A couple of weeks ago I reported that the Washington Health Benefit Exchange reported enrolling a seemingingly astonishing 190,000 people into 2019 policies in just the first 10 days of the 2019 Open Enrollment Period. This is highly misleading, of course, because only a small fraction of these are new enrollees, and a somewhat larger portion are current enrollees actively renewing their policies.
The vast bulk of that 190K are current enrollees who are auto-renewed into 2019 policies by the exchange itself...with the option to then actively go into the system and opt to cancel their renewals if they wish. There's nothing wrong with this, and in fact more and more of the state exchanges seem to be doing it this way as they improve and streamline their software (I've confirmed that Maryland, Massachusetts, Minnesota, Rhode Island and Washington State are "front-loading" autorenewals this year, although Maryland hasn't actually reported their data yet).
Earlier this week, a picture of a letter sent to a patient needing a heart transplant recommending that they find a way to raise $10,000 to cover some costs went viral on Twitter and Facebook, with various celebrities, politicians etc. reposting it.
I'm sure you've seen it already, but just for the record, here's one of the most viral variants, from freshman Congresswoman-elect Alexandra Ocasio-Cortz. It's important to clarify that the letter was not sent by the insurance carrier, and the $10K in question would not be going to pay an insurance company...or, in fact, even "Spectrum Health" aka the "Heart & Lung Specialized Care Clinics" noted in the letterhead.
Insurance groups are recommending GoFundMe as official policy - where customers can die if they can’t raise the goal in time - but sure, single payer healthcare is unreasonable.
PROVIDENCE — HealthSource RI, the state’s health insurance exchange, reports 31,000 people have signed up for health care coverage about a month into the open enrollment period for the 2019 plan year ending Dec. 23, 3,600 enrollments ahead of where they were at this point last year.
Last year at about this time during open enrollment, HealthSource RI had counted about 27,400 people enrolled for health insurance through the exchange, according to HealthSource RI Director Zachary W. Sherman.
Sherman said the agency has seen many people renewing existing coverage either manually or automatically.
“We’re pleased with where we are with sign-ups,” Sherman said.
A month ago I posted a Red Alert about the latest regulatory attack on the ACA...this time coming directly from CMS Administrator Seema Verma. At the time, Verma had just announced a draft version of the new rules for Section 1332 Waivers...starting with changing the name from "State Innovation Waivers" to "State Relief and Empowerment Waivers", which sounds in no way like Orwellian doublespeak propaganda.
Here's the basic backstory on 1332 waivers:
One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":
A couple of weeks ago I noted that the Illinois state Senate unanimously overrode outgoing Governor Rauner's veto of their bill restricting the sale of non-ACA compliant short-term, limited duration healthcare plans.
Today, I'm happy to report that the state House has followed up and overrode the veto as well:
Breaking: Just got word that the Illinois legislature has overridden the veto on SB1737 which limits short term plans to 6 months and bans rescissions of short term plans. @GtownCHIR h/t @stephanibecker
This report provides average effectuated enrollment and premium data for the Federal and State-Based Exchanges for the first six months of the 2018 plan year. The Centers for Medicare & Medicaid Services (CMS) publishes effectuated enrollment data semiannually to provide a more accurate picture of enrollment trends for the Exchanges than indicated by the number of individuals who simply selected a plan during Open Enrollment. For coverage to be considered effectuated, individuals generally must pay their premium for the given month.
In week three of the 2019 Open Enrollment, 500,437 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.
Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.
The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.
*"Not as bad as expected" depends on your perspective. Even the 6-7-point average premium increase caused by mandate repeal is still an average of $430 - $500 per unsubsidized enrollee for the year...or $1,300 - $1,500/year for a family of three.
Earlier this year, most healthcare wonks (along with the Congressional Budget Office) projected that Congressional Republicans repealing the ACA's individual mandate last December (effective January 1, 2019) would have a significant Adverse Selection impact on the ACA-compliant individual market risk pool. Projections of the premium increases imposed in response to the drop-off of healthy enrollees ranged from 10% (CBO) to as high as 16.6% (Urban Institute, although that also included a small increase due to Trump's expansion of short-term plans as well).
Last week, Bernie Sanders posted the following video (click to view) on Twitter. It tells the tragic story of a young Minnesota man named Alec Smith with diabetes who died soon after after no longer being able to afford either health insurance or the insulin and other medical supplies needed to keep him alive:
Alec Smith died at 26 because he was rationing insulin that was too expensive. The greed of the pharmaceutical industry is killing Americans and it has got to stop. (with @NSmithholt12) pic.twitter.com/xmryYm0Enr
The main point of the video is the horrific price gouging on insulin, and a new drug price control bill which Sen. Sanders is pushing for which would tie U.S. drug pricing to that of a half-dozen other countries.
It's a genuinely depressing story, and the proposed drug pricing bill is interesting and worthy of discussion.
I just received an official 2019 ACA Open Enrollment Period report from the Massachusetts Health Connector...
As of today, we have 254,177 enrolled for January 1. That is up about 10,000 from last year's 244,308 at the same date. When you include people with plans selected but not paid, we are at 264,118.
The high number is again explained by the fact that Massachusetts, like several other state-based exchanges, front-loads their auto-renewals. 254K / 244K = around a 4% increase year over year, which is solid and right in line with other state-based exchanges to date...while the federal exchange (HC.gov) continues to lag around 11% behind last year. On the other hand, HC.gov doesn't front-load auto-renewals, so it's a bit of an apples to oranges comparison.
Now that the Democrats have officially retaken control of the U.S. House of Representatives, everyone's expecting them to try and save and improve the ACA. I stress "try", of course, because without the Senate, it's unlikely that any bill to protect or improve the law will get passed...and even if it did somehow, the odds are high that it would then be vetoed by Donald Trump (or Mike Pence, in the unlikely-but-still-conceivable event that Trump is removed from office before January 20, 2021).
HOWEVER...they can certainly at least try. With a likely 235:200 advantage in the House and a caucus which is far more progressive on healthcare issues than it was a decade ago, the Dems shouldn't have too much trouble passing a fairly robust healthcare reform package even knowing that it's unlikely to go anywhere in the Senate. The question is how robust?
In week three of the 2019 Open Enrollment, 748,244 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.
Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.
The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.
Last spring, both New Jersey and Maryland were among the states which were the most pro-active about passing lesiglation to cancel out Donald Trump's attempts to deliberately sabotage the Affordable Care Act. Both states passed laws cracking down on non-ACA compliant short-term and association health plans (NJ actually already didn't allow short-term plans before the ACA anyway), both states established robust reinsurance programs, and both states tried to pass bills reinstating the ACA's Individual Mandate Penalty which Congressional Republicans repealed last winter in different ways.
New Jersey was successful: They kept their mandate penalty restoration bill pretty much identical to the version repealed at the federal level and plan on using the revenue from it to help pay for the reinsurance program. The combined impact of all of their anti-sabotage efforts led to roughly a $1,500 annual premium savings for every unsubsidized individual market enrollee in the state.
With all the attention being paid to the midterm elections causing ACA Medicaid expansion to be passed in Utah, Nebraska and Idaho (while also now being at risk in Alaska and Montana), I've kind of lost track of the situation in Virginia, where it was expanded last May to over 400,000 Virginians.
Thankfully, Esther F. linked me to this article from the Virginia Mercury, which brings me up to speed on the actual implementation of the VA expansion program:
Less than two weeks after Virginia opened registration for its expanded Medicaid program, officials say they’ve already drawn thousands more applicants than initially anticipated.
The state had expected the new program to enroll 300,000 over the next year and a half. They now expect that number to reach 375,000. The new estimates won’t alter the total expansion population, which the state has said will be about 400,000.
...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.
...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.
...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.
We're over 1/3 of the way through the 2019 Open Enrollment Period in most states, so I figured this would be a good time to check in and see where things stand.
DENVER — More than 25,000 Coloradans selected health coverage through Connect for Health Colorado® between Nov. 1 and Nov. 15, a number 13 percent ahead of the pace one year ago, according to new data released today.
“This number of initial sign-ups is the strongest start to an Open Enrollment Period we have seen,” said Connect for Health Colorado® CEO Kevin Patterson. “By acting early, these Coloradans will ensure their health coverage is in place Jan. 1, 2019, protecting their health and their family finances.”
The two-week period saw 25,614 medical plan selections. The total was 22,650 medical plan selections for the comparable period in 2017. Twelve percent of the plan selections are by customers who are new to Connect for Health Colorado and 88 percent are renewing customers.
The midterms are over, and the Democrats won back the U.S. House, so the ACA is (mostly) safe at last, right?
Well...maybe. In addition to the ongoing regulatory sabotage by the Trump Administration to undermine, weaken and generally piss all over the law as much as possible, there's also still a little thing called Texas vs. Azar, aka the #TexasFoldEm federal lawsuit. Oral arguments were held way back in early September, and right-wing Judge O'Connor claimed that he'd rule on a preliminary injunction "quickly" afterwards.
Well, today is November 18th, and there's been nary a peep from Judge O'Connor. Does 75 days later count as "quickly"? In judiciary time, I suppose it might.
HARTFORD, CT — The number of customers purchasing plans through Connecticut’s insurance exchange is around what it was last year in the first two weeks of open enrollment.
Since Nov. 1, 12,777 customers have shopped and purchased a plan for 2019, according to Access Health CT officials. That means about 85,000 enrollees have yet to renew into a 2019 policy.
