Well, it's around 7pm EST on Sunday, 1/31/16. As of this writing, HealthCare.Gov is loading quickly, as are all 13 of the state-based exchange websites. Aside from a "high call volume" message at Covered California and "extended call center hour" messages from CoveredCA and various other SBMs, I'm not seeing any evidence of website server load strain, etc.
In fact, the only "overtime/extension period" announcements so far are from the Maryland Health Connection and Covered California, which each announced official "In Line By Midnight" extensions for those who start their enrollment process by midnight tonight.
This is only appearing on the home page of the Massachusetts exchange website, but the wording of it suggests that it applies to all of the state-based exchanges.
Yeeks. Don't be surprised if there's a few more #ACAOvertime announcements after all....
UPDATE 10:50pm: Hmmm...it's been over an hour and no other state exchange websites are reporting any problems, nor have I seen any Tweets or Facebook posts which indicate any outages.
All websites including HC.gov are still loading smoothly.
UPDATE MIDNIGHT: Welp, that's that, at least for the Atlantic and Eastern Time Zones. *Central, Mountain West and Pacific still have a bit to go, and of course Alaska and Hawaii are 5 hours behind, but I've gotta get some sleep myself...
I assume there'll be some sort of rough tally announcement tomorrow, but all eyes will be on the Iowa Caucuses anyway, so there you go.
Fox News host Chris Wallace cornered Republican presidential candidate Ted Cruz on Sunday about his claim that President Barack Obama’s health care reform law had cost jobs.
“The fact checkers say you’re wrong,” Wallace told Cruz. “Since that law went into effect, the unemployment rate fell from 9.9% to 5% as 13 million new jobs were created, and 16.3 million people who were previously uninsured now have coverage.”
“There are plenty of problems with Obamacare, but more people have jobs and health insurance,” the Fox News host added.
...“Wait,” Wallace interrupted. “There’s certainly no question that more people have jobs and more people health insurance.”
...The Texas senator became irritated as the Fox News host pressed for an answer to his original question.
STEPHANOPOULOS: You say that Ted Cruz is a liar, but you have said that you want everyone to be covered on health care and the government is going to pay for it. How is that not ObamaCare?
TRUMP: I want people takes -- that's true. I want people taken care of. I have a heart. I want people taken care of. If people have no money, we have to help people. But that doesn't mean single payer. It means we have to help people.
STEPHANOPOULOS: How do you do it?
TRUMP: We'll work something out.
And...scene.
(OK, I admit I left out some of Trump's blather before/after; feel free to click the link for his "fully detailed" response).
Senator Ted Cruz is often asked about doing away with President Obama’s health care law. He is less rarely pressed by voters on what will replace it.
But at a middle school cafeteria here, a man, Mike Valde, presented him with a tragic tale. His brother-in-law Mark was a barber — “a small-business man,” he said. He had never had a paid vacation day. He received health insurance at last because of the Affordable Care Act. He began to feel sick and went to a doctor.
“He had never been to a doctor for years,” Mr. Valde, 63, of Coralville, Iowa, said. “Multiple tumors behind his heart, his liver, his pancreas. And they said, ‘We’re sorry, sir, there’s nothing we can do for you.’ ”
The room was silent.
“Mark never had health care until Obamacare,” Mr. Valde continued. “What are you going to replace it with?”
Mr. Cruz expressed condolences and pivoted quickly to a well-worn answer assailing the health care law.
UPDATE: I've expanded the second half of this entry.
A week or so ago, I took a good look at Bernie Sanders's Single Payer healthcare proposal and was, as I put it, "beyond disappointed" due to it's lack of detail, and naiveté about not only the political realities of trying to get such a plan through (which is the biggest issue that Sanders supporters insist can be overcome through a "political revolution" etc etc), but also due to the sheer mountain of legal, economic, infrastructure and logistical headaches that would have to be navigated.
The irony is that, for me, the math behind such a plan (ie, how much it would end up saving people overall in terms of actual dollar savings as well as reduced administrative overhead, greater efficiency, etc) was something which I didn't even get into. I was operating on the assumption that, while the specifics would obviously jump up and down here and there, the numbers were generally in the right ballpark. HOWEVER, according to Emory University expert Kenneth Thorpe (who's actually a strong single-payer advocate who has authored several SP plans himself), that may not be the case whatsoever. Dylan Matthews of Vox writes:
UPDATE: I thought this was obvious, but apparently not: I'm not saying that a complete relocation of the entire population of Flint will be necessary, I'm just trying to get some sort of feel for how much it would theoretically cost if they had to be relocated.
"A September estimate, only recently released by Michigan governor Rick Snyder, puts the cost of replacing all the lead pipes in Flint at $60 million. And the project will take 15 years.
I'm surprised by this for several reasons. The snowstorm was nearly a week ago, and there's still 3 days left for people to enroll as it is; are there still a lot of areas of Maryland coping with power outages/other disruptions which are making it unreasonable to expect people to get in under the wire?
Second, because CMS just stated pretty unequivocally that HealthCare.Gov will not be offering any official deadline extension (although, like the MD exchange, they did say that they'll have an "in line by midnight" exception). I assumed that if HC.gov was taking a "hard line stance" that the state exchanges would as well.
As a single payer advocate, it may sound strange to hear me rooting for private, for-profit insurance carriers to do well, but the fact remains that for the time being, the ACA exchanges are a huge part of the individual heatlhcare market, and they're based on the capitalistic theory of a competitive market helping keep prices from spiraling out of control. For the next few years, at least, it therefore behooves me to be hopeful for their success.
Remember how the Risk Corridor program was put in place specifically to help guide insurance carriers through the rocky, turbulent, confusing waters of the early years of the ACA exchanges by mitigating massive premium rate miscalculations the first few by having carriers which did better than expected chip into a kitty to be passed out to those which missed the target for the first 3 years?
Remember how the carriers which lost money the first year were really, really counting on those Risk Corridor funds to be there to help cushion the blow?
Remember how as a result, when it came time to start doling out the RC funds to the carriers which had a crappy first year, there were only 12 cents on the dollar sitting in the cupboard?
LANSING -- In January of 2015, when state officials were telling worried Flint residents their water was safe to drink, they also were arranging for coolers of purified water in Flint's State Office Building so employees wouldn't have to drink from the taps, according to state government e-mails released Thursday by the liberal group Progress Michigan.
A Jan. 7, 2015, notice from the state Department of Technology, Management and Budget, which oversees state office buildings,references a notice about a violation of drinking water standards that had recently been sent out by the City of Flint.
...State officials could not immediately answer e-mailed questions about the water purchases, including how long the state continued to buy bottled water for state employees in Flint while telling Flint residents the water was safe to drink. An official said the administration was "looking into these issues."
SACRAMENTO, Calif. — Covered California announced that a surge of consumers interested in affordable, quality health care coverage had signed up through the agency this week. Through Jan. 27, more than 329,000 new enrollees had picked a health coverage plan during the current open-enrollment period. In addition, more than 148,000 new and renewing consumers had enrolled in the new optional family dental coverage.
As always, CoveredCA is happy to tout their new enrollees but has a weird thing about keeping mum on the number who renewed policies from 2015. This would make sense if the renewal number sucked, but it doesn't: The ASPE report through 12/27 clearly states that they had 1,411,664 QHP selections, of which 84% were renewals (automatic or active) by 2015 enrollees.
84% of 1,411,664 = roughly 1,186,000. Add 329K to that and you get 1.515 million QHP selections to date.
Nearly 71 million individuals were enrolled in Medicaid and CHIP in November 2015. 7 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.
This number is about 900K lower than October's report (71.8 million) due to a reporting correction in California:
There was a quick "Final Countdown" conference call with the CMS team this afternoon, pushing the upcoming final Open Enrollment deadline this Sunday at midnight.
There wasn't a ton of notable news; most of it was reiterating the numbers put out yesterday, giving a shout-out to certain states and specific cities which are substantially outperforming last year so far (14 states are 20% ahead of where they were last year at this time, and several southern cities were recognized specifically:
States which are 20% ahead of last year: OR, NV, IA, UT, SD, LA, NE, ND, TN, OK, AL, ME, WI, NJ
Southern cities outerperforming last year: Houston, Dallas, San Antonio, Austin, Nashvillle, New Orleans, Atlanta and Miami
They also noted that yes, traffic is finally starting to ramp up in the final days: A 50% increase in HealthCare.Gov traffic, twice as many phone calls came in by this morning as all of yesterday, etc.
Maryland already exceeded my (and their) OE3 target of 150K QHPs a few weeks ago, so anything more is just gravy, but every bit helps counter the shortages I'm seeing in other states. Last week they reported 155,701 QHP selections as of 1/20/16.
Just now, they confirmed the latest numbers ahead of Sunday's final deadline:
As of 1/26, 156,695 QHP / 304,667 Medicaid / 25,784 Dental.
I've never really tracked dental plans, and I'll be writing about the latest Medicaid numbers later, but that's 156,695 QHPs as of 1/26, or 994 more in the past 6 days, or 166 per day.
This is actually a slowdown from MD's average from 12/28 - 1/20, when they reported a net gain of 5,408 over 23 days (235 per day). On the other hand, given how much Maryland has been kicking butt this year, perhaps they're just running out of people to, you know, enroll.
Anyway, MD is on track to add at least another 1,000, potentially up to 3,000 more for a final number close to 160K.
As noted yesterday, after seeing the writing on the wall for several weeks now and lowering my final 2016 Open Enrollment Period projection by around a million already (from 14.7 million down to a range of 13.6 - 14.0 million), I've gone ahead and lowered it once again to a range of 12.4 - 12.9 million. It's still possible that the final weekend will see a shocking vertical spike, of course, but it would have to shoot up something like 10-12x last week's daily average in order to hit the 14 million range (as opposed tolast year's 3-4x increase in the final week.).
So...what went wrong? Well, from the HHS Dept's POV, nothing...or at least nothing that they didn't already project last October. They had already openly stated that they didn't expect any dramatic exchange enrollment increases this year, giving a wide open enrollment range of 11.0 - 14.1 million QHP selections...which has a mid-range of 12.6 million.
The proper question here is how I managed to get it wrong, overestimating by what could be up to 2 million people, Obviously I can't be expected to nail every number, but that would be the least-accurate projection I've had to date.
I'll run a full post-mortem after the final numbers come in next week, of course (it may take even longer for a few of the state exchange numbers to roll in), but there are three four major factors I wanted to address right now (and no, none of these have anything to do with how affordable the policies are, whether the networks are too narrow or the deductibles too high, etc etc; those all contribute, of course, but are also a completely separate discussion):
Your Health Idaho has only issued one official enrollment data press release to date, back on 12/18, when they reported "over 93,000" private policy selections.
There was one additional update via the HHS Dept's ASPE report, which reported exactly 96,662 QHPs as of 12/26/15, which seems about right given that it included 8 extra days.
BOISE, Idaho – The deadline to get health insurance coverage through Your Health Idaho is just days away. If you want health insurance for 2016 you must enroll by January 31. Already, more than 95,000 Idahoans have selected health insurance plans through the state’s health insurance exchange.
I may have seriously lowered my final projection earlier today, but Washington State is still cranking along. Just a few days ago they reported having enrolled 180,000 people in private policies (thru 1/21). Today they report:
Through the first 12 weeks of open enrollment, more than 188,000 residents have selected a Qualified Health Plan for coverage in 2016. Those sign-ups represent a 30 percent increase in plans selected over the first 12 weeks of open enrollment last year.
I presume "the first 12 weeks" means as of 1/23, which would mean another 8,000 people in just 2 days, which is excellent if true (WA was one of 3 states to have a later February coverage deadline...of 1/23).
In any event, this brings WA up to 188,000 people, or 89.5% of my 210K target for the state.
That leaves just 1 week to enroll at least 22,000 people, or 3,142 per day, which actually seems doable after all.
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
Note that whle the enrollment numbers for most states below are current through January 23rd, most of the state-based exchanges are either slightly more current or up to a month behind.
A few hours from now, CMS should be releasing the HealthCare.Gov Week 12 Snapshot report. As noted last week, the "pre-purge" factor has completely messed up my projection model this year, since the numbers for weeks 1-10 could have been lopped down by several hundred thousand people (nearly 250K of which were confirmed to have happened in Week 11 alone). While the purge numbers for the previous 10 weeks were likely much smaller, it still screws up my methodology.
As a result, my original projection for this week of around 400,000 QHP selections has an important caveat: It depends greatly on how whether that number includes the purged/cancelled enrollments or not:
A few minutes ago I noted that Michigan Governor Rick Snyder, currently in the hot seat for poisoning nearly 100,000 of his residents, has formally requested full Medicaid coverage for every Flint resident under the age of 21 (around 30,000 people, as far as I can tell). While my post was sarcastic, the need is real, and while it's revolting that Snyder would try to get the federal government to literally pay for his administration's crime, the move itself makes sense.
Here's a related development which makes sense as well (thanks to Rachel Karas for the link): A letter from U.S. Senator Gary Peters and U.S. Rep. Dan Kildee to HHS Secretary Sylvia Burwell (emphasis added):
Snyder to seek aid for Flint children exposed to lead
Michigan governor seeks to expand Medicaid to help at-risk young people exposed to lead in Flint during water crisis
Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.
...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.
Aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis. In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day. However, RI is also a tiny state with an even tinier ACA exchange population, in the 30K - 40K range, so it may be pointless to try and extrapolate nationally.
The Congressional Budget Office released their latest massive 225-page 10 year economic outlook report today. Obviously there's a ton of stuff there, but the part of most interest to me is, of course, their revised projections for ACA-related matters, both in terms of people and dollars.
Last March, they were still inexplicably projecting that a whopping 21 million people would sign up for ACA exchange policies...actually, even more than that, since 21M was projected to be the average enrolled per month. In order to achieve that, the actual enrollment tally would have to be several million higher since a) around 20% of enrollees wouldn't be signing up until after the January deadline (meaning they won't have coverage start until February or March) and b) general attrition via non-payments and drop-outs throughout the year. A good half of the increase over their projection of 11 million people for 2015 was based on the assumption that roughly 5 million additional people will shift from employer-sponsored insurance over to ACA exchanges:
First: While I'm incredibly flattered by Dr. Krugman's shout-out/support, I have to say that I'm really not comfortable with his referring to die-hard Bernie Sanders supporters as "Bernie Bros". I was a strong Howard Dean supporter back in 2003-2004 myself, and never cared for the term "Deaniac" which was thrown about...and "Bernie Bros" doesn't just suggest a level of dedication, but implies that only college-age men support Sen. Sanders, which obviously isn't the case.
I happen to like Sen. Sanders himself regardless of the words/actions of his more, shall we say, "devoted" supporters, and while I happen to have chosen to support Sec. Clinton, it is of paramount importance that the Democratic nominee win in November regardless of whether it's Sec. Clinton or Sen. Sanders.
Second: If you'd prefer to read the referred-to entries instead of the Daily Kos cross-post (where you'll have to wait for 900+ comments to load), here's the original versions:
More than 2.7 million New Yorkers currently enrolled in coverage through NY State of Health • New Yorkers must enroll by January 31 for 2016 Coverage
ALBANY, N.Y. (January 25, 2016) – NY State of Health, the State’s official health plan Marketplace, is encouraging uninsured New Yorkers to learn about affordable health coverage options and enroll in a plan by January 31, 2016. To date,more than 2.7 million people are enrolled in health insurance through NY State of Health, including 1.9 million enrolled in Medicaid, and 827,000 enrolled in non-Medicaid coverage. This includes 210,000 children enrolled in Child Health Plus; 260,000 individuals enrolled in a Qualified Health Plan and 356,000 people in the new Essential Plan, a new and more affordable option for lower income New Yorkers.
Throughout the first two years of the ACA exchanges, the DCI exchange's official enrollment updates were simultaneously clear & simple as well as frustrating. On the one hand, they break out the numbers quite cleanly, such as this one from October 21st of last year:
From October 1, 2013 to October 16, 2015, 173,090 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:
25,702 people enrolled in a private qualified health plan,
125,261 people have been determined eligible for Medicaid, and
22,127 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)
On the other hand, as noted above, these numbers are cumulative, dating all the way back to October 2013 when the exchanges originally launched. This makes the numbers shown kind of useless for the same reason that Chrysler stating that they've sold 100 million cars since the company was founded tells you nothing about how many cars they've sold so far this year.
The final 2016 deadline to enroll in a qualifying healthcare plan for policies starting coverage as of March 1st officially ended as of MIDNIGHT on January 31st.
As usual however, there are a few caveats to this...but not as many as the past two years:
While this isn't an official update, yesterday they posted this blog entry, pushing today's deadline for February coverage (again, the final deadline for coverage starting in March is still January 31st, like every other state):
Washington Healthplanfinder has seen a continued increase in sign-ups as residents coming into the final days of open enrollment. An additional 11,000 customers have selected new or renewed health plans since the start of the new year, bringing the total number of sign-ups to 180,000 since open enrollment began on Nov. 1.
On a related note, earlier today I wrote about being proven correct in my projection that while the projected average 2016 premium rate hikes would end up being around 12-13% nationallyif everyone renewed their existing policies, if enough people shopped around, the national average would likely end up coming in below 10% after all.
Sure enough, the 8.5 million who enrolled via HC.gov through Christmas (which is likely to be over 60% of the total) ended up with an effective average rate hike of...just 9.1%.
Here's how it breaks out state by state. It doesn't include the state-based exchanges like California, Colorado, etc, nor are any enrollees since 12/26 included, but it still gives a pretty good picture of the overall situation. As you can see, 6 states did get slammed with 20% or higher hikes (ouch), while 10 states came in with increases of less than 5%, and two of them (Indiana and Maine) actually have lower rates on average than last year.
Again, these numbers will likely shift up or down slightly after the remaining enrollees are added in (likely around 5.5 million nationally), but for now, this is where things stand.
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head. For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions. Very likely no boots had been produced at all. Likelier still, nobody knew how many had been produced, much less cared. All one knew was that every quarter astronomical numbers of boots were produced on paper, while perhaps half the population of Oceania went barefoot.
According to the McKinsey Center report, the nationwide weighted average increase is 11.7%, slightly below my 12-13% estimate. Unlike the Avalere Health report, the McKinsey study appears to be more of a true apples-to-apples comparison:
It includes all 50 states, plus DC.
It includes all Silver plans, not just the lowest-priced one.
It includes all Metal Levels as well as Catastrophic.
In fact, the only significant differences between the McKinsey Center report and mine are:
My estimate includes off-exchange ACA-compliant policies as well as exchange-based ones
My estimate attempted to look at the average change as opposed to the median change (the distinction of which, admittedly, is often difficult to remember)
Regardless, I think it's safe to say that my 12-13% estimate is on pretty damned safe ground.
Last night I bit the bullet and posted a "quasi-endorsement" for Hillary Clinton in the Democratic Presidential Primary. I say "quasi" because I never came right out and actually stated that I think other people should choose her over Bernie Sanders. What I said was that I have serious concerns about her, but when it comes to the subject of healthcare, I find myself coming to the conclusion that as much as I may support a single payer (or some similar type of universal coverage) healthcare plan, I just find Sen. Sanders's just-released plan to be a) too vague even as a broad, general outline and b) too unrealistic even as a negotiating starting point.
While the response in the comments here has been calm and reasonable, the response from some Sanders supporters over at Daily Kos was...well, "passionate", to put it mildly. Many people were supportive, some offered reasonable rebuttals and counter-arguments...but a certain subset accused me of being a Hillary shill, a GOP stooge and so forth, claiming that I never actually supported single payer in the first place (and that I don't now, even though it was the approach and timeline which I was debating, not whether SP is the way to go at all).
Add 290K to that and you're up to roughly 1.476 million people.
My official target for California is 1.80 million, so CoveredCA has reached 82% of where I was expecting them to be by now...which is right in line with where I think things stand nationally.
For the record, that also means 93,616 renewals from last year.
They also confirmed later that these numbers are as of 1/19, so that's an additional 4,467 in 14 days, or 319 per day on average.
They'll almost certainly reach their own target of 105K - 115K QHPs, but to achieve my target of 125K they'll have to ramp things up to over 1,300 per day for the remaining 12 days of open enrollment, which is probably pushing it (120K might be doable, however).
Maryland had previously reported just over 150,000 QHPs as of 12/28/15, so this sounds about right: Around 5,000 more people in the first 3 weeks of January, with 10 days left to go (I'm not sure what date the 155K figure is through, I'll assume that's as of last night). That's roughly 220 per day.
Assuming no final week surge of any sort, Maryland should add roughly 2,200 more people by the 31st, but I'm guessing it'll be closer to another 5K, for perhaps 160K in the end.
UPDATE 1/21/16: Updated to include new data from Colorado, Maryland, Connecticut and California.
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
Note that whle the enrollment numbers for most states below are current through January 16th, most of the state-based exchanges are either slightly more current or up to three weeks behind.
At yesterday's MNsure Legislative Oversight Committee meeting, CEO Allison O'Toole reported that as of January 15, MNsure had enrolled 75,000 Minnesotans into private health insurance coverage since the beginning of open enrollment, November 1, 2015.
As of January 10, MNsure had enrolled 69,671 Minnesotans into private coverage. This means MNsure has seen an increase of 5,329 private plan enrollments in five days. In addition, about 45 percent of private plan enrollees are new to MNsure for 2016. This is the highest percentage of new enrollees nationwide.
MNsure's goal is to enroll 83,000 Minnesotans by the end of open enrollment.
This will be the final enrollment update until preliminary end of open enrollment numbers are released on Monday, February 1.
As a reminder, the 2016 open enrollment period ends on Sunday, January 31. The MNsure Contact Center will be open extended hours on Saturday, January 30, from 8 a.m. - 8 p.m., and on Sunday, January 31, from 8 a.m. - midnight.
The national total was around 11.50 million QHP selections as of January 9th. Since I won't know how big of a difference the "Live Purge!" factor is making until well after the end of March (when the Q1 effectuation report comes out), I still have to work within the confines of how CMS has been reporting enrollments this season.
With that in mind, I've dropped my end-of-OE3 projection down from 14.7 million to somewhere between 13.8 - 14.2 million (call it 14.0 million even for simplicity).
In order to hit 14.0 million total, 2.5 million people will have to enroll in the final 3 weeks, most likely broken out something like:
Until tonight, I hadn't decided for certain who I'm voting for in the Democratic Presidential Primary between Hillary Clinton and Bernie Sanders. That is, I've made no secret about being a "Hillary leaner"...but I am a strong supporter of single payer healthcare (or something close to it, anyway), I do have concerns about her close ties to Wall Street, I do side more closely with Sanders than Clinton on many other issues, and yes, I'm still deeply bothered by her vote over a decade ago to invade Iraq. I used to listen to "Brunch with Bernie" on the Thom Hartmann show years ago (I think it used to be broadcast on Air America?), and gained tremendous respect for Sen. Sanders and his no-nonsense style.
Over the past few months, I've ranted repeatedly about what a stupid, short-sighted, petty move it is of Kentucky Governor Matt Bevin to shut down the kynect ACA exchange, for a variety of reasons...most of which center around the fact that the kynect exchange has been operating smoothly since the moment it launched in October 2013. In other words, there's very little reason to kill kynect, and plenty of reasons to keep it operational.
Democratic Leader Nancy Pelosi visited the University of California, San Francisco (UCSF), today to highlight a new report showing that thousands of Californians who have obtained health insurance as a result of the Patient Protection and Affordable Care Act have received vital treatment — including brain surgeries, heart transplants, cancer treatment and trauma care — since January 2014, when the health exchange opened its doors.
“Today’s report is the latest evidence that the Affordable Care Act is delivering on the promise of making health care a right for all, not just a privilege for the few,” Pelosi said. “Covered California has been an enormous success. Thanks to this historic law, nearly 1.3 million Californians now have affordable coverage through the Covered California marketplace — and this data today makes clear that Californians are using this coverage to access vital, high-quality health care.”
DENVER — Between Nov.1 and Jan. 15, more than 190,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.
“These enrollment figures show strong growth during this open enrollment period,” said Connect for Health Colorado® CEO Kevin Patterson. “But we are now only days away from this year’s enrollment deadline for many. I strongly urge everyone who does not have health insurance provided through their employer to act right now to provide financial security for their families and to avoid a penalty that experts estimate will average nearly $1,000 per household. The final deadline for 2016 coverage for many Coloradans is Jan. 31.”
Back in early December there was a lot of discussion/debate about whether or not people were using Special Enrollment Periods to "game the system". The idea is that people may be waiting until after Open Enrollment ends, ginning up a "qualifying life event" to enroll off-season, quickly arranging for a bunch of pricey healthcare services/procedures and then dropping their policy as soon as possible. By taking advantage of the various lengthy grace periods as well as loose enforcement of those qualifying events, the concern is that insurance carriers are losing millions of dollars due to people who, to put it diplomatically, aren't taking the "spirit" of the ACA's coverage requirements to heart, so to speak.
As I've noted before, aside from HealthCare.Gov itself, the Rhode Island exchange is the only state-based exchange which provides weekly updates on a consistent basis (the other exchanges range from no updates at all to monthly to a "whenever they feel like it" schedule). In addition, RI's updates cover the exact same 7-day periods as HC.gov's Snapshot reports, so they can often act as a bit of a harbinger of the larger report to come the following day.
On the other hand, Rhode Island is also a very tiny state, with enrollment numbers in the 30-40,000 range, so I have to be careful about extrapolating out to the federal exchange, which covers 38 states and likely has over 9 million people enrolled by now.
I'm actually kind of...disappointed by both of them, for different reasons (which is particularly stunning given that healthcare reform is such a major part of both of their platforms).
My problem with Sec. Clinton was that she had criticized Sen. Sanders healthcare plan on two fronts: First, by noting that the only formal plan he had presented at the time (from 2013) ceded too much authority over to the individual states (thus opening up the possibility of GOP-controlled states screwing around with everyone's coverage even more than they do under the ACA (ie, Medicaid expansion, state exchanges, etc). This may have been a valid attack. The part I had a problem with was when she went after his plan for "costing" $1.5 trillion per year without acknowledging that it would subtract the cost of all private insurance expenses (premiums, deductibles, etc.) from everyone (both employers and individuals):
DISCLOSURE: This is a sponsored post. HealthNetwork is a healthcare marketing company that reaches more than 15 million health insurance shoppers annually and connects consumers with health plans.
Sponsor Message: At HealthNetwork, we're entirely focused on improving the consumer experience when it comes to researching and enrolling in a health insurance plan. We are neither a health insurance broker, nor are we a "lead gen" company that collects information from consumers and resells it to third parties. We simply allow consumers to research their options and enroll in a plan in the method that is best for their specific needs - online, telephonically or even meeting face-to-face with a licensed insurance professional.
OK, all caught up? The national total was around 11.50 million QHP selections as of January 9th. Since I won't know how big of a difference the "Live Purge!" factor is making until well after the end of March (when the Q1 effectuation report comes out), I still have to work within the confines of how CMS has been reporting enrollments this season.
With that in mind, I've dropped my end-of-OE3 projection down from 14.7 million to somewhere between 13.8 - 14.2 million (call it 14.0 million even for simplicity).
In order to hit 14.0 million total, 2.5 million people will have to enroll in the final 3 weeks, most likely broken out something like:
Note: I tend to focus almost exclusively on the wonky "bean counter" side of the ACA at the expense of the human side. In addition, I haven't done a Guest Post in quote awhile, so this . one is ideal. Maurice Harris wanted to tell his story, a case study of how the ACA has helped him and his wife. You can find Maurice's other musings at his own blog, The Accidental Rabbi --Charles
Thank you Pres Obama and all in Congress who made Obamacare happen.
I’m sharing a screenshot of the adjusted insurance premium we will be paying even though it’s the kind of info I’d usually treat as very private. But because there are powerful political forces determined to get rid of the ACA should they ever get the chance, I feel it’s important to share our family’s concrete example.
Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
Note that whle the enrollment numbers for most states below are current through January 9nd, most of the state-based exchanges are either slightly more current or up to two weeks behind.
UPDATE 12/25/20: Another year has passed. 2020 has been The Worst in countless ways. Ruth Bader Ginsburg passed away...and was immediately replaced with an ultra-right wing religious zealot. We lost John Lewis, David Prowse, Carl Reiner, Buck Henry, Brian Dennehy, Max von Sydow, Alex Trebek, Kirk Douglas, Sean Connery, Diana Rigg, Chadwick Boseman, Wilford Brimley and Neil Peart.
Oh...and we also lost a friend of mine (well, an online friend...I only met her in person once), Deborah Roseman, one of the sweetest, nicest and insightful women I've had the honor of crossing paths with. She died of a brain tumor in October, leaving behind a husband and young child.
Her pinned tweet remains poignant:
I've come to realize: Privilege is the difference between choosing to advocate change and having no choice but to do so.
Minnesota held their monthly board meeting. At first glance, it looks like they've managed to add 1,991 QHPs since December 28th, which would be impressive...except that, as a later slide shows, 1,871 of these are due to including their SHOP (small business) enrollees in today's number versus these folks not being included in the news article a week or so ago.
Nothing wrong with this, actually, but it does mean that the net gain of individual market QHPs is far less impressive (just 120), for a total of 67,800:
UPDATE/CORRECTION: I've been informed by the MNsure exchange that, in fact, they did add 1,991 individual QHP enrollments since 12/28/15 after all; apparently the 67,680 figure from a couple of weeks back also included SHOP QHPs, so the net increase really is nearly 2,000 people, which is indeed very impressive.
Adding 1,991 in just 13 days represents a 3.0% increase during the slowest part of the enrollment period. By comparison, as I noted earlier today, HC.gov added just 157,536 people from 12/27 - 1/09...or only 1.8% in 14 days. Minnesota has basically been doubling the enrollment rate of the federal exchange since Christmas, which is interesting even if the raw numbers are still small.
In addition, as MNsure noted in their correction: "45% of our QHP enrollments are NEW to MNsure in 2016. That's the highest percentage nationwide according to the data HHS released about a week and a half ago now."
My apologies for the error, and mazel tov on the improved numbers!
With all that in mind, if the Week 10 HC.gov Snapshot comes in anywhere under 200,000 today, I'll be dropping my final estimate to a range between 13.8 - 14.2 million.
Well, the Week 10 Snapshot was just released, and sure enough, it was pretty anemic:
Yeah, that's not great. In fact, this is almost identical to the number of new enrollees during Christmas Week (just over 74,000), making this the second lowest week of the Period.
As I noted last week, I'm expecting today's HC.gov Week 10 Snapshot Report to announce around 130,000 additional QHP selections between 1/03/16 - 1/09/16, which would bring the HC.gov total up around 8.74 million. This would also likely bring the national total up to around 11.55 million.
While those numbers wouldn't be bad, they would also make it very likely that the final 3 weeks are going to be weaker than I expected. Back on December 28th, I noted the following:
As of today [last week], we should be appx. 1.9 million ahead of last year...but as you note, the question now is whether it will continue to stay ahead of last year *proportionately*.
11.2M vs. 9.3M = appx. 20% ahead. My 14.7M projection assumes 25% growth over 11.7M. It's that 5% difference I'm concerned about (again, see the final week).
A subcommittee of a state task force recommended Monday continuing with a state-run health insurance exchange like MNsure for now, rather than transferring Minnesotans to the national exchange called HealthCare.gov
Moving to the federal website would be costly and wouldn't work with the state's MinnesotaCare insurance program, said a report endorsed by the 11-person subcommittee of the state task force on health care finance.
Plus, by moving to HealthCare.gov, the state would lose control over its network of health insurance navigators that help people enroll in coverage, according to the report.
Last week, the Rhode Island exchange reported a total of 34,627 QHP selections--paid and unpaid, as they're always careful to note.
The breakdown at the time was:
30,165 renewed/re-enrolled from 2015
4,462 newly-added for 2016
They also noted that:
27,124 of the 34,627 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.
Given that the thru-date was after New Year's, it was inevitable that another chunk of those who selected QHPs would be dropped soon...and sure enough, HealthSourceRI has done so in this week's report:
INDIVIDUAL AND FAMILY ENROLLMENT • As of January 9, 2016:
About 1.4 million households that got financial help for health insurance under President Barack Obama's law failed to properly account for it on their tax returns last year, putting their subsidies at risk if they want to keep coverage.
...IRS said the more than 1.4 million households that have failed to properly account for their 2014 tax credits include:
I guess the question here is just how much verification the HHS Dept. and/or the assorted state-based exchanges are doing of these claims. In cases like getting married/divorced, giving birth, becoming a citizen or getting out of jail, I would imagine the verification should be pretty easy. However, the "Tax Penalty Ignorance" exception was pretty much based on an honors system, and I don't know how easy/difficult it is for the feds to "verify" that your income has increased/decreased substantially...at least, not until you file your taxes the following year, which could be up to a year after the claim is made.
...So, what's the solution to this, assuming the problem is widespread? Well, I can think of some obvious tweaks to the rules, almost all of which involve simply reducing grace periods:
OK, there's a lot of confusion (including some by myself) about the whole "saving money" issue with regard to Matt Bevin shutting down Kentucky's kynect exchange. I've discussed it with Louise Norris, and I think the situation is as follows:
Currently, kynect's $28 million annual budget is covered by a 1% fee charged to all premiums for everyone on individual policies (on or off exchange), small group policies and large group policies.
Kentucky has roughly 4.4 million people. Of these, around 9% are still uninsured, 27% are on Medicaid (much of this thanks to ACA expansion!) and at least 18% are on Medicare (800K as of 2012, more today). That means that no more than 46% of the state's population is currently paying this 1% fee; it's likely around 40% doing so.
In other words, right now, as far as I can tell, around 1.8 million Kentuckians are paying roughly $16 per year to pay for Kynect.
FRANKFORT, Ky. - Following through on a campaign pledge, Gov. Matt Bevin has notified federal authorities he plans to dismantle kynect, Kentucky's health insurance exchange created as part of the Affordable Care Act.
In a Dec. 30 letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, Bevin said he plans to wind down the state health exchange and transition Kentuckians to the federal site, healthcare.gov, to shop for insurance under the law also known as Obamacare.
Louisiana Gov.-elect John Bel Edwards has set an ambitious timeline for a Medicaid expansion, saying he wants to have government-funded health insurance cards in thousands more people's hands by July 1.
...that's assuming the Republican-led Legislature doesn't try to throw up any roadblocks seeking to slow down an expansion effort.
Edwards, a Democrat who takes office Monday, said he would issue an executive order "within 24 hours from being sworn in" that starts the work required to expand Medicaid as allowed under the federal healthcare law. Health coverage for the people who would be eligible for the insurance under the expansion, he said, would begin July 1.
...The incoming health secretary estimated that about 300,000 people, mainly the working poor, would be enrolled for Medicaid under an expansion.
Just a quick reminder: This Friday, January 15th, is the deadline for people to sign up for healthcare coverage that starts on February 1st in most states:
The deadline for February coverage is Friday, January 15th in 46 states & DC.
The deadline for February coverage is Saturday, January 23rd in Massachusetts, Rhode Island and Washington State.
The FINAL deadline, for coverage starting in March in all states (& DC) is Sunday, January 31st.
Exceptions: Aside from the normal "off-season" Special Enrollment Period (SEP) for getting married, giving birth, etc., it's important to note that anyone who lost their coverage due to one of the dozen Co-Ops which shut down in December still has until March 1st to enroll (h/t to Amy Lotven for the reminder):
Everyone is posting various tributes to the late, great David Bowie today. Most will likely relate to Major Tom, Ziggy Stardust or Under Pressure.
For my part, I'm posting something a little different. Instead of anything from his music career, here's the clip of Bowie's brief but oddly appropriately-cast role as Pontius Pilate opposite Willem DaFoe in Martin Scorcese's "The Last Temptation of Christ".
Hey, remember back in October when I was deeply concerned about the 1.5 million taxpayers receiving APTC (Advance Premium Tax Credits) via ACA exchange policies last year who were at risk of losing those tax credits this year because they either didn't know they had to file a tax return, knew but didn't get around to doing so, or filed their taxes but forgot to fill out/include Form 8962?
Some readers may wonder why I, a lifelong Michigan resident who authors a website devoted to healthcare issues, haven't posted anything about my home state's latest shame, the Flint Water Poisoning scandal.
As of this week, Access Health CT announced it has more than 104,000 individuals enrolled in qualified health plans. That number could change during the final weeks of open enrollment and as existing customers renew coverage.
Lt. Gov. Nancy Wyman, who chairs the Access Health CT board, said the group is urging residents to check their healthcare coverage to make sure everything is correct for 2016. People without health insurance could face federal tax penalties.
...Access Health CT reported in late December over 34,000 new Connecticut customers had enrolled in health coverage since Nov. 1, on par with last year at this time. The new enrollment number represents 11,000 qualified health plan members and 23,000 Medicaid members.
One of the more obscure provisions of the ACA is the ability/funding for states to set up something called a "Basic Health Plan" for residents who are low income, but not that low income; it's sort of a "Medicaid Plus" program, in a way; here's the Kaiser Family Foundation's explanation:
The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.
I wrote about this last night as part of a larger piece, but the "Young Invincible Risk Pool" issue from yesterday's official Open Enrollment Report seems to be generating a lot of hand-wringing, so I decided to write something specifically about it.
One of the biggest concerns people have about the ACA exchanges is whether or not there are enough so-called "Young Invincibles" (ie, young adults aged 18-34 years old) in the market to help balance out the risk pool. The assumption is that "YI's" are considerably healthier than older folks, and therefore should help reduce the overall cost of medical services over the coming year. From an insurance carrier POV, it's a lot more profitable to have 10,000 healthy customers than 1,000 cancer or diabetes-ridden customers. In the past, of course, this meant that carriers would cherry-pick their enrollees; if they suspected you'd be a high risk customer, they'd simply tell you to go pound sand.
I'm not going to get into everything here, of course; a lot of this stuff is beyond my pay grade (which is to say, zilch, as I'm not paid to operate this site), while other stats just aren't of any particular interest to me, though obviously they may be useful to others. I'm mostly just running through all 81 pages (27 in the main report, 54 in the state-level supplemental) to see what catches my eye.
This entry will focus purely on the main report; I'll look at the supplemental report (which goes into state-level data) tomorrow.
Within the Marketplaces as a whole (all 50 states +DC):
(note: I'm live updating as I type this stuff, so keep checking back, I'll be adding more updates/analysis over the next hour)
Wow! OK, I'm back from my kid's field trip (nature center; they learned about how animals handle the winter via hibernation, migration & adaptation...learned about fossils...went on the nature trail to look for animal tracks...and even dissected owl pellets, hooray!!). Of all the days to miss a major HHS/CMS conference call, this was a big one. I'm furiously poring over the HHS Dept's ASPE January Enrollment Report which, as I expected this morning, was just released less than two hours ago.
There's some sort of press conference call this afternoon with official updates on the 2016 Open Enrollment Period. Unfortunately, I have a field trip to attend with my kid all afternoon, and a client call after that, so I won't be able to get in on the call, nor will I be able to write anything up about whatever's discussed (or any press releases which come out after the call) until several hours later.
Since enrollments over the past two weeks have been virtually dead due to a) the January coverage deadline having passed for all states; b) Christmas week and c) New Year's week, my guess is that the major reasons for today's call will include:
Here's what I wrote last July, when Gallup released their 2015 Q2 Uninsured Rate survey (which pegged the uninsured rate among adults (over 18) at 11.4%:
Going forward, I'm actually not expecting the Q3 2015 Gallup survey to show much of a change; we're in the heart of the off-season, the #ACATaxTime additions have already been accounted for, and Montana is the only state which is expected to expand Medicaid anytime soon, so Q3 will probably hold steady at 11.4%, give or take; the rate might even inch up a few tenths of a percent due to attrition. Still, the overall picture is pretty dramatic: Whatever else you can say about the ACA in terms of cost, it's definitely accomplishing the other half of its goal: The total number of uninsured Americans has been cut by about 16 million people since October 2013.
If you look at the State-By-State OE3 enrollment breakdown, you'll notice that there are still 4 blank fields all the way down at the bottom, plus a special note regarding California:
I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.
It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Kentucky, New York or Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).
With all those caveats out of the way, here's where things stand. Just like last year:
So what about this week? Well, it should play out very much the same: Practically all QHP selections going forward should be for new additions, and we have New Year's Eve and Day included. Sure enough, last year there were just 103K added to HC.gov from 12/27 - 01/02...slightly more than Christmas week.
Assuming this year follows a similar pattern, there should be roughly 80,000 people tacked onto the HC.gov total for Week 9, bringing the cumulative total up to just over 8.6 million.
If this does happen, then yes, I'll have to seriously re-evaluate my current 14.7 million OE3 projection...because that will suggest that the final 5 weeks are gonna play out a good 20% lower than my expectations.
And if that's the case, then instead of another 3.5 million new folks signing up, it'll only be around 2.8 million...bringing a grand total of right around 14.0 million even.
Ah. OK. Well, this time it's different, because this time, the Republican-controlled Senate has signed onto repealing the ACA as well, which means that it'll actually make it as far as President Obama's desk for once, requiring him to...pull out a pen and veto it.
...as Majority Leader Kevin McCarthy puts it, that’s the goal: “With this bill, we will force President Obama to show the American people where he stands.”
One of the many standard Republican talking points when it comes to healthcare is this old chestnut:
"Let insurance carriers sell their products across state lines!!"
I've never quite understood why this was supposed to be such a panacea, but I guess it's supposed to have something to do with "removing burdensome government regulations!" and "allowing the Invisibile Hand of the Free Market" to work it's wonders, bla bla bla. The idea is that the carriers have, until now, staked out their turf and aren't allowed to compete with each other outside of their home states; presumably, if they were allowed to do so, prices would drop accordingly due to competitive pricing, etc etc.
Long-time readers may have noticed that unlike private QHP enrollment, I've sort of given up on trying to track Medicaid expansion numbers at the state-level on the Medicaid Spreadsheet this year. Quite frankly, there's simply too much missing data and way too much "churn" in Medicaid for me to keep track of it at that granular level. Instead, I've just been looking at the Medicaid numbers from the national level, guided by CMS's monthly reports...but I've proven to be pretty accurate with my proejctions on those trends so far, so I'm not too concerned about it.
Starting Friday, low-income Montanans covered by Montana’s expanded Medicaid program can start using their coverage – and 20,000 people have already signed up.
Connect for Health Colorado® and Colorado Medicaid Report Enrollment Gains of More Than 169,000
January 5, 2016
DENVER — Between Nov.1 and Dec. 31, more than 169,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.
“We are very happy with the enrollment growth during the first two months of this open enrollment period,” said Connect for Health Colorado® CEO Kevin Patterson. “But I want to urge everyone who does not have health insurance provided through their employer to act now to provide financial security for their families and to avoid a penalty of nearly $695 or more. The final deadline for 2016 coverage –Jan. 31 – is fast approaching.”
Rhode Island, which already had one of the later deadlines in the first place, just bumped it out even later...all the way out through December 29th. However, having such a small population, Rhode Island's latest update still doesn't move the needle that much:
INDIVIDUAL AND FAMILY ENROLLMENT As of January 2, 2016:
34,627 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan.
4,462 of the 34,627 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
27,124 of the 34,627 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.
A new study further undercuts a major claim by critics of the Affordable Care Act, who contended that the law would encourage companies to slash full-time workers' hours and shift them into part-time work in order to avoid having to offer them health insurance.
The study "found little evidence that the ACA had caused increases in part-time employment as of 2015," according to a summary of its findings published in the journal Health Affairs on Tuesday.
In 2014 and 2015, the Washington State ACA exchange was one of a handful of exchanges which also handled the billing for QHP enrollees...and in their case, ran into a lot of technical problems in doing so. This year, they've given up on trying to handle the payments themselves, offloading them to the actual insurance carriers as most other states do. I have no idea how much impact this change has had as opposed to improved outreach, the individual mandate penalty increase and so on, but whatever the reasons, WA's numbers are dramatically improved this year:
The Washington Health Benefit Exchange today announced that nearly 174,000 residents have signed up for or renewed their health coverage as 2016 open enrollment enters its final month. The deadline to select a Qualified Health Plan through wahealthplanfinder.org is Jan. 31 for coverage effective March 1. Customers who select a plan by Jan. 23 will have their coverage start Feb. 1.
I've been getting a little worried about the Minnesota exchange of late. Their first two years were pretty rough, and their most recent update prior to today had them at only 26.5K QHPs as of 12/13. Of course, that didn't include the critical final few days before the January enrollment deadline...nor did it include the extended deadline for Minnesota, which was pushed all the way out to 12/28.
Abby Goodnough had an interesting story in the NY Times yesterday about the fact that for some people, simply paying the Affordable Care Act's "Shared Responsibility" tax (otherwise known as the Individual Mandate penalty) may actually be more affordable than actually signing up for an ACA-compliant healthcare policy.
I've written about this before, of course. It is absolutely true that for some people (the Kaiser Family Foundation estimates roughly 7.1 million people), their mandate tax (whether a flat $695/person or 2.5% of their household income, whichever is greater) is indeed less than the annual premiums for the lowest-cost policy available in their area (even after taking federal tax credits (APTC) into account). By KFF's estimates, the mandate tax would cost more than the least-expensive policy for only around 3.9 million currently-uninsured Americans (although the actual number of uninsured who could potentially enroll in exchange policies, whether with APTC or at full price, seems to be closer to 15 million according to the very same KFF study from which they stated the 11 million figure...I'm not sure what accounts for the 4 million difference, but that's actually besides the point here).
Now, as I noted in my own analysis of the potential impact of the mandate tax on "Young Invincibles", I noted that given a choice between paying $X for nothing and $X + (some variable amount) for a ACA-compliant healthcare policy, my guess is that most people are likely to still go ahead and sign up as long as the cost is less than perhaps twice as much, even if the plan itself seems somewhat skimpy.
In other words, if the choice is between a $700 penalty for bupkis and, say, $1,000 for a Bronze plan (43% more), most people will probably go ahead and spring the extra $300...but they if the least-expensive plan is more than twice the penalty (say, $1,500) they're much more likely to say "screw that!" and just pay the tax. Again, I'm not basing this on any hard analysis, it's just my gut instinct; I could be wrong about this.
Three portions of the total are eligible to enroll in private policies through the ACA exchanges: "Tax Credit Eligible", "Ineligible for Financial Assistance due to ESI Offer" and "Ineligible for Financial Assistance due to Income" (22%, 15% and 12% respectively). It's important to remember that "Ineligible for Financial Assistance" means that they can enroll through the ACA exchanges, they just have to pay full price if they do so. Many of these folks will simply enroll off-exchange, directly through the insurance carriers, but there's nothing preventing them from going through the exchange instead.
