled on the Year One open enrollment season to discuss my plans for the ACA Signups project going forward. I used it again less than 2 months ago, at the close of Year Two open enrollment (including the #ACATaxTime extension period).
Normally I'd hold off until sometime in February 2016 to pull it out again, but with the King v. Burwell decision out of the way, this seems like a good time to pause and take stock of what lies ahead.
The actual numbers haven't changed much over the past week, of course...but The Graph itself has one slight difference. See if you can spot it; it's pretty subtle...
OK, I do have one very quick post this afternoon, and believe it or not, it ties this morning's historic Supreme Court ruling allowing marriage equality for same-sex couples with yesterday's ruling on ACA federal tax credits.
How? Well, the HHS Dept. just posted this on Twitter:
(I know I'm posting the whole thing, but it's only like 6 sentences...please click thru to give Politico the traffic...)
A Texas Republican is taking aim at the Supreme Court after its 6-3 decision upholding Obamacare subsidies with a new bill requiring the justices and their aides to purchase coverage on the law’s exchanges.
Rep. Brian Babin is seeking co-sponsors for the bill, titled the “SCOTUScare Act of 2015” — which refers to a quip from Justice Antonin Scalia’s scathing dissent.
“As the Supreme Court continues to ignore the letter of the law, it’s important that these nine individuals understand the full impact of their decisions on the American people,” the freshman Republican said in a statement. “By eliminating their exemption from Obamacare, they will see firsthand what the American people are forced to live with!”
The King v. Burwell decision this morning is huge. Everything--everything--about the 2016 Open Enrollment Period rested on this morning's decision. And yes, I'm even including the states which have their own exchanges, like California, Kentucky and Connecticut. While those states wouldn't be impacted directly, I guarantee that there would have been some peripheral consequences even for them.
For instance, would a sizable number of self-employed people have moved from, say, Virginia to Maryland due to the 60-90% rate difference they might see between the states? I know it's not easy to just pick up and move your whole family on a whim, but you could be talking about a $500+/month difference for those paying full price...and the difference between having coverage at all or not for those whose premiums had just been cut off. Now, thankfully, we'll never know.
So, for the past few weeks I've been shouting from the rooftops about the other fallout of the King plaintiffs winning: Massive rate hikes next year, which would likely cause a roughly 50% rate hike across 34 states for millions of people.
I based that on the assumption that 2016 rates would already be going up 10-12% on average anyway, plusan additional 35-47%, for a total increase of around 50%. I based this on:
100 x 1.10 x 1.35 = 148.5 (48.5% increase)
100 x 1.12 x 1.47 = 164.64 (64.6% increase)
I decided to be err on the low side of this range, figuring that even a 50% rate hike would be more than enough to make the point.
Please bear with me. I just got dressed (yes, I spent the whole morning in a bathrobe) and I haven't eaten anything today.
I'll have much, much more to say later on today and over the weekend, I'm sure, but for now, just a few quick items.
First, here's President Obama's official statement in response to today's ruling. Video & transcript included. It was an excellent speech (though as several others have noted, it would've been even better if he'd simply walked out, dropped the mic and then walked back inside without saying a word). However, there are a couple of bits which caught my ear:
Yup, there's no denying that all of this sounds like a whole big bag of hurt. Installation, configuration, maintenance and improvement of technical infrastructure costs money, time and know-how.
The funny thing is, if the King v. Burwell plaintiffs are shot down and if Healthcare.Gov ends up in the free and clear to continue operations including providing the federal tax credits, I, for one, would have no problem with some or all of the state-based exchanges making the move to HC.gov.
It's certainly more fiscally efficient (HC.gov has cost somewhere around $250-$300 per enrollee to date, as opposed to the several thousand dollars per enrollee that most of the state exchanges are costing....or, to use an extreme case, the $57,000 per person that Marco Rubio's Republican "Anti-Obamacare" Brainchild, "Florida Health Choices" has cost to date).
6/27/16:In light of the 1-year anniversary of the Supreme Court's King v. Burwell decision...along with the celebration of the Obergefell vs. Hodges decision and today's Whole Woman's Health v. Hellerstedt decision, I've dusted off this post from a year ago...
(THIS IS BEING UPDATED MOMENT TO MOMENT, SO CHECK BACK FREQUENTLY FOR UPDATES)
However, if the courts decide to look at the case on the "micro" level--parsing exact definitions of the word "State" (which seems to be the concensus as to how they're proceeding from the people I've talked to about it), then they'll also have to (or at least certainly should) also look equally closely at two other words: "Establish" and "Facilitate."
So, as I said, depending on how the court defines the terms "establish" (ie, to "establish" an insurance marketplace) and "facilitate" (as in, "facilitating" the purchase of insurance policies through the marketplace), it's conceivable that all it would take for any of the individual states to "establish" their own exchange would be to register a domain name at GoDaddy or wherever and set up a simple welcome/information portal site...which would then lead them to HC.gov for the actual purchase of the policy.
As petty and stupid as this may sound, it's no more petty and stupid than the plaintiff's case in the first place.
But LePage has also tried to take advantage of a wording error with the 2013 law funding energy efficiency programs. While lawmakers wanted $60 million spent to help homemakers use less energy heating their homes, the snafu would have reduced that to $22 million—less than half.
The text error in Maine involved just one word left out—"and." However, it wasn’t just the wording that mattered but also a decision from a body controlled by his appointees, the Maine Public Utility Commission, that ruled 2-1 that there would be far less money for efficiency projects than legislators wanted.
The error came down to this, according to the Portland Press Herald:
Trying (once again) to get these off the books ahead of tomorrow's Supreme Court Opinion Announcements (although most people seem to think that King v. Burwell will be announced on either Friday (most likely) or Monday)...
Cathy Barney remembers well the days her family budget was overwhelmed with a nearly $1,200 monthly bill for health insurance.
...The Milford family of four finally got the break they’d been pleading for two years ago. Under key provisions of the Patient Protection and Affordable Care Act, the Barneys now pay just $400 a month for their health insurance thanks to cost-saving tax credits ushered in by President Barack Obama’s long debated health reform law, also dubbed Obamacare.
“We finally got some relief,” said Barney. “It’s been nice to not have been so squeezed these last two years.”
So, for the past few weeks I've been shouting from the rooftops about the other fallout of the King plaintiffs winning: Massive rate hikes next year, which would likely cause a roughly 50% rate hike across 34 states for millions of people.
I based that on the assumption that 2016 rates would already be going up 10-12% on average anyway, plusan additional 35-47%, for a total increase of around 50%. I based this on:
100 x 1.10 x 1.35 = 148.5 (48.5% increase)
100 x 1.12 x 1.47 = 164.64 (64.6% increase)
I decided to be err on the low side of this range, figuring that even a 50% rate hike would be more than enough to make the point.
However, according to a new article by the Urban Institute (the source of the earlier 35% increase estimate...the RAND Corporation was the source of the 47% estimate), it looks like it could be even higher:
Yes, with the All King v. Burwell, All The Time® mindset this month, it's easy to forget that the core purpose of this website is supposed to be to track the enrollment numbers...and between KvB and this being the middle of the off-season, it's no wonder that there hasn't been much of that lately.
With that in mind, thanks to Andrew Sprung for this tidbit...Indiana is one of the states which initially refused to expand Medicaid under the Affordable Care Act, but which came around earlier this year, starting enrollment in their (heavily modified) Medicaid expansion program at the end of January.
"The Healthy Indiana Plan ... is aspirational," said Brian Neale, the governor's health policy director. "We believe that individuals, if offered the opportunity, will make the right choices."
The Kaiser Family Foundation has posted their latest Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.
The main paragraph which leaps out, of course, is this one:
Across the 11 cities we examined, the premium for the second-lowest-cost silver plan in the Marketplace – before accounting for any tax credit – is increasing by an average of 4.4%. By contrast, in these cities, the average change in the benchmark silver plan was -0.6% from 2014 to 2015. (The nationwide average increase in this plan was 2% from 2014 to 2015).
Reuters reports that Senate Democrats are already preparing to roll out their response if the Supreme Court invalidates Obamacare subsidies for millions in three dozen states:
No. 2 Senate Democrat Dick Durbin said that if the administration loses the case, Democrats would offer a short piece of legislation clearly saying the tax subsidies are also available to people on the federal exchange.
“It’s one sentence and it’s already been written,” Durbin said in a Capitol hallway. “I hope we don’t need it,” Durbin added.
I can add more: According to a Dem leadership source, Democrats already have a one-sentence bill written on both sides — in the House and the Senate — and it will be introduced in both chambers at the “first available opportunity” if the Court ruling requires it.
...This should be an easy choice for opponents of Obamacare. The end of federally subsidized exchanges will be the first step in freeing patients, doctors, and insurers from government control. Unbelievably, however, some are considering legislation to extend the subsidies, should the Supreme Court block them.
A whole mess of people keep asking me (as they do other ACA bloggers/reporters/pundits) how I think the Supreme Court will rule on the King v. Burwell case.
I've gained a lot of acclaim & attention over the past year and a half for making pretty accurate projections for ACA exchange enrollment numbers.
However, when it comes to predicting how the Supreme Court will rule on stuff, I haven't a clue.
Having said that, it seems to be pretty well accepted that the 4 more left-leaning Justices (Ginsburg, Sotomayor, Breyer & Kagan) will almost certainly rule for the federal government, while the 3 hard-right Justices (Scalia, Thomas and Alito) will almost certainly rule for the plaintiffs. That would leave Anthony Kennedy and Chief Justice John Roberts as the "swing votes".
Some of them have also reported on the secondary results: Another 6.5 million (give or take) facing massive premium increases next year (well beyond whatever increases they were already planning anyway).
A few (well, me, anyway) have even reported on a (admittedly unlikely, but still possible) tertiary consequence: An adverse ruling could even be made retroactive to January 2014.
If the Supreme Court rules against Obamacare subsidies, the four governors running for president will face a harsh choice: Let tens of thousands of people get kicked off their health plans, or try to create a state exchange and lose credibility with a virulently anti-Obamacare Republican primary base.
Louisiana’s Bobby Jindal, Wisconsin’s Scott Walker, New Jersey’s Chris Christie and Ohio’s John Kasich all refused to set up Obamacare exchanges, as did most other GOP governors. Their states would be directly affected if the court rules that the health law’s subsidies can go only to people living in states that did establish the new online Obamacare markets.
Let's suppose that the Supreme Court does rule for the plaintiffs.
Let's suppose that they don't include any sort of mitigating factor, like a 6-month stay or whatever.
Let's further suppose that neither Congress nor any of the states do anything to resolve the issue (remember, Delaware and Pennsylvania may have been approved for "state-based" exchanges, but those won't officially kick in until January 2016), leaving 6.5 million people to lose their tax credits.
As I understand it, assuming no stay is issued, the earliest that the credits would be yanked would be August (I believe there's a 25-day period before rulings take effect, so July should be in the clear after all).
So. 6.5 million people receive their August premium bill, and instead of $92 (on average) it's around $364 (on average). For many, it'll be far more dramatic yet...rising from, say, $25 to $500 or whatever.
I know the site has been pretty much All King v. Burwell, All The Time for the past month or so, and no doubt that'll continue for the next few months (if the plaintiffs win) or the next week (if the government wins). However, with the decision imminent (expected either Friday or Monday now), I thought this would be a good time to update The Graph.
As you can see, assuming appx. 7,500 QHP selections per day nationally, the grand total for 2015 should have crossed the 12.7 million mark sometime over the past few days. Of course, it's possible that this average has become substantially higher or lower over the past few weeks as people learn more about the impending KvB decision...some eligible off-season enrollees might be jumping on it in hopes of snapping up at least a month or two worth of tax credits before the Supreme Court lowers the boom, while others who were planning on doing so may have decided not to bother even trying, figuring that it'll just be a lot of paperwork for nothing (shrug).
A couple of weeks ago I posted my own crude state-level graphics breaking out just how many people in each of the 34 states which would be impacted by an adverse King v. Burwell ruling who are currently receiving federal tax credits would be screwed by having said credits torn away, as well as a rough estimate of how much of an immediate tax hit they'd take to keep their policies through the end of this year and how much they'd likely see their premiums skyrocket next year as a result.
There was a time when I thought that ACA-related news would quiet down after the Open Enrollment Period ended. That day may come at some point, but with the King v. Burwell decision bearing down on everyone, forget about it.
In addition to this morning's release of the big CDC National Health Interview Survey, here's not one, not two, but five major pieces out today. Unfortunately I don't have time for lengthy write-ups for each, but they're all pretty important in different ways:
As the U.S. Supreme Court prepares to issue a ruling that could impact the Affordable Care Act, 47 percent of Americans now approve of the health care law, the highest in CBS News and New York Times polling (although support is still short of a majority). For the first time, more Americans now approve than disapprove of the ACA, but by a narrow margin.
The Centers for Disease Control has released their big National Health Interview Survey, which confirms what every other study, survey and poll has: The Affordable Care Act did indeed caused the uninsured rate to plummet last year. On the one hand, this isn't exactly surprising news to anyone other than former U.S. Senator/NH Governor Judd Gregg and current U.S. Representative Gary Palmer, but whatever.
Monday's New York Times has a pretty thorough look at just what the "establish an exchange" status is across the various states which would otherwise have millions of people devastated by the impact of the GOP's King v. Burwell court case, which will be decided on either Thursday, Friday or next Monday (most likely Friday now, as I understand it).
They cover the three states which already have a "federally-assisted" state-based exchange (Oregon, Nevada, New Mexico); Hawaii, which is in the process of moving to that status; the two states which are hoping to do so next year (Delaware and Pennsylvania)...as well as the other 32 states which don't have bupkis at the moment.
At first, this article in the Washington Times doesn't look like anything special...it's basically one of dozens of stories about the potential political and real-world impact of the King v. Burwell decision on a specific state...in this case, Oklahoma:
OKLAHOMA CITY (AP) - While the U.S. Supreme Court considers a key case related to the Affordable Care Act, officials in Oklahoma have taken little action to prepare for a ruling that could threaten the tax subsidies nearly 90,000 residents are using to purchase health insurance.
HOWEVER, it's the next couple of paragraphs which made me do a double-take:
Because Oklahoma opted not to create a state exchange where residents could shop for health insurance, Oklahomans instead purchased their plans through a federal exchange, but opponents who are challenging the law, including Oklahoma Attorney General Scott Pruitt, argue the law only allowed for the subsidies through state exchanges.
Note: My estimate for Alaska is actually slightly lower than this (16K), and my estimate of the average tax hike those Alaskans would have to pay is actually half of the amount in the article ($3,200 vs. $6,400), but that's because I'm assuming only the 2nd half of the year's credits would be rescinded:
Robin Barker, a longtime resident of Fairbanks and Bethel, struggled with chronic illnesses for years that kept her from working. Her only option for health insurance cost nearly $800 a month for a policy that came with a $15,000 deductible. Prescriptions alone set her back $12,000 a year.
“Money was just pouring out of our retirement savings,” she said.
...Interviewed at her Fairbanks home as she recovered from a bout with pneumonia, Barker said she was happy to qualify for Medicare but was concerned about Alaskans who won’t be able to afford health coverage if the U.S. Supreme Court strikes down subsidies. If that happens, she says, “families will be destroyed.”
Well, since King v. Burwell was not announced today, I guess I'll clear out another mess of stuff from my in box (Note: Many of these stories should have their own full entries, but I just don't have time at the moment):
IMPORTANT: The "death spiral" which isn't happening referred to in the link below is the one which Republicans claimed would happen due to the ACA itself. Ironically, if they win King v. Burwell, such a death spiral would almost certainly happen in the 30+ states which aren't running their own exchange.
Not so long ago, critics of Obamacare were warning of death spirals, the risk that too many sick people and not enough healthy ones would sign up for insurance, triggering a cycle of ever higher costs for insurers and steep premium hikes for consumers.
No King v. Burwell Supreme Court decision again today, but most pundits were always expecting it nextMonday, June 29th, anyway.
However, there's a total of 7 cases still left to announce (including Obergefell v. Hodges, aka the same-sex marriage case), so they've also tacked on another extra Opinion announcement day: Thursday the 25th.
I'm not gonna get a damned bit of billable work done this week, am I?
UPDATE: According to CNBC's Dan Mangan, they've added Friday the 26th as well...
At this point, pretty much every healthcare reporter, pundit and especially the healthcare actuaries are pretty much reduced to this:
Welp, it's Monday again, which means it's time to once again huddle in front of my keyboard while anxiously watching SCOTUSblog's Live Blog of the Supreme Court's opinion announcements...
Of course, they might not make the King v. Burwell announcement today, either; it could still be next Monday, the 29th. Or, they could throw in another surprise "bonus" decision day on Thursday. (sigh)...
UPDATE 10:20am: NEVER MIND. No King v. Burwell announcement today.
I think the headline accurately depicts former Texas Governor and current Presidential Candidate Rick "Do The Glasses Make Me Look Smarter?" Perry's defense of the appallingly high uninsured rate in Texas during his 14-year tenure as chief executive of the state.
Perry appeared on FOX News Sunday with Chris Wallace this morning, and for the 2nd week in a row, Wallace actually acted like a Real Journalist® instead of a GOP/FOX hack and pressed Perry with some solid questions regarding the sorry state of healthcare coverage in his state.
Took my wife and 9-year old to see Pixar's latest, Inside Out.
Sheer brilliance. Run-don't-walk to see it, etc. etc.
For anyone who was afraid that they'd lost their touch with Cars 2* (and only partly regained their footing with Brave and Monsters University), I'm thrilled to report that they're back at full throttle here.
That is all.
*(I actually kind of liked Cars 2, but I know most people seemed to hate it.)
No matter how the U.S. Supreme Court rules on the King v. Burwell challenge to the Affordable Care Act, Vermont lawmakers say they are optimistic about their state’s health exchange.
State Republican leaders are ratcheting up the pressure on Congress to overhaul the Affordable Care Act if the Supreme Court this month rules that subsidies on the federal exchange are invalid.
Republicans from 33 states have written to Congress as part of a coordinated message urging federal legislators to develop a plan that would free states from the pressure of setting up their own exchanges to salvage subsidies, according to the Foundation for Government Accountability, a conservative think tank.
While some people spend their lives in search of the Holy Grail or the Lost City of Atlantis, Huffington Post healthcare reporter Jeffrey Young has spent the past year and a half on a Lifelong Quest to discover the elusive, mysterious Republican Replacement Plan for the Affordable Care Act.
Now, here's the thing: I'm not saying that Mr. Roy's 20% is wrong, or that McKinsey's 27% is wrong. Maybe they're correct. I've only documented about 10% of the QHPs as being off-exchange; perhaps it really is only 20 or 27% of the total. I'm just saying that there's too many unknowns for anyone to conclude that it is 20% or 27% for exchange QHPs either. It's still a big unknown.
Furthermore, I do appreciate him at least bothering to read my own analysis. He's a Big Established Expert and I'm just some web developer in Michigan. He's (from his Forbes bio) the Opinion Editor for Forbes, a Senior Fellow at the Manhattan Institute for Policy Research, and was a health care policy advisor to Mitt Romney...while I create websites for small businesses, often while wearing a bathrobe.
But that doesn't mean that he's right, either...and unless I'm missing something important here, nothing that he's said proves that he is.
When the Republican Party replaced the director of the Congressional Budget Office, Doug Elmendorf, with "one of theirs" (Keith Hall, who previously worked as an economist for George W. Bush), there was understandably plenty of concern (or hope, depending on your politics) that CBO projections would suddenly become radically different from what they had been under a "Democratic" CBO director, especially when it comes to politicized issues such as the Affordable Care Act.
Summary Over the past several years, a number of proposals have been advanced for repealing the Affordable Care Act (ACA), which became law in March 2010. In this report, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) analyze the main budgetary and economic consequences that would arise from repealing that law.
Greg Sargent at the Washington Post does a nice job of summarizing the Republican response if they win their King v. Burwell court case at the Supreme Court:
The GOP argument is basically this: Obamacare is to blame for the awful outcome of millions of people losing Obamacare, so Republicans will protect all those people from Obamacare by temporarily restoring their Obamacare, before repealing it entirely for all its beneficiaries, and replacing it with … “oh, wow, look over there, a unicorn is wandering through the Capitol!”
Here it is in video form, compliments of South Park:
Over at Vox this morning, Ezra Klein has a good "big picture" look at the true impact of the plaintiffs winning King v. Burwell which goes beyond the specific numbers of people impacted or the dollar amounts involved. His main point, which I generally agree with, is that while the results would be pretty horrible, they wouldn't result in the law being repealed any more than the Medicaid expansion ruling did. In Klein's view, at worst (which, he admits, would be pretty bad), the 2-tier healthcare split between rational & irrational states would deepen...but only temporarily.
So King can't destroy Obamacare. What it can do is let Republican elected officials destroy Obamacare in states where they have a majority. That's a very different thing, and it will lead to very different political dynamics.
For the most part I agree with him, but there's two things I wanted to call attention to: One which he doesn't mention, another which I feel he shouldn't have.
I know I snarked about "nothing interesting happening" while I was out of town/unavailable yesterday/this morning, but the reality is that a whole mess of stuff is always going on in the healthcare/ACA field, so here's a quick roundup:
...lawmakers went along with Raimondo’s bid to raise the state’s $3.50-a-pack cigarette tax — already the third-highest in the nation — by 25 cents to reap an extra $7.1 million.
They backed a scaled-down version of the new health-insurance surcharge that Raimondo proposed to pay for the state-run health-care exchange that they expect to average 2.86 percent on individuals’ monthly premiums, and .59 percent on average for small-business groups’ monthly premiums.
There were also an estimated $120.9 million in spending cuts in the state’s fastest-growing subsidy program: Medicaid, including $70.5 million in projected state dollar savings.
Way back on April 30th I posted the first in a series of 2016 rate change request entries for Oregon. At the time, the initial news didn't look very good, with the weighted (by market share) average increase looking to be around 23%.
At the time, and since then, I've posted a whole bunch of stuff regarding the importance of keeping calm about these initial rate requests for a variety of reasons. One of those reasons is that none of the initial requests had actually been approved yet. Last year, many large rate increase requests were denied nationally, with only more modest increases being approved by state regulators, and the same is likely to happen in many cases this year.
THIS REMAINS LIKELY TO BE THE CASE OVERALL. However, there's another possibility which, while I always knew was possible, I wasn't aware of actually having happened until today:
Of the 14 "full" state-run exchanges remaining (i.e. running their own website platform), one of them (Hawaii) recently threw in the towel due to technological and funding issues. The other 13, funding issues aside, seem to mostly be operating pretty well, but a few are still having technical issues...one of which is tiny Vermont.
Vermont Health Connect Reports on Progress toward Key Milestones
Number of Customers Awaiting Changes Reduced by 1,600
ESSEX, VT –State officials delivered a regular monthly report on Vermont Health Connect to legislative oversight committees today. The report covered key performance indicators and enrollment data for the month leading up to recent system upgrades which greatly enhanced the speed at which Vermont Health Connect can process customer requests.
I was out of town all day yesterday, having flown down to Atlanta, Georgia to address the Society of Actuaries conference. It was a small audience but went very well; a great group and an interesting experience. I was up at 5am to catch the flight down, caught the red eye back at midnight and then had to get my kid to an MRI appointment this morning (nothing serious, it went fine; he has to take it easy the rest of the day while recovering from the anesthesia, but otherwise all is well). Needless to say, I'm pretty exhausted myself.
So...did I miss anything ACA-related the past day or so?
1. The King v. Burwell decision was not announced this morning, so we'll all be alternately twiddling our thumbs and holding our breath until at least Monday.
...because apparently King v. Burwell will be causing them for at least another 4 days.
No decision announced by the Supreme Court today. That leaves Monday the 22nd or Monday the 29th, unless they squeeze in another opinion day in between.
Mild touch of irony: As I noted the other day, the main reason I'm not in a position to post detailed entries this morning is because I'm at the hospital waiting for my son to undergo an MRI.
If the Supreme Court does side with the Republican Party/CATO Institute and kills federal exchange tax credits, we'd be among those who'd lose them.
Now, to be fair, it's a relatively small amount for us, so losing the credits wouldn't destroy us financially. In addition, thankfully, in my son's case, it's not a serious issue.
Even so, we would be among those who'd likely see a massive rate hike (on the order of 50% or more here in Michigan)...meaning that it's conceivable that we wouldn't be able to afford the procedure, say, 7 months from now.
Now, take our situation, increase the seriousness of the medical problem while lowering the household income level somewhat, and the situation becomes far more dire.
As I noted the other day, I'm flying out to Atlanta, Georgia early tomorrow morning to address the Society of Actuaries annual convention (expo? whatever), and won't be back until after midnight. Then, Thursday morning, my kid has an MRI scheduled (nothing serious, but it can't be rescheduled). As a result, I'll be either unavailable or completely wiped until at least Thursday afternoon.
Seeing how the Supreme Court has added Thursday morning (at 10am) to their list of decision announcement dates, there's a 1 in 3 chance that the King v. Burwell decision will be announced right in the middle of the procedure (although most experts seem to think they'll hold off until the 29th anyway).
This means, of course, that several hours could pass after the announcement before I'm able to write anything about it. The irony of this is not lost on me.
In any event, if they make the Big Announcement and any reporters/pundits/etc. wants a reaction/quote from me, please hold off until at least noonish, ok? Thanks!
I also noted that if you cross-reference this data with this handy interactive map provided by Enroll America, you can even figure out roughly how many people would be screwed in every county in each state, by dividing the state-wide percentage receiving subsidies by the total number enrolled per county.
No, I'm not the first to use the "Dog Catches Car, Now What?" metaphor for the Republican Party when it comes to King v. Burwell, but I think this classic Warner Bros. cartoon is an even better metaphor...because not only would a ruling for the plaintiffs mean that the dog has finally caught the car, that car has grown much larger since the dog started chasing it.
Back in 2013, when the various "no subsidies for federal exchanges!" cases were originally originally cobbled together by the CATO Institute (there were several essentially identical cases, including King as well as "Halbig v. Sebelius"), ACA exchange enrollments were still theoretical. The websites were either not launched yet or still a mess, and either no one had actually enrolled yet or their healthcare coverage hadn't even kicked into effect yet.
Last week I posted a series of 34 graphics demonstrating just how many people would lose their federal tax credits in the event of the Republican Party winning their King v. Burwell court case at the Supreme Court...along with how much of an unexpected tax hike they'd have to shell out in order to keep their coverage for the rest of 2015. The amount varies by state, but overall it averages just over $1,600 apiece.
This amount is based on a simple formula: These 6.5 million people are receiving an average of $272 in federal tax credits per month. Assuming the Supreme Court cuts off those credits starting in July, that's $272 x 6 months = $1,632 for the rest of this year. Simple.
On All In with Christopher Hayes last night, former GOP Senator Judd Gregg gave an incoherent, nasty and just plain bizarre appearance in which he not only tried to claim that only 4 million people have gained insurance since the ACA was implemented (versus the actual net gain of 14-15 million), but actually tried to mock and insult Hayes when the host tried to correct him...by claiming that Hayes' numbers were the ones which were off.
I'll post the transcript below later, bit here's the actual clip...it's really difficult to capture the sheer craziness of Gregg's ramblings (thanks to Crooks & Liars for the video)
A hospital group in cash-strapped Illinois says the state might be able to set up a health insurance exchange at a lower cost by "leasing" the federal government's technology, an option that could appeal to as many as 34 states where subsides could be jeopardized by an unfavorable U.S. Supreme Court decision.
Schramm has colon cancer. Doctors diagnosed it this fall, after she started feeling stomach pains during an RV trip through Tennessee. Doctors there removed the tumor, and she's now in Austin receiving chemotherapy, which should continue through this summer.
Schramm isn't sure if she will still be able to afford her health insurance come June. She's among the 6.4 million Americans receiving subsidized coverage through Healthcare.gov. A pending Supreme Court case, King v. Burwell, argues that these subsidies are illegal — that the White House does not have the legal authority to give people like Schramm financial help.
...But Schramm doesn't really have the luxury of living without a back-up plan. She knows she needs chemotherapy and knows she can't afford it without health-insurance coverage.
There are 17 decisions left to announce this session, so they could add even more dates, but assuming they don't, this means that the possible decision dates are now reduced to this Thursday, next Monday the 22nd or the following Monday the 29th.
Here's the kicker: If they do make the announcement 3 days from now, I may not be able to post anything about it until several hours later.
For one thing, I'll be pretty exhausted that morning from catching the Red Eye back from Atlanta, Georgia, where I'm addressing the Society of Actuaries on Wednesday the 17th.
I've made a slight modification to The Graph. Instead of projecting just how many would lose their tax credits, the new version plots the likely total loss of actual QHP enrollees either directly (i.e., those who lose their credits...around 6.5 million) or indirectly (i.e, those who are currently paying full price for their premiums but would likely have to drop that coverage due to the massive (50%+) rate hikes being projected by several studies in response to the adverse selection factor...around 1.5 - 2.0 million by my estimates).
Since the ACA requires insurance companies to continue coverage for existing policyholders for 90 days after they fail to make a payment, most of the expected drop-off probably wouldn't officially happen until the end of September (assuming that the tax credits are actually cut off starting with the July premiums).
A couple of weeks ago, I noted that the all five of the Republican Party's assorted "fixes" for their plaintiff winning King v. Burwell have basically been given "junk" status by the American Academy of Actuaries...who aren't exactly known for sticking their noses into public policy debates. These guys are about the least-political, most level-headed bunch around, and they just took a giant dump on the GOP's half-baked KvB "fixes" only a few months after sending a pretty urgent open letter to HHS Secretary Sylvia Burwell in which they stressed that a King plaintiff win, without either Congress or the states taking action to resolve the issue, would likely resolve in massive rate hikes and disruption of the entire individual insurance market.
Also, I may have forgotten to mention, King is a Vietnam Veteran, and he could get free healthcare through the VA and be exempt from having to buy healthcare insurance out of pocket at all. This entire fight is a scam – what? You thought a limo driver could fund a legal fight all the way to the Supreme Court on his own, did you? You’re so darned cute. King is nothing but a conservative stalking horse who wants to screw six million people out of medical coverage while he himself gets taken care of under a federal healthcare program.
I've written a lot about how the 2016 policy rate increase request numbers flying around in scary-sounding headlines at the moment are misleading for a bunch of reasons:
1. They may not be weighted by company market share
2. They may not be weighted by metal level
3. The percentages listed may be based on relatively small dollar amounts
Of the 6.5 million people who would lose their federal tax credits, and almost certainly their healthcare coverage (completely apart from the additional 6.5 million who would have an economic boulder dropped on them indirectly) in the event of a King v. Burwell plaintiff win, over 1/3 live in just two states: Florida and Texas. 1.34 million Floridians and 846,000 Texans would be be among the direct casualties...close to 2.2 million between the two of them.
Given that both are completely run by off-the-rails batcrap-insane Republicans in the House, Senate and Governor's office, it's safe to say that you can expect a LOT of stories like the following from the Sunshine and Lone Star states.
A new survey finds that 81 percent those enrolled in ObamaCare plans are satisfied with their health insurance.
The survey from the Commonwealth Fund, a health research group, found that 45 percent of people enrolled through ObamaCare’s marketplaces are “somewhat satisfied,” and 36 percent are “very satisfied.” Fifteen percent are not satisfied.
The 81% number refers specifically to ACA exchange-purchased QHPs; it doesn't include off-exchange enrollments or Medicaid expansion. While the survey doesn't break the numbers out this way, I'd be willing to bet that the 15% who aren't satisfied mostly consist of those who also aren't receiving federal tax credits to help pay for the premiums.
David K. Jones is an assistant professor at the Boston University School of Public Health. Nicholas Bagley is an assistant professor of law at the University of Michigan. Over the past week or so, they and their colleagues have posted a series of 3 pieces detailing the King v. Burwell response situation across 5 states currently at risk of losing their subsidies. The first part covered Florida. The second covered my home state of Michigan along with New Hampshire. The final piece looked at North Carolina and Utah.
The whole series is excellent and worth a read. However, there's one particular bit in the North Carolina section which caused me to #FacePalm so hard I may have caused a concussion, and my eyeballs to roll so far back in my head that I may need an ophthalmologist more than Luis Lang:
A state task force is developing a waiver request that would protect Hawaii’s employer-based health coverage law amidst other Affordable Care Act plans to be offered under the federal platform, the executive administration has confirmed.
...One concern is that employers could opt for cheaper federal plans in lieu of the state plans already in place.
Hawaii’s 41-year-old Prepaid Health Care Act requires employers to offer workers robust health insurance plans. Under the prepaid health care law, the Affordable Care Act’s bronze and silver plans are technically not legal in Hawaii.
Four of the nine health insurers selling Obamacare plans in Indiana are expecting to cut their average rates next year, according to filings with the Indiana Department of Insurance.
So, with all the fuss & bother over the imminent King v. Burwell decision, what's the deal here in the Wolverine state?
Well, first of all, here's what's at risk if the Supreme Court rules for the plaintiffs, Congress fails to pass a simple tweaking of the law to resolve the issue and the state administration fails to "establish" an exchange which passes muster with regard to the minimum legal definition required:
In other words, be very careful to understand the context of the "rate increase" story before drawing any conclusions when reading reports of either "excessively high" or "quite reasonable-sounding" 2016 premium rate change requests.
A couple of days ago I noted that the primary damage (but by no means the only damage) of the Supreme Court ruling for the plaintiffs in King v. Burwell would be for appx. 6.5 million people to have to shell out an average of over $1,600 in extra taxesthis year to keep their current healthcare policy through the end of 2015, plus a likely average 493% hike in premium rates if they want to keep the same policies in 2016.
However, seeing one big blobby spreadsheet isn't exactly conducive to capturing people's attention, so I've taken the liberty of whipping up social media-friendly individual state graphics. Feel free to share widely!
The California Assembly has approved a bill to designate pregnancy as a qualifying life event to allow women to purchase health plans through Covered California outside of the regular open enrollment period. The bill is now set for review by the state Senate.
In New York, three separate bills have been drafted with the same goal, in a bid to increase the odds that a version will be passed.
Moves like the one in California could influence federal policy on the issue, suggests Christina Postolowski, health policy manager at Young Invincibles.
Sec. Burwell responded in the only rational way possible: By pointing out that if [the Republican Party is] absolutely determined to destroy the lives of millions of likely voters across 34 states (including swing states like Florida, Ohio, Michigan and Wisconsin) while simultaneously forcing insurance premiums up an additional 35% - 45% for everyone else in those states (on top of whatever they were set to go up already), when it would literally take about 5 minutes for them to "fix" the very issue that they ginned up as the "problem" in the first place, there's not a hell of a lot that she can do to stop them.
...None of the above options involve anything that Sec. Burwell has any control over.
In other words, her only "contingency plan" is "try to convince the Republicans controlling the Supreme Court, Congress or those states to stop being colossal jackasses and actually do something to help the people they're supposed to be serving."
Not a plan likely to succeed, of course...but it's a plan.
A couple quick developments in the ongoing saga of Luis Lang, the guy from South Carolina with serious medical and insurance issues whose story went viral a few weeks back.
I've been occasionally chastized for my occasional use of less-than-professional language. Terms like "pile of crap" or, rarely, more crass terminology.
Now and then I think, "hey, I should probably tone down the language here!"
And then, the Speaker of the United States House of Representatives, the 3rd in line to the Presidency, is reduced to issuing grade-school insults taken from 3-month old New York Post op-eds written by FOX News correspondents...
Over at the Washington Post, Greg Sargent notes that Mitch McConnell, as expected, is following the standard Republican playbook when it comes to...well, everything, really: Blame President Obama.
BAIER: Doesn’t this hold some potential problems for the GOP? What do you think the solution is if you have to deal with this quickly?
McCONNELL: Depending on what the Supreme Court decides, we’ll have a proposal that protects the American people from a very bad law. Obamacare was the single worst piece of legislation that’s been passed in the last half century. The single biggest step in the direction of Europeanizing our country…What we will do is offer a proposal to protect the American people.
Setting aside the "Europeanizing" part for the moment (seriously, I always wonder about the impact on foreign policy/diplomatic relations with our allies whenever a Republican says something like this), Sargent lays out the GOP's options:
There's not any new info here, but this bit pretty much summarizes what you'll be seeing across 2/3 of the country in a worst-case scenario:
...HealthCare.gov, the federally run exchange, is where 27-year-old Kathryn Ryan, a restaurant server in Philadelphia, turned for health coverage, as soon as the law took effect.
"I was excited because if it weren't for Obamacare, I wouldn't be insured at all," she says. "I wouldn't have the ability to go to the doctor."
She can afford health insurance thanks to a $200 a month subsidy that brings her premium down to $60 a month.
Ryan, who's also studying social work, is one of nearly 400,000 Pennsylvanians who have qualified for income-based financial assistance. But like a lot of people, she had no idea that a case before the Supreme Court puts at risk the subsidies in states like Pennsylvania that rely on the federally run exchange.
The DC exchange just issued a welcome-but-unexpected update; as usual, they do this weird thing where they're including the cumulative totals dating back to October 1, 2013, which is pretty much pointless (this would be like measuring how well Chrysler is doing in 2015 by counting every car they've sold since 1925).
From October 1, 2013 to April 26, 2015, 106,364 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
22,354 people enrolled in a private qualified health plan,
67,761 people have been determined eligible for Medicaid, and
16,249 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)
Four words in the law could unravel Obamacare in the Supreme Court. So President Barack Obama is marshaling his own numbers – and an unusual moral weight — to stress the achievements of his health overhaul law on Tuesday.
In a speech to the Catholic Health Association, Obama will talk about the hundred years it’s taken to reform healthcare in the United States, and the millions it has helped over its five years of implementation. With a ruling due by the end of the month that could potentially send the new insurance marketplaces into a tailspin, Obama will warn, the social contract is at stake.
...On Tuesday, Obama will try to transcend the legal issues and political debate and instead focus on what the law has accomplished.
As I noted last month, Colorado's exchange reports are both crammed full of useful data and very confusing at the same time. Fortunately, with the help of Louise Norris, it should be a bit easier to figure out this time around (plus, during the off-season some of the numbers aren't as crucial anyway).
The total paid enrollment as of 5/31/15 is 73,438 + 54,811 = 128,249 people.
The number of these which were effectuated as of 5/31 appears to be 131,496 - 2,493 (SHOP) - 4,496 (Dental Only) = 124,507 people as of the end of May.
Until today, everyone has known that the idea of a Republican-controlled Congress taking 5 minutes out of their day to "fix" the wording "problem" in the ACA which they ginned up themselves was laughable...but to my knowledge, no sitting member of Congress (at least not one in a Senior leadership position, anyway) has come right and admitted this.
SCALIA: What about Congress? You really think Congress is just going to sit there while all of these disastrous consequences ensue? I mean, how often have we come out with a decision such as the you know, the bankruptcy court decision? Congress adjusts, enacts a statute that takes care of the problem. It happens all the time. Why is that not going to happen here?
NOTE: Shortly after Greg Sargent tweeted out a link to this story, I screwed something up and had to rewrite the entire piece. If you visited earlier and got a blank page, I apologize; it's 99% identical to what it was at the time.
Over at CNBC, Dan Mangan has a good write-up about 2 new polls out today regarding King v. Burwell...specifically, public support for the ACA's federal tax subsidies in the 34 states at risk:
Two new polls show strong public support for the high court maintaining financial aid that helps people in 34 states buy health coverage through the federal Obamacare marketplace.
The first survey, from Public Policy Polling, found that 61 percent of Americans believe that everyone in the U.S. at similar income levels should be able to get Obamacare subsidies regardless of where they live.
Support for that idea was strongest among Democrats, at 74 percent. But even a plurality of Republicans favored keeping subsidies for HealthCare.gov customers—49 percent in support, and 41 percent opposing the idea.
For months now, both ACA detractors and some supporters alike have kept asking the same question about King v. Burwell: What sort of "contingency plan" do President Obama, HHS Secretary Sylvia Burwell and the Democrats in Congress have in the event that the plaintiffs win the case?
The House Republicans had sent an incredibly "CHOOTZ-PAH" filled letter to her demanding that she tell them what the HHS Dept's "contingency plan" would be in the event that the Supreme Court ends up doing their bidding by tearing away federal tax credits from 6.5 million people this summer.
Just over a year ago, just after the 2014 Open Enrollment period ended, Daily Kos founder & publisher Markos Moulitsas, along with his team, unexpectedly set up a fundraiser for me as a thank you for the work I put into the ACA Signups project for Year One (as well as to encourage me to keep it going for Year Two).
The folks over at dKos raised a substantial amount to help me out...for which I'm more grateful than they can ever know, becuase quite frankly, I had lost about half a year's income during the process and would have been in deep financial difficulty without their help (along with the generous folks here who had/have donated before and since then).
Over the years, I've consistently kept any personal favors to a minimum. I don't like to abuse the position you all have afforded me to make personal non-political requests. But I'm going to break from tradition for this special case.
If the U.S. Supreme Court decides later this month that 34 states including New Jersey are not permitted to share in federal subsidies used to lower the cost of Obamacare premiums, Gov. Chris Christie said Congress should "fix" the law to preserve the money.
The Republican governor and unannounced presidential candidate has been critical of the Affordable Care Act, calling it a "failed" program last year.
But when asked what he thinks ought to be done if the nation's highest court rules that only the 16 states that operate their own "exchanges" — an online hub to sell health insurance coverage — can receive subsidies, Christie did not call for rolling back the program.
"Congress should fix it," Christie said speaking outside the Corner View Restaurant in Concord, N.H. "If Congress messed up the statute, the Congress and the President created the statute; they should fix it. If they're saying it's not what they intended, then go back and fix it."
In 2014, Hawaii's enrollment numbers were pretty bad, but they were at least consistent: About 400 through the end of November; 2,200 at the end of December; 3,600 at the end of January, 4,600 at the end of February and about 8,600 through mid-April. Their cumulative total through the end of the off-season last year was just shy of 11,000, which again, was pretty in line with what I'd expect.
As you can see from the reposts below, for 2015, Hawaii's numbers have been all over the place, making sense some days and completely out of whack on others. The official HHS Dept. ASPE report has Hawaii with 12,635 QHPs selected for 2015 as of Feb. 21st...which sound about right to me (ie, that's a pretty lame number, but it's still around a 47% increase over 2014). Then, a few days ago, CMS released the effectuated enrollment numbers as of 3/31. For Hawaii, this number is 8,200...a 35% drop. While that's a disturbingly heavy drop (the other states averaged just a 13% "drop" overall), it's at least plausible.
Tom Wolf, the newly-elected (Democratic) Governor of Pennsylvania, announced back in March that yes, he would absolutely push to "establish" a state ACA exchange in the event of a King plaintiff win, and earlier this week he made good on this by formally submitting an application to the HHS Dept.:
Pennsylvania became the first state Tuesday to publicly put in motion a back-up plan to protect its federal health insurance subsidies in the event the Supreme Court dismantles a key part of President Obama’s health care law.
Among the major takeaways was that as of 3/31/15, effectuated (ie, active/paid for) private policy enrollments via the ACA exchanges stood at 10,187,197 people.
The spin on this via both the New York Times and the McClatchy Washington Bureau is that this means that "13% Left Health Care Rolls" (the Times) or, alternately, that "U.S. marketplace health plan enrollment falls to 10.2 million" (McClatchy).
Depending on your perspective, neither of these are accurate (although the first headline is worse; "13% left healthcare rolls" makes it sound as though over 40 million people suddenly became uninsured nationally).
As of this writing, the countdown clock reads 24 Days, 18 Hours, 14 Minutes and 27 Seconds. 21 Days, 0 Hours, 48 Minutes, 21 Seconds. However, the Court's decision could be announced as soon as 4 days from now! 1 Hour from now!Commenter "secretadvocate" noted that according to the Supreme Court's calendar, they plan on making their Major Decision announcements on each Monday of June. Since they took a pass on King a few days ago, that leaves 4 possible dates for the Big Announcement:
You don't hear a whole lot about the other ACA healthcare exchange system, the Small Business Health Options Program (SHOP, although it should really be "SBHOP" which looks like a typo). In fact, to my knowledge, the HHS Dept. has never said a peep about the SHOP numbers in any of their official reports or press releases. There's a reason.
Rhode Island just made an announcement about their SHOP program. RI only has a total population of just over 1.05 million people anyway. so 3,500 people enrolled in the state's Small Business exchange policies actually isn't too bad, really (for comparison, this would be the equivalent of California enrolling around 128,000 people in theirs).
One, from CNN Money, took an alarmist stance in the headline, but the article itself--while still angled towards the high increase end--was technically accurate.
The second, from Capital New York, was more complete and accurate including the proper context (it included all companies and weighted them by market share, as opposed to partial, skewed data). It also had a less sexy, but far more accurate headline.
There's also a third way to present the story: Making crap up, aka lying about it.
Thanks to commentor "pilon" for the head's up on this silliness from some right-wing outfit called the "Washington Policy Center" (I'm not gonna link to them, but I'll include the URL in the screen shot):
Over the past couple of weeks, I've posted a bunch of entries both here and over at healthinsurance.org about not freaking out when you see "OMG!!! MASSIVE OBAMACARE RATE HIKES NEXT YEAR WE'RE ALL GONNA DIIIIIIIIE!!!"-style headlines such as this giant one from CNN Money:
The angle being played is emphasized right off the bat with the big, scary-looking graphic above the story:
Even the sub-headline pushes the hair-on-fire meme:
While everyone is waiting for the King v. Burwell decision to come out in a few weeks, the CMS Dept. has quietly released their latest monthly Medicaid/CHIP enrollment report...which happens to line up almost perfectly with what I was expecting:
Nearly 71.1 million individuals were enrolled in Medicaid and CHIP in March 2015. 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.
534,845 additional people were enrolled in March 2015 as compared to February 2015 in the 51 states that reported comparable March and February 2015 data.
Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both March 2015 enrollment data and data from July-September of 2013, over 12.2 million additional individuals are enrolled in Medicaid and CHIP as of March 2015, an approximately 21.2 percent increase over the average monthly enrollment for July through September of 2013.9 (Connecticut and Maine are not included in this count.)
With the latest official enrollment data out of the CMS division of the HHS Dept., I've had to make some modifications to The Graph to make it more accurate.
First, here's the old version, updated through yesterday (click either one to load full-size version in new browser window):
Yesterday's giant data dump from the CMS division of the HHS Dept. noted that as of March 31st, 2015, 6,387,790 people were receiving APTC (Advance Premium Tax Credits) across the 34 states at risk of losing those credits due to the King v. Burwell court case. That's the number of people who were actively enrolled in paid-for, effectuated policies as of 3/31/15. Fair enough.
I've gone ahead and plugged the actual 3/31/15 effectuated enrollment numbers for each individual state into the spreadsheet so I can compare them against my own estimate for that state. Below is how it turned out. As you can see, overall I was pretty damned close: 10.08 million vs. 10.19 million, a difference of around 110,000 people, or just 1.05%. Better yet, I underestimated the effectuated enrollments by a smidge (much better than overestimating them).
However, there's an important caveat to keep in mind: The CMS numbers are as of March 31, while my own estimates are projections as of July 1st, the first day which the tax credits could potentially be removed.
With all that done, here's the state-by-state breakdown of how many people I expect will be receiving federal tax credits for their ACA exchange-purchased healthcare policy as of July 1st, 2015:
March 2015: Average Advanced Premium Tax Credit by State
Consumers with household incomes between 100 percent and 400 percent of the FPL may qualify for an advance premium tax credit, which helps make their coverage more affordable throughout the year by lowering their share of monthly premium costs. Consumers who qualify for APTC may choose how much of the advanced premium tax credit to apply to their premiums each month, up to the maximum amount for which they are eligible.
This actually isn't as much of a surprise to me as you might think. Between the increased transparency during the 2nd Open Enrollment Period (weekly state-by-state snapshot reports for HC.gov) and especially with the King v. Burwell Supreme Court decision coming up later this month, I was expecting HHS to release some sort of update about just how many people are currently enrolled in exchange-based private policies...in particular, the number who are receiving Advance Premium Tax Credits across the 34 states at risk of losing theirs.
Yesterday I posted about Healthcare.Gov's new "Rate Review" tool, and how, while it's very handy for seeing which comapanies are trying to jack up their premium rates by more than 10% next year (and allowing public comment on them), it's essentially useless for trying to calculate the overall average rate increase in a given state (or in some cases, even for a given company in that state).
I used Connecticut as an example: The actual statewide, weighted average increase request is around 7.7%, but if you only use the Rate Review database as your source it makes it look like it's over 18%.
Officials from states across the nation flew to Chicago in early May for a secret 24-hour meeting to discuss their options if the Supreme Court rules they have to operate their own exchanges in order for residents to get health-insurance subsidies.
Over the course of an evening reception, a day’s presentations and a Mexican buffet at the O’Hare International Airport’s Hilton hotel, some of those officials concluded their options are likely unworkable.
Unfortunately, for all the Top Secret Urgency, their conclusion was pretty grim...
The new Rate Review searchable database added to Healthcare.Gov should make it much easier to figure out the weighted average rate change requests for every state. It's clean, simple to use, includes all 50 states (plus DC and even throws in U.S. Territories to boot!), lets you filter out transitional policies and pre-2016 years and so on. In addition, the layout is consistent and doesn't require downloading 6,000 page PDF files (!)
Yes, in terms of following the requirements of the HHS Dept, it's very useful for people to look up their particular company in their state, see what their "average" rate increase request is and submit cranky public comments (which will in most cases probably be ignored, but hey, you never know).
As it happens, Healthcare.Gov has set up a nifty new section devoted to displaying a searchable database of exactly this type of data, RateReview.Healthcare.Gov:
This has already been proven to be highly useful for things like this Enroll America map which breaks out private exchange enrollment by county, as well as my own entry which provides the tools for breaking out roughly how many people an adverse King v. Burwell ruling would lose their federal tax credits in each state/county/zip code (I've only done this by state; doing the actual county/zip code work would take a tremendous amount of work).
The GOP’s months-long debate over when and how to send a repeal of Obamacare to the president’s desk now appears to have an answer.
They can’t do it all at once.
Repealing the law “root and branch” is probably out of the question, the chamber’s parliamentarian is hinting, because some parts of Obamacare don’t affect the federal budget. That’s a must in order to use the obscure procedure known in Senate parlance as reconciliation, which allows lawmakers to avoid the 60-vote filibuster hurdle and pass bills on a simple majority vote.
That’s not the GOP’s only problem. Under those rules any Obamacare repeal has to reduce — not increase — the deficit. So Republicans will have to pick and choose which parts of the Affordable Care Act they most want to ditch.