...Traffic on the website is trending about 18 percent higher than it was at this time last year, according to Access Health CT’s Director of Technical Operations and Analytics Robert Blundo.
...An estimated 60 percent of customers are picking plans that are different from their plan in 2018 and that’s compared to only 18 percent who were changing their plans last year. It also means there are a higher percentage of customers using brokers to help them make a decision about the health plan that’s right for them.
Illinois Senate voted unanimously to override the Governor's veto of a bill to limit short-term health plans to 6 months. Protecting consumers and insurance markets from long-term short-term plans does not appear to be a partisan issue. https://t.co/fJ4NVV4LRQ
FULL DISCLOSURE: HealthSherpa has a paid banner ad at the top of ACASignups.net.
As I noted last week, HealthSherpa is indeed a paying advertiser on the site. However, since they happen to specialize specifically in selling ACA-compliant individual market policies through the ACA exchange (they're an authorized 3rd-party online brokerage), they're also an excellent "finger on the pulse" of Open Enrollment data, providing more-detailed weekly data than CMS usually does; I'd be posting their stats whether they were an advertiser or not.
Hey, remember this? That's Zombie-Eyed Granny Starver Paul Ryan and his motley crew yucking it up right after voting to strip away healthcare coverage from 23 million people on May 4, 2017 by passing the American Health Care Act (AHCA), which not only most repealed the ACA but also gutted Medicaid spending and a bunch of other nasty stuff.
Well, what goes around comes around, which the House Democrats clearly knew at the time; as you can hear in the video, they were actually singing "Hey, hey, goodbye!" to the House Republicans immediately after the vote, because they knew exactly what the consequences would be of passing that pile of elephant poop.
Sure enough, exactly 551 days later, the 2018 Midterm Elections caused a Big Blue Wave to crash over the House GOP.
In week two of the 2019 Open Enrollment, 804,556 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.
Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.
The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.
More than 97,000 Minnesotans have signed up for private health plans through MNsure since the start of open enrollment
Open enrollment runs until January 13, 2019
ST. PAUL, Minn.—Today MNsure announced that over 97,000 Minnesotans have signed up for private health plan coverage through MNsure during the first two weeks of open enrollment.
MNsure's open enrollment runs until January 13, 2019. For coverage that begins January 1, 2019, Minnesotans must enroll by December 15, 2018.
“We are excited with our smooth start to open enrollment and that over 97,000 Minnesotans have signed up for private health plans,” said CEO Nate Clark. “With rates decreasing from 7 to 27 percent across the state, we encourage Minnesotans to visit MNsure.org to see if they can save.”
Over at Bloomberg News, Aziza Kasumov has written up what is, for the most part, an excellent profile of a middle-class family who crystalize the single biggest real flaw in the design of the Affordable Care Act (as opposed to the bullshit ones made up by opponents over the years): Those enrolled in individual market policies who earn more than 400% of the Federal Poverty Level (around $48,000/year for an individual, or $98,000 for a family of four):
David and Maribel Maldonado seem the very definition of making it in America. David arrived in the U.S. from Mexico as a small child...His wife Maribel, whose family is also from Mexico, worked as a hairstylist while caring for the couple’s two children. David’s annual salary reached about $113,000 by the time the children were in their teens. It was more than enough to live in a pretty suburban house outside Dallas, take family vacations, go to restaurants and splurge at the nearby mall. And to afford health insurance.
The bold-faced bit above has some relevance later in the story.
With the 2018 Midterm Elections mostly out of the way (there's still at least 7 statewide races which haven't been called yet in Georgia, Florida and Arizona which are currently in the process of various counts, recounts and/or run-off elections), the Democratic Party has indeed retaken the U.S. House of Reprentatives by a solid margin, adding anywhere from 33 - 40 House seats when they only needed a net gain of 23 to take control. Starting in January, the House Democrats will be able to vote on and pass pretty much whatever bills they want, presumably under the leadership of Nancy Pelosi as Speaker of the House.
Last year, the Washington Health Benefit Exchange reported enrolling roughly 4,500 new ACA exchange enrollees in the first 8 days, which was a whopping 53% increase over 2017. This was in addition to what I estimated was roughly 13,000 current enrollees actively renewing their existing policies or switching to a different one, for a total of perhaps 17,500 QHP selections.
Despite changes to the Affordable Care Act during the past couple of years, local health-insurance officials are optimistic that the state’s health-insurance exchange will flourish in 2019.
Since enrollment for 2019 began Nov. 1, about 190,000 people have signed up for health insurance through the Washington Health Benefit Exchange, which is about 5 percent more than the same period last year.
Collaborations with Lyft, Uber, Independent Drivers Guild Reach Drivers Across NYS
ALBANY, NY (November 9, 2018) – NY State of Health, the state’s official health plan Marketplace, today announced it is partnering again during the Open Enrollment Period with ridesharing companies Lyft and Uber, and with the Independent Drivers Guild. Through the partnership, tens of thousands of drivers throughout New York State will be urged to visit the Marketplace to shop for and enroll in quality, affordable health insurance. Open Enrollment for 2019 coverage began November 1. Consumers must enroll by December 15, 2018 for coverage beginning January 1, 2019.
MNsure Update on First Week of Open Enrollment
November 8, 2018
ST. PAUL, Minn.—MNsure CEO, Nate Clark, issued the following statement recapping the first full week of open enrollment:
“This year’s open enrollment continues to go smoothly with consistently low wait times throughout the first week. With lower rates across the state, we have seen a steady stream of Minnesotans signing up for health coverage. We encourage Minnesotans to visit MNsure.org to see if they are eligible for exclusive tax credits that could lower their monthly premiums.”
This year to date, MNsure has renewed more people into coverage than ever before.Open enrollment figures will be released next Wednesday (11/14) at MNsure’s public board meeting at 1 p.m.
HealthSherpa is a California-based technology company focused on connecting individuals with health coverage. The site was initially developed as an alternative to research plans from Healthcare.gov, and now provides individual health, dental and vision benefits to both part-time employees and retirees. As of February 2017, over 800,000 people have been enrolled in individual health coverage through HealthSherpa.
First, I want to clarify that I'm not shilling for HealthSherpa here. They aren't paying me for this post. I have no idea whether their customer service is awesome or sucks or anything like that.
In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Legislation, including the Hyde Amendment, generally restricts the use of funds allocated for the Department of Health and Human Services and consequently has significant effects involving Medicaid recipients. Medicaid currently serves approximately 6.5 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).
Under Georgia law, if no candidate ends up with more than 50% of the total vote, the top two candidates move on to a run-off election, so if Kemp's lead ends up dropping by around 13,000 more votes as the thousands of remaining ballots are counted, it's on to a run-off between the two.
Covered California, the largest state-based ACA exchange for the largest state in the country, actually launched their 2019 ACA Open Enrollment Period over three weeks ago, on October 15th.
They still haven't posted any 2019 enrollment numbers, which I find rather irritating, but they did just send out the following press release regarding a promotional bus tour they're doing which highlights a couple of interesting data points:
Covered California Launches Iconic Bus Tour to Promote Enrollment and Show How “Life Can Change in an Instant”
As I noted a few days ago, now that the 2019 ACA Open Enrollment Period is actually underway and the approved individual market premium rate changes have been posted publicly for every state, I'm finally able to go back and wrap up my 2019 Rate Hike Project for the nine states which I was still missing final numbers for.
As I further noted, the approved rates in most of those states didn't change much compared to the preliminary/requested rate changes I had already analyzed earlier this year:
In past years, this blog post would be a pretty big deal for me, given that it's all about the very core of this website: ACA Signups. As both enrollees, carriers, analysts and reporters have gradually become more used to the annual Open Enrollment Periods, however, these Weekly Snapshots, while still extremely useful, have become somewhat mundane.
OK, it's 3:00 in the morning, and I've been running around either canvassing, phone banking, attending various election night events or simply watching/tweeting about the results as they came in from around the country as well as here at home, so forgive me if this is kind of disjointed and scattershot. I'll have more coherent thoughts in the coming days...after I've gotten some sleep and recouperated.
Michigan:
With Gretchen Whitmer winning as Governor, ACA Medicaid expansion is mostly safe for the next four years. Unfortunately, it looks like the Dems will come up short in both the state House and Senate (though they made impressive gains in each), which probably means a stalemate on the issue.
The net effect will likely be that the just-passed work requirement law will end up going into effect after all starting January 1, 2020, which will almost certainly lead to tens of thousands of Michiganders losing coverage anyway, unless Whitmer is somehow able to convince a still-GOP controlled state legislature to modify the law back to where it stands today.
I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.
Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these.
Nebraska has a slightly confusing siutation, which is surprising since Medica is the only carrier offering ACA policies in the state, When I first took a look at the requested premium changes for 2019 back in August, it looked like the average was around 1.0%...that was based on splitting the difference between the 3.69% and -2.60% listings, since the filing form was redacted and I didn't know what the relative market split was between Medica's product lines.
I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.
Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these.
However, while state insurance regulators left one of the three carriers offering individual market policies alone, they knocked the other two down substantially: CareSource was lowered from around 13.1% to 9.5%, while Highmark Blue Cross Blue Shield was lowered from an average of 15.9% to 9.0%.
I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.
Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these. In addition, in a few states the insurance department has also posted their own final/approved rate summary.
I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.
Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these. Making things even easier (although not necessarily better from an enrollee perspective), in three states the approved rates are exactly what the requested rates were for every carrier: Alabama, Mississippi and Utah:
