Republicans will first have to overcome a revolt from Senator Rand Paul on unrelated budget issues, with the Kentucky Republican saying Tuesday in an interview he would oppose the budget resolution because it adds significantly to the deficit.
"It never gets to balance. Not in 10 years, not in 100 years, not in 1,000," Paul said.
As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.
My standard methodology applies:
Plug in the 2/01/16 QHP selections by county (hard numbers via CMS)
Project QHP selections as of 1/31/17 based on statewide signup estimates
Knock 10% off those numbers to account for those who never end up paying their premiums
Multiply the projected effectuated enrollees as of March by the percent expected to receive APTC subsidies
Then knock another 10% off of that number to account for those only receiving nominal subsidies
Whatever's left after that are the number of people in each county who wouldn't be able to afford their policy without tax credits.
In the case of Florida, assuming they hit 1.825 million exchange enrollees this year, it comes to a whopping 1.35* million people.
Justin Kloski learned that he qualified for Medicaid under the worst of circumstances. The student and part-time lawn-company worker had lost 20 pounds, could not shake a nagging cough and was sleeping 14 hours a day when he decided to visit a clinic in Muncie, Ind., that provides free care for the poor and uninsured. A clinic employee invited Mr. Kloski, now 28, to apply for Medicaid.
A few days later, he took his new coverage to the emergency room at IU Health Ball Memorial Hospital in Muncie. A CT scan found a 15-centimeter tumor in his chest, so big it was pressing on his windpipe. In May 2015, he learned he had Hodgkin’s lymphoma, a form of cancer that is curable if caught early.
The Affordable Care Act, and Governor Pence’s decision to go against many other Republican governors and expand Medicaid under the law, may well have saved Mr. Kloski’s life.
A definitely-NOT-comprehensive selection of opinions regarding the Republican Party's imminent "Repeal & Delay" strategy for the Affordable Care Act:
What outside experts are saying about repeal and delay:
American Academy of Actuaries: “Repealing major provisions of the ACA would raise immediate concerns that individual market enrollment would decline, causing the risk pools to deteriorate and premiums to become less affordable. Even if the effective date of a repeal is delayed, the threat of a deterioration of the risk pool could lead additional insurers to reconsider their participation in the individual market.” [Letter to Congress, 12/7/16]
Nick Gerhart (Iowa Republican Insurance Commissioner): “If you're going to repeal this, I hope that there's a replacement stapled to that bill.” [NPR, 11/21/16]
New York is a little different: For one thing, they haven’t actually released any 2017 Open Enrollment data yet (other than a cryptic “55K enrolled over a 3-day period", which isn't very useful). They should be up to around 200K w/out auto-renewals by now. More significantly, they're one of only 2 states (Minnesota's the other) which features the ACA's Basic Health Plan. Unlike QHPs, which are divided into subsidized and unsubsidized enrollees, the BHP program is entirely dependent on ACA financing, so if the law is repealed, all BHP enrollees are kicked to the curb, just like Medicaid expansion enrollees would be.
OK, this appears to be quickly turning into my next project thing. The methodology here is pretty much the same as the other states; the only major difference is that while I do know the total Medicaid enrollment for each county (as of December 2016), I don't have that broken out between traditional and expanded Medicaid. Fortunately, I have a hard state-wide number for that: Around 398,000, or roughly 20.8% of the state-wide total. I've therefore multiplied each county number by 20.8% to get a rough estimate of the ACA expansion tally for each.
Like Texas, I'm also no longer expecting Arizona to beat last year's Open Enrollment total by much. Assuming 209K QHP selections, there should be around 125K indy market enrollees and 399K Medicaid expansion enrollees who'll be in a world of hurt post-repeal, or roughly 524,000 altogether.
(sigh) OK, after doing this for Michigan earlier today, I said that I wasn't gonna do this for every state, and I'm not...but the irony is that the 19 non-expansion states are actually easier to compile this data for than the expansion states...because you can't rip away healthcare from someone you never provided it to in the first place. Anyway, someone requested that I do a county-level estimate of how many people would likely lose their healthcare coverage in Texas under a full repeal of the Affordable Care Act, so here it is.
Regular readers (and Twitter followers) know that for the past month I've been heavily pushing my state-by-state analysis projecting how many people I expect to lose their healthcare coverage if/when the Republican-held Congress follows through on their promise to repeal the Affordable Care Act. As noted in that post and the various links within it, part of the projection is very specific and confirmed (ie, the exact number of Medicaid expansion enrollees), while the rest is more speculative. For one thing, I don't know exactly how many people will have enrolled in ACA exchange plans, because we're still in the middle of the open enrollment period; even then, the percentage of those enrollees who will be receiving APTC assistance is still unknown as well...and even then, not all of those folks will be receiving substantial subsidy assistance which would make or break their ability to keep their policy.
It's New Year's Day, so I figured I should indulge in a little year-end navel-gazing by looking back and seeing which posts generated the most traffic throughout the year. There's a good chance that this site won't survive the new year anyway, so what the heck.
Below is a daily traffic graph showing the days with the biggest traffic spikes, along with the specific stories driving those spikes. I hope you don't mind, but I'd rather not post the actual numbers involved publicly.
As you can see, in 2016, there were 5 stories in particular which captured tons of traffic:
