I noted a few weeks ago that as many as 9 states are ramping up plans to reinstate one version or another of the ACA's just-repealed Individual Mandate. I concluded:
My only advice is that if they do take the political risk of imposing a mandate penalty, at least make sure it's more stringent than the one which was just repealed--I'd probably recommend making it something like the same cost as the least-expensive Bronze plan available on the exchange after whatever tax credits they'd otherwise have applied.
Well, I don't know about the details, but it looks like the District of Columbia, at least, is full-steam ahead:
This just in...I used to track the monthly Medicaid/CHIP reports pretty religiously, but the total numbers have actually stayed fairly stable month to month for the past year or so (mainly because the states which expanded Medicaid under the ACA have mostly "maxed out" by now). This should start changing in Maine later this year as they voted to expand the program via ballot initiative last November, and Virginia may end up expanding Medicaid to up to 400,000 people there as well later this year.
In the meantime, here's where things stood as of the end of 2017, according to CMS:
Art As Social Inquiry combines art and advocacy as a way to engage audiences. Theresa Pussi Artist BrownGold is the painter/writer/performance artist behind Art As Social Inquiry.
"I have often wondered why so many good people have such different and divisive opinions. Art As Social Inquiry asks the questions: Are we our opinions? Or are we something more? Then what? What is beyond the emotional charge of our opinions? And how do we get there?"
Art As Social Inquiry — an artist-at-work painting portraits of real people whose lives embody the social issues of the day, issues like access to healthcare, immigration, how we die. The artist also uses songwriting and performance art, two more art-making tools, to help us see ourselves in the bigger world, and the opinions we cling to.
Our opinions affect our actions. Art As Social Inquiry unearths those opinions.
The cumulative enrollment numbers are also important: During the entire off-season (from 2/01/17 - 12/31/17), 41,387 people selected QHPs via Special Enrollment Periods (SEPs), or roughly 124 per day. Of course, technically speaking the last day of SEP enrollment for 2017 should have been 11/15/17 (for coverage starting December 1st), but it looks like a few hundred people slipped in after that.
Colorado's SHOP enrollment, meanwhile, hovered right around the 3,000 person mark all year.
ALBANY, N.Y. (February 27, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released county-level enrollment data as of January 31, 2018, showing that overall enrollment increased in each of New York’s 62 counties. Total enrollment in the Marketplace is now over 4.3 million people, reflecting an increase of 700,000 people (19 percent) from 2017. Many upstate counties saw significant enrollment gains in the last year.
“Consumers from Chautauqua to Suffolk and every county in between are shopping for health plans through the Marketplace,” said NY State of Health Executive Director, Donna Frescatore. “With affordable premiums and a robust choice of plans, NY State of Health is where New Yorkers go to get covered.”
Texas is suing the federal government over President Barack Obama's landmark health law — again.
In a 20-state lawsuit filed Monday in federal court, Attorney General Ken Paxton argued that after the passage of the GOP's tax plan last year — which also repealed a provision of the sweeping legislation known as "Obamacare" that required people to have health insurance — the health law is no longer constitutional.
Please watch the full video above before reading this entry.
I've been debating about whether to post this for several days now.
My son is on the Autism spectrum. His case is fairly low-level/high-functioning (mostly in the Aspergers Syndrome category, I believe), and most of the time it's not all that noticeable, but it's definitely an issue in certain circumstances...and the video above gives a perfect example.
I've made one or two vague references to a member of my immediate family being in need of mental health services and physical therapy (he also has a mild case of cerebral palsy), but haven't gone into specifics before. This is partly because it wasn't really necessary to the point I was making, but mainly because my wife and I are very protective of our son and don't want him to grow up thinking of himself as an "Aspie" or whatever the label is; he's just himself. However, he's old enough now that I decided to ask him if he's OK with my mentioning it publicly, so here we are.
In 2018, unsubsidized premiums for ACA-compliant individual healthcare policies have shot up by around 30% on average nationally. Around 18 points of this (60% of the total) is due specifically to policy decisions by the Trump Administration and Congressional Republicans, primarily the cut-off of Cost Sharing Reduction reimbursement payments and the (accurate, as it would later develop) anticipation, by some carriers, of the ACA's individual mandate being repealed.
What about 2019, however? The 2-3 points tacked on out of concern for the mandate being repealed was only a small portion of the full impact insurance carriers expect it to have, and of course there's the further undermining of the ACA via Donald Trump's "Short Term" and "Association Plan" executive orders. Finally, there's the impact of what is assumed to be another year of the advertising/outreach budget being starved by the Centers for Medicare & Medicaid.
Medicare Extra for All: A Plan to Guarantee Universal Health Coverage in the United States
By the CAP Health Policy Team Posted on February 22, 2018, 6:00 am
OVERVIEW: This proposal guarantees the right of all Americans to enroll in the same high-quality plan modeled after the Medicare program.
(CNN) A top official at the Department of Health and Human Services has been placed on administrative leave after a CNN KFile inquiry while the agency investigates social media postings in which he pushed unfounded smears on social media.
Jon Cordova serves as the principal deputy assistant secretary for administration at HHS. A KFile review of Cordova's social media accounts found that he pushed stories filled with baseless claims and conspiracy theories, including stories that claimed Gold Star father Khizr Khan is a "Muslim Brotherhood agent" and made baseless claims about Sen. Ted Cruz's personal life.
"Principal deputy assistant" is probably just a gussied-up name for a low-level flunkie, right?
Back in June 2016, the Obama Administration rightly clamped down on "Short-Term Plans", limiting them to, you know, a "short term"...no more than 3 months out of the year, while also making them non-renewable; that is, you couldn't get around the 3-month limit by simply renewing the policy every three months:
EMMA GONZALEZ: Well what we have set up right now we have a website, March for Our Lives. We're going to be doing a march in March on Washington where we get students all over the country are going to be joining us. These kids are going to make this difference because the adults let us down. And at this point I don't even know if the adults in power who are funded by the NRA I don't even think we need them anymore because they're going to be gone by midterm election. There's-- there's barely any time for them to save their skins. And if they don't turn around right now and state their open support for this movement they're going to be left behind. Because you are either with us or against us at this point.
UPDATE 2/18/18: I noted in my original post last night that "it's important to note that the [3/14] walkout doesn't appear to have started with the Stoneman Douglas students themselves, but the Women's March folks. Or perhaps it was suggested to them by some students, I don't really know."
Well, it sounds like there may have been a bit of message co-opting, (or perhaps not; see 2nd update below) well-intentioned though it may have been. Apparently there's a third date being touted for a different event: #MarchForOurLives, on March 24, nationally...and this one is officially endorsed/touted by the students themselves, which I think is critically important:
Last November, along with voting to keep a Democrat in the Governor's office, Virginia voters also swept a huge wave of Democrats into office in the state legislature. They didn’t quite take a majority, but they came within a single vote of getting a 50-50 tie in the state Assembly. Instead, they have a two-vote shortfall (51-49), matching the same two-vote shortfall (21-19) in the state Senate.
A prominent Republican state legislator from southwest Virginia announced his support Thursday for expanding Medicaid, an about-face that could make it easier for other rural conservatives to get on board after four years of steadfast opposition.
*Update: It turns out that while he is a white supremacist himself, he isn't necessarily an official member of any specific white supremacist organization, not that it makes much difference.
On the other hand, assuming there isn't enough time to re-set the premiums back to "CSRs funded" levels for 2018, that means that prices will spike for next year [2018]...and then presumably would drop by about 15-20% starting in 2019, just in time for the midterms. If that happens, I guarantee that the GOP will run around trying to claim that they "fixed" Obamacare and "saved" the American public from spiraling premiums, bla bla bla. Of course they'll try to do that whether it kicks in for 2018 or 2019, but if prices go up this year and drop next, it'll make for much more dramatic campaign ads.
Trump, of course, will claim to have "saved" (or even "repealed") Obamacare no matter when anything kicks into effect. If the deal falls through, of course, he'll once again blame everyone but himself as he always does.
From the Cabinet Meeting scene in the comedy "Dave":
DAVE: Now the Commerce Department..,
SECRETARY OF COMMERCE (sitting erect): Yes, Mr. President?
DAVE (from a card): You're spending forty-seven million dollars on an ad campaign to... (reading) 'Boost consumer confidence in the American auto industry.'
SECRETARY OF COMMERCE: Um...yes, sir...it's designed to bolster individual confidence in a previous domestic automotive purchase.
DAVE: So we're spending forty-seven million dollars so someone can feel better about a car they've already bought?
SECRETARY OF COMMERCE: Yes, sir, but I wouldn't characterize it that way...
DAVE (indignant): Well I'm sure that's really important, but I don't want to tell some eight- year-old kid he's got to sleep in the street because we want people to feel better about their cars. (beat) Do you want to tell him that?
SECRETARY OF COMMERCE (quietly): No sir...(looks at TV cameras)...no sir, I sure don't.
UPDATE 2/17/18: I've also embedded the full speech of Cameron Kasky's fellow Stoneman Douglas student Emma Gonzalez, who gave one hell of an impassioned speech today at a rally.
I'm incredibly impressed by students like Kasky, Gonzalez, as well as David Hogg (a student reporter who actually recorded interviews with the students while they were hiding from the murderer and Sarah Chadwick, who's pretty much obliterated Donald Trump and the NRA on Twitter. These "kids" are far more mature, eloquent and savvy about what's going on than most adults and should be listened to.
This isn't normally the sort of thing I write about, but gun violence is absolutely a healthcare policy issue, whether you're talking about the physical injuries, rehabilitation, mortality rates, psychological/emotional trauma or, of course, mental health. But even if it wasn't, I really don't care; I'm posting this anyway:
OK, let me get this out of the way up front: Yes, this is pretty self-serving of me, and kind of stupid, but it's something which has been bugging me for four years now, so I finally decided to do something about it.
As longtime readers know, ACA Signups didn't start out as a full website. Originally it consisted entirely of a Google Docs spreadsheet with a domain name pointing to it. The domain wasn't even ACASignups.net; I started out using ObamacareSignups.net, which still repoints to the site today. I changed it after the first month or so not because I have a problem with "Obamacare" but because ACASignups.net is simply faster to type out.
The ACA Signups project actually started out as a series of blog posts over at Daily Kos, one of the largest online progressive political sites in the country, where I had already been posting under the name Brainwrap on any number of issues for nearly a decade.
President Trump’s budget plan released Monday endorsed an Obamacare repeal and replace bill that gives funding to states and makes cuts to Medicaid.
...Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., are behind the legislation that takes Obamacare’s funding for the Medicaid expansion and tax subsidies for lower premiums and gives it to states through block grants. The senators introduced the bill in September along with Sens. Ron Johnson, R-Wis., and Dean Heller, R-Nev.
The bill would end the Medicaid expansion under Obamacare but supporters say states can implement it individually if they want. However, the bill makes cuts to Medicaid overall by capping federal funding per beneficiary.
The bill failed to get enough support in Congress in September, as some senators from expansion states worried about Medicaid cuts and protections for people with pre-existing conditions.
According to this article from last May, the total budget for operating HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states,was around $2.1 billion in 2016. Donald Trump proposed slashing the budget down by about 20% to $1.7 billion in 2017.
Where does that money come from? Well, HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states, is not funded out of the general federal budget. Instead, it's funded by assessing a 3.5% premium surcharge on policies sold on it.
OK, that's not quite true; the 3.5% only applies to the 34 states which are fully operated by the federal exchange; there are 5 states (Arkansas, Kentucky, Nevada, New Mexico and Oregon) which have their own exchange operations but "piggyback" on HC.gov's technical platform; those states were charged just 1.5% of premiums in 2017 and 2.0% for 2018. However, those 5 states combined only make up around 5% of all HC.gov enrollments, so the lower fees only knock perhaps 2% off the total user fee revenue.
So @SenatorCollins sold out for bills which won’t help much and aren’t gonna happen anyway.@jeffflake sold out for a promise to attend a meeting which won’t happen.@lisamurkowski sold out for destroying her own environment.@SenJohnMcCain sold out for...nothing at all. Huh.
On October 1st, 2013, the first Open Enrollment Period (OE1) under the Affordable Care Act kicked off to much hoopla. As everyone knows, the largest of the ACA exchange websites, HealthCare.Gov, infamously melted down at launch due to a multitude of hardware and software problems ranging from insufficient server capacity to poor workflow design to buggy coding and much, much more. However, as Steven Brill detailed in the March 10, 2014 issue of Time magazine, by early December, the worst of the problems had been resolved, and by the time the second Open Enrollment Period came along a year later, HealthCare.Gov had been completely overhauled, with additional improvements and enhancements every year since.
The difference has been dramatic: On October 1, 2013, only six people (not six thousand or six hundred...six) were able to actually make it all the way through the HC.gov interface and enroll in a healthcare policy. On December 15, 2016, six hundred and seventy thousand enrolled.
Wellmark spurns Obamacare exchange, but two competitors don't
Moderate-income Iowans who want to use Affordable Care Act subsidies to purchase health insurance still won't be able to choose policies from Wellmark Blue Cross & Blue Shield next year. But they should be offered policies from at least two competitors.
One of the most popular provisions of the Affordable Care Act's Three-Legged Stool's "Blue Leg" is the prohibition of caps on annual or lifetime benefits. When you consider that a baby born prematurely or a cancer patient undergoing chemotherapy can eat up several million dollars worth of care within a few months, this makes perfect sense. Even a moderately wealthy family can be brought down by high medical costs, and a middle class family can be financially wiped out. If you're lower income, don't even get me started.
After approving Medicaid work requirements, Trump’s HHS aims for lifetime coverage limits
After allowing states to impose work requirements for Medicaid enrollees, the Trump administration is now pondering lifetime limits on adults’ access to coverage.
Senate Democrats, led by Sen. Patty Murray, are pushing to increase the Affordable Care Act's subsidies as part of a stabilization bill being renegotiated with Sen. Lamar Alexander. This would mean increasing the amount of financial assistance people receive, as well as making it available to more people.
...“We’re interested in both expanding access to subsidies and increasing their value. You’ve got two different sets of populations that will be impacted in different ways depending on how cost sharing” is structured, a Democratic aide told me.
Welp. In the end, enough Democrats joined Republicans in both the U.S. Senate and House to pass a massive spending bill in the dead of night. Donald Trump signed it into law early this morning.
Needless to say, I'm not happy at all about a major missing piece of the bill: The DREAM act, which would protect around 690,000 young adults who were brought to the United States as children, was not part of the bill. The Dems in the Senate were able to lock in a formal immigration debate which will presumably be focused in large part on DACA and the Dreamers, but there was no such guaranteed baked in on the House side by Speaker Paul Ryan. Personally, I'm pretty disappointed with the 73 Dems who folded on the issue, but the fight isn't over yet.
According to the CMS/ASPE 2016 Final Enrollment Report, during the 2016 Open Enrollment Period, Louisiana enrolled 214,148 people in exchange-based Qualified Health Plans.
Most states dropped a bit year over year in 2017 in large part due to the Trump administration cutting off outreach/marketing during the critical final week, but Louisiana saw the worst year over year drop. Why? Well, the most obvious reason was pretty simple: The state expanded Medicaid halfway through the year.
Last year, in my "If I Ran the Zoo" piece, I stuck my neck out and noted that the single biggest problem with the Individual Mandate isn't that it exists, but that it's not strong enough (conservative healthcare writer Michael Bertaut, who I disagree with on most issues but respect on this topic, also argues that the mandate has never been enforced strongly enough either). Here's what I said at the time:
The reality is that as much as everyone complains about the $695 or 2.5% income individual mandate penalty for NOT having qualifying healthcare coverage, the penalty should really be increased. There, I said it. The problem is that if the penalty is significantly less than the amount that the premiums would be, some people will still decide to eat the tax instead of signing up.
UPDATE: (sigh) OK, it looks like the final number for the District of Columbia was slightly too low; I've received official notice from the DC exchange that it was actually 22,584, 115 enrollments higher than the NASHP report pegged it at. The Graph and spreadsheet below have both been updated...
OK, here it is...
This morning Covered California issued their final 2018 ACA Open Enrollment numbers. I was a bit disappointed to discover that instead of beating out last year slightly, they ended up coming about 2.3% short year over year...but there's a very good reason for that: Like Maryland, California not only utilized the full "Silver Switcharoo" strategy with individual market premiums, they actively encouraged current UNSUBSIDIZED on-exchange Silver enrollees to switch to off-exchange Silver plans instead.
Note: This is more of a placeholder for the moment; it'll be updated as soon as the numbers are available.
At around 10:30am this morning, Covered California will be announcing their final, official 2018 ACA Open Enrollment Period numbers, along with other various demographic info.
Keep in mind that California is second only to Florida in terms of ACA exchange enrollees, with around 13% of the national total each year, so this is a big deal.
Last year Covered CA's 1/31 total hit 1,556,676 (or just under 15,000 enrollees higher). In 2016 they had their all-time high of 1,575,340, so they'd have to have tacked on about 34,000 more over the final 10 days of Open Enrollment this year in order to beat their record.
Last month, Covered California issued an extensive analysis of the individual market landscape for 2019 and concluded that the recent actions taken by Donald Trump and Congressional Republicans (especially, of course, the repeal of the individual mandate) will collectively cause rates to spike by up to 30% even without taking into account the normal medical inflation one would normally expect every year anyway. I didn't see a whole lot of reporting on this report other than my post and Michael Hiltzik's story on it at the L.A. Times, but I might've missed others.
Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.
So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.
The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.
Maryland was originally one of 3 state-based exchanges which stuck to the "official" half-length, December 15th Open Enrollment Period deadline this time around. However, with just 2 days to go before the original deadline, the MD Health Connection announced that they had decided to bump out their deadline by an extra week after all, through December 22nd.
I want to be clear about something: Much of my data analysis has a bit of snark to it, adding an acrid tinge of dark humor to healthcare, a topic which is often fraught with pain, suffering, grief and sadness. Once in awhile I take pause before twisting the sarcasm knife too much.
This is one of those moments. I'm therefore limiting the snark to the headline only.
Three Januarys ago, Gov. Rick Snyder described a River of Opportunity all Michiganders could enter as long as the state improved third-grade reading proficiency.
“One of the important metrics in someone’s life on the River of Opportunity is the ability to be proficient-reading by third grade,” he said in January 2015. “How have we done? We were at 63% in 2010, and we are at 70% today. … But 70% doesn’t cut it.”
Over the past month or so, former CMS Administrator and healthcare hero Andy Slavitt has been urging people to fill out a sparsely worded, cryptic online form if they're interested in "making our nation's health care system work better for all Americans."
There are too many agendas that aren’t about making health care work for all Americans. We need to put health care over politics again.
Within a month, a major initiative will be announced that I and many Americans will come together for. If interested... https://t.co/7BBDUS2J8u
I filled it out, of course, as did what I presume are thousands of others, but few had any idea what Slavitt specifically had in mind at the time. Today he's gone public with the details:
From Alleigh Marre, HHS Dept. National Spokesperson, less than an hour ago (h/t Kimberly Leonard for the heads up):
"Even Charles Gaba, the author of ACAsignups.net admits in his analysis, “The simple truth is: Yes, full-price, unsubsidized premiums for individual market healthcare policies probably have doubled since 2013…” His analysis of the report drives home that Obamacare’s one-size-fits all mandates and regulations have driven up prices for all."
NOTE: The last few paragraphs of this post have been reformatted for clarity only.
All of Twitter is abuzz with this tweet (since deleted) by Republican Speaker of the House Paul Ryan:
A secretary at a public high school in Lancaster, PA, said she was pleasantly surprised her pay went up $1.50 a week ... she said [that] will more than cover her Costco membership for the year. https://t.co/yLX1Bod1j0
Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:
d) Enrollment Update
Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.
Indiana Adds Work Requirement To Medicaid, Will Block Coverage If Paperwork Is Late
PHIL GALEWITZ
Indiana on Friday became the second state to win federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act. A less debated provision in the state's new plan could lead to tens of thousands of people losing coverage if they fail to complete paperwork documenting their eligibility for the program.
The federal approval was announced by Health and Human Services Secretary Alex Azar in Indianapolis.
Medicaid participants who fail to promptly submit paperwork showing they still qualify for the program will be locked out of enrollment for three months, according to updated rules.
At this point, the only significant top-line 2018 Open Enrollment numbers missing are the final 10 days out of California (which could add perhaps 40,000 to the total) and a solid month of enrollment from the District of Columbia (23 days, actually, but they extended their deadline by 5 extra days, which may or may not be included in the final, official report from CMS). DC's tally through 1/08 was 21,352 QHP selections. Their all-time high was around 22,700 set in 2016, so I can't imagine that they added more than perhaps 2,000 more since 1/08. In other words, about 99.5% of the 2018 OEP QHP selections have likely been accounted for.
That means it's time to move on to...breaking down the demographic data! Woo-hoo! Parrrr-tyyyy!!
The big, official CMS report from the Assistant Secretary for Planning and Evaluation (ASPE) presumably won't be released for a couple of weeks, but some of the state-based exchanges are faster about posting their demographics. First up: Connecticut!
OK, this may seem kind of silly; data that I've compiled has been cited/quoted by any number of publications, news stories, healthcare wonks and so forth over the past 4+ years, so I suppose this really shouldn't be that big of a deal to me.
This Just In, courtesy of Dan Goldberg of Politico New York...
.@charles_gabaNY releases final numbers --253,102 in QHP with 41% receiving NO financial assistance. (That's amazing!) 738,851 in Essential Plan 374,577 in Child Health Plus
Last year, after 7 years of doing everything in their power to undermine, sabotage and weaken the ACA, Congressional Republicans tried every which way they could to repeal the law. They tried passing AHCA , B-CRAP, ORRA, Graham-Cassidy and a few other variants along the way to no avail.
Finally, in late December, desperate for a win on "repealing Obamacare"--any type of win--they said "screw it" and just repealed the ACA's individual mandate all by itself. They didn't replace it with a reasonable inducement for people to get covered, mind you, against the advice of actuarial expert advice, mind you; they just...got rid of it.
The vote to repeal the mandate penalty was incredibly short-sighted and will almost certainly lead to negative consequences when it actually goes into effect (which won't be until next year, causing much confusion until then, but that's a different discussion)...but at least it's legal.
