Every once in awhile, I like to take a look at the analytics reports for ACASignups. Usually it's just keeping track of the number of site visitors; occasionally I'll poke around a bit more in depth, especially when there's a huge traffic spike like the one caused by Michael Hiltzik's L.A. Times story showcasing my "Total Coverage Type" Pie Chart a few days back.
However, once in a blue moon I'll snoop around a bit more and look at who's visiting...and the results can be surprising, even after you cull out the random typo visits and bot crawlers.
Case in point: Check out this map showing where the most recent 1,000 visitors to the site were located. For the most part it's not terribly surprising, with the vast bulk of traffic coming from the U.S. (including at least one visitor from Hawaii) or Europe, followed by scattered instances from other countries here and there...
OK, this is totally off-topic, and I know I'm gonna face an earful in the comments over this, but I have to make a few comments on the ongoing "Democratic Superdelegate" brouhaha amongst Bernie Sanders's supporters.
First of all, there are 712 "unpledged" delegates (or "superdelegates") for the Democratic Party this year out of 4,763 total. That's around 15% of all Democratic delegates. The eventual nominee needs at least 2,382 total delegates to win the nomination.
So, it's important to keep in mind that pledged delegates from primaries and caucuses determine around 85% of the total. It's the remaining 15% who people are getting all worked up about.
Normally, of course, this isn't an issue because one candidate or another ends up securing more than half of the grand total via the caucuses/primaries anyway, making the SDs a moot point.
So, the Big Story today is a new report from the Blue Cross Blue Shield Association revealing that (wait for it)...people who signed up for private health insurance via the new Obamacare exchanges over the past two years are a lot sicker and more expensive to treat than those previously enrolled in the individual healthcare market. From their opening summary of findings:
Comparing the health status and use of medical services among those who enrolled in individual coverage before and after the ACA took effect, as well as those with employer-based health insurance, the study finds that:
UPDATE: I just asked Larry Levitt, Senior Vice President for Special Initiatives at the Kaiser Family Foundation, to take a look at my analysis to see if anything below seems to be significantly off-base in terms of my logic, analysis, estimates and so forth. I was particularly concerned because I've modified/extrapolated from a lot of data which was originally reported on by KFF. His response:
@charles_gaba Obviously some of the estimates are approximations, but I don't see any glaring problems.
Over the past few days, I've been fine-tuning an ambitious attempt to boil down the entire U.S. population into a single pie chart broken out by type of healthcare coverage (or lack thereof).
Today I'm looking at the December 31, 2015state-by-state data. I'll return to the actual ASPE report (for Part 3) next:
On December 31, 2015, about 8.8 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of December. Of the approximately 8.8 million consumers nationwide with effectuated Marketplace enrollments at the end of December 2015, about 84 percent, or about 7.4 million consumers, were receiving an advance payment of the premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $272 per month.
Ouch. There's no putting a pretty face on this number. Last fall I projected that the Q4 (12/31/15) effectuated enrollment figure would be around 9.7 million (although I was obviously proven wrong when the Q3 9/30/15 report was released; the number had already dropped down to 9.3 million by that point). This alone is a large part of the reason I was so far off in my projection of 14.7 million total OE3 enrollees; I assumed 9 million 2015 enrollees would renew, when in fact there didn't end up being 9 million people still enrolled in 2015 policies total. However, the actual number fell short of even the HHS Dept's lower projection of roughly 9.1 million. Needless to say, this is pretty disappointing from their POV.
ATTENTION L.A. TIMES READERS:
This is actually an older version of the blog post.
I later RE-DID THE WHOLE THING HERE.
IMPORTANT UPDATE 3/27/16 1:30pm: At the suggestion of several people to make the color-coding more distinctive and after re-reviewing a couple of surveys/reports, I've made the following revisions to the chart:
I want to make one thing very clear right off the bat: Some of the numbers in this post are very rough estimates, a combination of hard data and guesstimates extrapolated from the information I have on hand from the Kaiser Family Foundation, the Congressional Budget Office and the HHS Dept.
Having said that, here's a crude table and "stacked area" chart depicting how the U.S. Individual Health Insurance Market has changed over the past 2 1/2 years, from the launch of the ACA exchanges in October 2013 through the end of March 2016.
As you can see, there are 6 columns/sections: Three exchange-based (subsidized QHPs, full price QHPs and Basic Health Plan enrollments) and three OFF-exchange (ACA compliant, "Transitional" and "Grandfathered").
Back in 2013-2014 when I started this project, the most frustrating data to track down was OFF-exchange individual market healthcare policy enrollments. I tried my best to do so, painstakingly verifying around 560,000 across a handful of states, but with the knowledge that there were at least a few million more out there.
While this may sound obvious now, at the time, there were a lot of people who should've damned well known better, like Avik Roy, who actively tried to claim that the off-exchange individual market was nominal at best, documented in this jaw-dropping Tweet from him:
@UriManor@charles_gabaOff-exchange enrollments don’t affect exchange risk pool; usually previously insured. Not a big number either way.
Welcome, fellow Wonks! It's a great honor to be asked to host Health Wonk Review, especially the week of the 6th Anniversary of the Affordable Care Act!
Since this is the first time I've hosted HWR, I'll keep things pretty straightforward:
David Harlow of HealthBlawg addresses the question of "Narrow Networks in California?", pointing out that "Managing cost and quality requires use of narrow networks. A proposal up for consideration in California is deemed “novel” by some. Opponents seem afflicted by the Lake Wobegone Effect."
Now, I'm no fan of Gov. Kasich, but credit where due: Like my own otherwise-destructive governor here in Michigan, Rick Snyder, Gov. Kasich knew a good deal when he saw it and pushed through the ACA's Medicaid expansion program in the Buckeye State, resulting in somewhere between 590,000 - 650,000 additional low-income Ohioans receiving heatlhcare coverage, many for the first time.
I'm aware that aside from my mini-obsession with the Ohio Town Hall incident, my posts have been a bit light the past few weeks, and I've missed out on some important ACA stuff this month.
Part of this is catching up with my day job (which I'm massively backed up on); part is general burnout, and part is due to an unrelated side project that I'm working on (more on that soon).
Anyway, aside from hosting HWR this week, I'm also putting together my final OE3 ASPE/State Breakdown analysis, along with some "ACA at 6" stuff. Look for it over the next few days.
A few days ago, I noted that several Ted Cruz supporters had filled out and submitted the contact form on this site, oblivious to the fact that it has nothing to do with Cruz's campaign.
This morning I received yet another one of these:
I watched your talk this morning on FOX News concering the latest bombing. I take offense to your turning this event into a political issue with your comments on Trump. Whether or not I I am a Trump supporter is of no consequence. I will vote for the GOP candidate that shows the most civil campaign and does no degrade another, but talks more about their policies and ambitions.
Aside from the insanity of suggesting that Donald Trump has run a "civil campaign" which "doesn't degrade others", I'm still flabbergasted that these people are incapable of digesting the voluminous evidence that they're at the wrong website. For once, I decided to address the issue head on by writing this individual back:
Dear XXXXXXX,
I realize that you likely misspelled Sen. Cruz’s name when entering the domain name to visit my website.
There's growing evidence that most of the dramatic gain in the number of Americans with health care coverage is due to President Barack Obama's law, and not the gradual recovery of the nation's economy.
That could pose a political risk for Republicans running against "Obamacare" in the GOP primaries as they shift to the general election later this year.
...Under "Obamacare," the share of Americans without health insurance has dropped to a historic low of about 9 percent, with room to go even lower. But even as the economy has expanded, major government surveys point to a lackluster rebound for employer-based coverage.
Last October, I posted a piece in which I blasted the Heritage Foundation for posting a widely-disseminated article in which they claimed that only 3% of the net increase in 2014 insurance coverage was "due to" private ACA healthcare policies, with the remaining 97% being found via expansion of Medicaid via the ACA.
It's a long, wonky piece, but Heritage's claims fell into two main areas:
First, they, like so many other right-wing organizations, constantly operate under the presumption that Medicaid "doesn't count" for some reason or another.
Apparently people enrolled in Medicaid aren't human beings deserving of healthcare coverage, and can therefore simply be subtracted from the "real people" total. This is the same type of logic which, to this day, has Republicans stating that "Barack Obama only won because so many black people voted for him"...which, even if true, is utterly irrelevant: "So many" black people did vote for him, and their votes count just as much as anyone else's. You could just as easily argue that most other presidents "only won" because so many white people voted for them, and it would have exactly the same relevance to the fact that they were still, you know, elected president.
More to the point, though, the other main claim was this:
Yes, the Heritage Foundation says, the private individual market did increase by about 4.8 million people, however...
Over 4.5 million people who had been covered by employer-sponsored insurance lost or moved off of their plans at the same time, meaning that...
...the net increase in private policy coverage only went up about 260,000 people, which, in their view, means that...
only about 3% of the 9.25 million net increase in covered individuals in 2014 was via private policies, with the remaining 97% being via Medicaid expansion.
I countered by pointing out a whole mess of other reliable sources which collectively concluded that the "4.5 million ESI reduction" was likely way off base for a variety of reasons, including cherry-picking multiple sources, misinterpreting datasets and so forth.
Samaritan Ministries is an organization of devout Christians who eschew traditional health insurance to pool their money and cover each other’s catastrophic medical bills. It’s one of the very last mutual aid societies in the U.S., in which a community of individuals with shared beliefs band together to form a voluntary social-safety net. A century ago, an estimated one-third of American men belonged to mutual aid societies, but most faded away with the expansion of the welfare state.
Three years ago, I travelled to Samaritan’s headquarters in Peoria, Illinois to learn more about this remarkable organization.
In the story that came out of that trip, I predicted that Obamacare would lead to the demise of Samaritan and two similar organizations in the U.S. This model, I thought, wouldn’t be able to compete with the heavily subsidized plans soon to become available on the new health-care exchanges.
Thanks to Richard Simpkins for bringing this to my attention.
A week or so ago, Akash Chougule, Director of Policy at Americans for Prosperity (you know, the Tea Party political outfit funded by the Koch Brothers), posted an Op-Ed piece at Forbes tearing apart Ohio Governor John Kasich's decision to expand Medicaid via the Affordable Care Act. From a Republican POV, of course, Kasich agreeing to accept ACA Medicaid expansion is blasphemous. The piece was posted just ahead of the Ohio Republican Presidential primary, so naturally it was intended to hurt his chances of winning his home state (it didn't work, of course; Kasich did indeed win Ohio, keeping his campaign alive awhile longer, if just barely).
Anyway, here's the part which made both Simpkins and myself scratch our heads:
Ohio Governor John Kasich has spent no small amount of time on the presidential campaign trail discussing his decision to expand Medicaid to 650,000 able-bodied adults under Obamacare. But policymakers in non-expansion states should take a closer look at what’s actually unfolded in Ohio before considering going down the same path.
SORRY ABOUT THE DELAY!! I posted Part One on March 11th and planned on posting Part Two last weekend, but the week kind of got away from me...
In Part One of my analysis of the final, official OE3 ASPE report, I looked at the grand total nationally, the final state-based exchange numbers, revisited the BHP/pre-purged QHP factor, and also took a quick peek at some other odds & ends. Here's my long-overdue look at the rest of the report:
Re-Enrollments:
In 2015, appx. 6.1 million people ended up renewing their policies nationally (4.5 million via HC.gov, 1.6 million via the SBMs) out of 6.3 million still enrolled through the end of the year. That's a 97% renewal/re-enrollment rate, which is pretty good.
In 2016, appx. 7.8 million people renewed their policies nationally (5.6 million via HC.gov, 2.2 million via the SBMs) out of 8.8 million still enrolled through the end of the year. That's down to an 89% renewal/re-enrollment rate...still not terrible, but concerning.
Bear in mind that I was expecting assumed 9.0 million to renew...but I was also expecting about 9.7 million to still be enrolled (ie, I expected a 93% renewal rate out of a higher total). HHS, meanwhile, had a mid-range of 8.1 million renewing out of an expected 9.1 million (89%). The actual numbers were lower on both sides, which isn't a good sign.
I've noted before that every once in awhile, someone trying to load Ted Cruz's official campaign website will inadvertently bring up this site instead, thanks to my whimsical decision a year ago to snap up a half-dozen copycat domains (TedCrooz.com, TedCruise.net, etc.) just for fun.
I further noted that a few of these folks still can't seem to figure out that the website clearly has nothing whatsoever to do with Ted Cruz's presidential bid, beyond occasionally poking fun at how full of crap he is when it comes to the Affordable Care Act, in spite of the overwhelming evidence. I know this because I've received at least 3-4 contact form submissions from these folks...and in every case before today, they still couldn't figure it out.
As you'll recall, the woman worded her question as follows:
O'DONNELL: Hello, I voted for Obama, but then my health insurance skyrocketed, from $490 a month to $1,081 a month, for a family of 4. I know Obama told us that we'd be paying a little more, but doubling...more than doubling our health insurance costs has not been a "little" more. It has been difficult to come up with that kind of payment every month. I would like to vote Democratic, but it's cost me a lot of money, and I'm just wondering if Democrats really realize how difficult it's been on working-class Americans to finance Obamacare.
I originally intended this to be an update to yesterday's post about the woman at the Ohio Democratic Town Hall in which a woman asked Hillary Clinton why her family's insurance rates have gone up from $490/month to $1,081/month since the Affordable Care Act was passed. However, that post had already gotten absurdly long and unwieldy, so I've split it off into a new entry.
In the comments yesterday, a man named Danny Robins posted the following. I've broken it up a bit for readability, and have included my responses; both his points and my responses lend some additional insight into both Ms. O'Donnell's dilemma as well as my own point about Clinton's response:
My Columbus Ohio based health insurance practice for the past 7 years has been focused on helping small employers offer more affordable health benefits outside of the employer sponsored health insurance market. It has been widely reported that up to 70% of small employers no longer sponsor a health plan because they can not afford it. As such, I have assisted with over 2,000 people obtain individual or family health coverage.
UPDATE: I made two major errors in my original calculations below: First, I thought that Ms. O'Donnell lived in Howell, Ohio; it turns out she lives in Powell, Ohio. Secondly, I didn't realize that her children likely qualify for the CHIP program, which is essentially the kid's version of Medicaid. I've updated all calculations to reflect both of these factors...and they actually make the point of the diary even more valid).
I didn't tune in to this evening's CNN Democratic Town Hall until right after a key question to/response from Hillary Clinton specifically about the premiums for individual policies on the Affordable Care Act exchanges. Fortunately, several people were uploading the entire things in chunks (of varying audio/video quality) even as it was being broadcast, so I was able to watch the clip in question:
A couple of weeks ago, I noted that the final, official ASPE report for the 2016 Open Enrollment Period was running quite a bit later than it did the first two years: In 2014 it was released either 12 or 16 days after open enrollment ended (OE1 ended on 4/15 but the report covered an additional 4 days), while last year it was also released 16 days after the end of the 2015 season.
For whatever reason, it took a full 40 days for the ASPE report to be released this year, but whatever; let's dig in!
First, it's worth remembering that the HHS Dept. included 1 extra day this year (Feb. 1st) for HC.gov as well as 4 of the state exchanges to account for some "in line by midnight" enrollees:
The Massachusetts ACA exchange reported exactly 196,554 QHP selections (including the still-qualifying "ConnectorCare" plans) as of January 31st, the final day of the 2016 Open Enrollment Period.
They just held their March board meeting, which always include highly detailed powerpoint charts & graphs running through the end of the prior month...so here's where things stand after the first month of the off season. The main number: The official effectuated enrollment number is up to 208,374 (remember, Massachusetts doesn't even report QHP enrollees until they've actually paid their premium. It'd be awesome if every other exchange was able to do so as well, as that would finally kill off the "But how many have PAID??" talking point once and for all.
UPDATE 3/19/16: OK, the voting period is finally over (for real, this time). The bad news is that we didn'tquitecrack the Top 10 in the end; our panel ended up with 11th place (122 votes), barely missing out on the 10th spot by a mere 3 votes.
The good news is that only 10 of the 90 total panel sessions were determined by the new voting system. The remaining 80 will presumably be decided by the traditional Netroots Nation selection committee process...and ours should still have an excellent chance of being picked, for two reasons:
Regular readers may have noticed that I've been posting fairly lightly of late. Now that open enrollment is over and we're deep in the thick of primary season, I'm trying to catch up with the massive backlog which has built up in my day job.
However, there's still a lot of stuff going on; today, for instance, brought some very positive Medicaid expansion news out of two states:
The New Hampshire House on Wednesday approved legislation that would keep 48,000 people on their insurance plans by continuing the state's expanded Medicaid program beyond the end of the year.
The bill, which now goes to the Senate, includes work requirements for recipients and asks insurance companies and hospitals to cover the state's share of the program's costs.
During the official Open Enrollment Period, MNsure enrolled 85,390 Minnesotans in Qualified Health Plans. Yesterday they held their March board meeting and updated their numbers through the first 5 weeks of the off season:
During Open Enrollment, MNsure averaged 928 QHP selections per day. During the off season, this has dropped down to 42 per day, or about 4.5% of the OE3 daily average.
If you extrapolate this nationally (and of course there's no way of knowing whether Minnesota is remotely representative), that would translate to around 6,200 people selecting exchange-based QHPs per day during the off season, which is lower than the past two years (7,000 - 9,000/day) but certainly within reason.
Oregon is considering proposals by four companies to provide a new software platform for the state’s health insurance marketplace.
The state uses the federal insurance exchange, http://www.Healthcare.gov, and state officials began to explore other options after the federal government decided to begin charging insurance companies a fee to use the exchange in Oregon.
Oregon has used the federal platform since its own insurance portal, Cover Oregon, failed to launch in 2013. The state and technology company Oracle, which built the Cover Oregon system, are still engaged in a legal battle over who is to blame for the problems.
OK, this is not only off topic, it's not even a particularly significant issue, but it bugs me because...well, frankly, because it's about my hometown.
Over on Twitter, several pundits/reporters have made this claim:
Trump dominated Oakland County Michigan, which includes Mitt Romney's hometown. ¯\_(ツ)_/¯ pic.twitter.com/wcsBcbFz7h
I wrote a lot about Matt Bevin during the Kentucky gubernatorial campaign last fall, as well as after he won the election, was sworn in as governor, and started doing his best to screw up stuff which wasn't broken. As you'll recall, when it came to the Affordable Care Act and the state ACA exchange (kynect), Bevin originally promised that he was going to kill the kynect exchange completely (even though there's no reason to do so, it's been operating smoothly for years and has excellent branding in the state) as well as killing the ACA Medicaid expansion (even though, again, it's been a huge success in the state at no cost to them so far and only pennies on the dollar going forward).
H&R Block says health care law fines have more than doubled
Many people who went without health insurance last year are now seeing fines more than double under President Barack Obama’s health care law, H&R Block said Tuesday.
The Kansas City-based tax preparation company said that among its customers who owe a penalty for the 2015 tax year, the average fine is $383. That compares with $172 for 2014, the company said in a report that marked the halfway point in the current tax season.
As of the end of the third open enrollment under the Affordable Care Act (ACA), 12.7 million people had signed up for coverage in the health insurance marketplaces, up from 11.7 million last year and 8.0 million in 2014.
Actual enrollment will end up somewhat lower than this because some people will not pay their premiums or will have their coverage terminated due to inconsistencies on their applications, and there is typically additional attrition as the year progresses (e.g., as some enrollees get jobs with health benefits). For example, in 2015 paid enrollees totaled 10.2 million as of end of March and 9.3 million as of the end of September. If a similar pattern holds, actual enrollment should end 2016 over 10 million, which was the target established by the Department of Health and Human Services (HHS). (There are reasons to believe that attrition may be lower this year, including the fact that terminations occurring during open enrollment have already been subtracted from official signup figures, which was not the case previously.)
While enrollment is in line with the HHS target announced in advance of this year’s open enrollment, it is short of earlier projections by the Congressional Budget Office (CBO), which became an implicit yardstick for judging the law. In March 2015, CBO projected average monthly marketplace enrollment of 21 million in calendar year 2016, though recently lowered that forecast to 13 million.
In this analysis, we look at why enrollment may be lower than projected by CBO and discuss the potential for future enrollment growth.
In a phone call, [Sen. Sanders's policy director Warren] Gunnels explained the $1.1 trillion gap. It comes down to five factors:
...Sanders assumes $324 billion more per year in prescription drug savings than Thorpe does. Thorpe argues that this is wildly implausible. "In 2014 private health plans paid a TOTAL of $132 billion on prescription drugs and nationally we spent $305 billion," he writes in an email. "With their savings drug spending nationally would be negative." (Emphasis mine.) The Sanders camp revised the number down to $241 billion when I pointed this out.
...When I pointed out that the yearly savings numbers they were presenting on prescription drugs were literally impossible, the Sanders camp revised the number to $241 billion — huge and arguably implausible but not larger than total annual spending on prescription drugs.
6/10/16: REPOSTED FROM THE ARCHIVES AS A REMINDER.
Yes, this is off topic. No, I don't care tonight.
Yes, the entire Republican debate was a revolting, disgusting, putrid embarrassment from start to finish (with the odd exception of the moderators from FOX News, who actually did a great job).
However, forget about the discussion of Donald Trump's penis size which opened the evening (no, I'm not making that up, and no, it's not a metaphor).
Just how grim the state’s budget situation has become was apparent Wednesday morning as the state House of Representatives discussed and ultimately agreed to a bill that would cut 111,000 Oklahomans, most of them women, from Medicaid.
While giving his big ACA speech in Milwaukee, Wisconsin a little while ago, President Obama mentioned a few key data points: 129 million people with pre-existing conditions being protected, 140 million people who were already insured having free preventative care added, etc etc.
He also dropped one really big new number: 20 million.
That's the net increase in the number of Americans who the HHS Dept. of the United States says have gained coverage (either via ACA exchange policies, Medicaid expansion or the ACA's provision requiring policies to allow young adults between 19 - 26 years old to say on their parents plans).
Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid, just announced that CMS has authorized expanding Medicaid to 15,000 children and pregnant women in Flint, Michigan, as well as expanding the services provided to 30,000 current Medicaid enrollees. Here's the full press release (emphasis mine):
HHS Approves Major Medicaid Expansion for Flint
FLINT, Mich. – Today, the U.S. Department of Health and Human Services announced that the Centers for Medicare & Medicaid Services (CMS) has approved the State of Michigan’s 1115 demonstration to extend Medicaid coverage and services to Flint residents impacted by the lead exposure. In recognition of the public health crisis in Flint, it is a top priority for the Administration and for the Department to ensure that all children and pregnant women exposed to lead in their water in Flint have access to the services they need. Approximately 15,000 additional children and pregnant women will be eligible for Medicaid coverage and 30,000 current Medicaid beneficiaries in the area will be eligible for expanded services under this new waiver agreement.
“Expanding Medicaid coverage to tens of thousands of expectant mothers and youth means the most vulnerable citizens served by the Flint water supply can now be connected to a wide range of needed health and developmental services, including lead-blood level monitoring and behavioral health services,” said HHS Secretary Sylvia M. Burwell.
Michigan will expand Medicaid coverage to children up to age 21 and pregnant women who were served by the Flint water system from April 2014 up to a date specified by the Governor, and who have incomes up to 400 percent of the federal poverty level (FPL). Michigan will also set up a state program allowing pregnant women and children up to age 21 who were served by the Flint water system and individuals with incomes above 400 percent of FPL to purchase unsubsidized coverage. This comprehensive health and developmental coverage includes lead-blood level monitoring and behavioral health services, among other services.
So, yesterday evening, Donald Trump finally released his "terrific" healthcare plan to replace the ACA. I started to write up a full deconstruction of it, point by point...
Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—Obamacare.
This legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history...
So here it is...Super Tuesday. Unless the GOP base suddenly decides that they don't want a xenophobic, misogynistic, hate-mongering, con-artist moron to be their standard-bearer, it's looking very likely that by the time midnight rolls around, Donald Drumpf will indeed be almost unstoppable as the Republican Presidential Nominee for 2016.
Which means, aside from the GOP establishment being on collective suicide watch, Mr. Drumpf will have to think about who his running mate will be for the general election.
