Charles Gaba's blog

Last night I wrote a pretty extensive post about the Q1 2016 ACA Exchange Effectuated Enrollment Report, which breaks out the effectuated enrollment numbers as of the end of March. This is a follow-up post with some additional oddball items of interest. I'll probably add some things, so check back later for updates.

First up: While the national net attrition rate from the end of open enrollment through the end of March was around 12.6% (11.08 million vs. 12.68 million), the drop-off rate ranged widely state to state. Here's a table breaking this out. The net attrition is over 20% in 5 states and DC and between 15-20% in 5 more states, but is under 10% in 14 states. In fact, Rhode Island saw a net increase in effectuated enrollees from January through the end of March.

With all of the lawsuits against the ACA flying around over the years, there are some which I haven't even heard about. One of them just came to my attention this morning (thanks to Nicholas Bagley for the heads' up): The State of West Virginia vs. the HHS Dept:

Elbert Lin, Solicitor General, Office of the Attorney General for the State of West Virginia, argued the cause for appellant. With him on the briefs were Patrick J. Morrisey, Attorney General, and Julie Marie Blake, Assistant Attorney General.

Lindsey Powell, Attorney, U.S. Department of Justice, argued the cause for appellee. With her on the brief were Benjamin C. Mizer, Principal Deputy Assistant Attorney General, and Alisa B. Klein and Mark B. Stern, Attorneys.

Before: KAVANAUGH and WILKINS, Circuit Judges, and SILBERMAN, Senior Circuit Judge.

Opinion for the Court filed by Senior Circuit Judge SILBERMAN.

Last year, there was roughly a 13% net attrition rate from the end of the 2015 open enrollment period and the end of March, from 11.7 million down to about 10.2 million over a 5-week period (2/22/15 - 3/31/15).

This year, as of the end of the 2016 Open Enrollment Period on January 31st, just shy of 12.7 million people (12,681,874 to be precise) had selected Qualified Health Plans (QHPs) via either the federal exchange (HealthCare.Gov) or one of the dozen or so state-based exchanges (Covered California, kynect, MNsure and so forth). A flat 13% drop should have resulted in the number still effectuated as of the end of the first quarter (3/31/16) having dropped to just barely over 11.0 million (11,033,230 to be precise).

Last month I wrote an extensive piece about Colorado's Amendment 69 initiative, aka "ColoradoCare", which would be the latest attempt to achieve a state-level single payer healthcare system (or at least near-single payer; if enacted, it would replace all current healthcare coverage except for Medicare, the VA/TriCare and the Indian Health Service).

While I was generally supportive of the idea overall, I also concluded that:

For me, however, ColoradoCare addresses many of the criticisms I've had of Bernie's plan. I'm not necessarily "endorsing" it (I still have a lot more to learn about the details and the criticisms before I can do so), but the bottom line is that it's more realistic and far better thought out than Bernie's national plan is. This is the best opportunity for achieving single payer that you're likely to see anytime soon.

The Kaiser Family Foundation released their monthly tracking poll today. In addition to the usual questions about the ACA (spoiler: Republicans generally don't like it, Democrats generally do, and there's absolutely no consensus about what the public wants to do about it anyway), they also mixed things up a bit by asking timely questions about the Zika virus and increasing insurance policy premiums.

Here's the one which I find the most depressing...but also the least surprising:

Overall, nearly nine in ten (88 percent) Americans say they are concerned about increases in the amount people pay for their health insurance premiums. This is followed closely by the percent who are concerned about increases in the costs of deductibles (85 percent), increases in what the nation as whole spends on health care (83 percent), and increases in prescription drug costs (82 percent). Fewer but still large majorities of insured Americans are concerned about increases in spending on government health insurance programs (74 percent) and increases in the amount employers pay for their employees’ premiums (71 percent).

Not much to add here:

A special session for Medicaid expansion will have to wait, Gov. Dennis Daugaard announced Wednesday.

After a weeks-long effort to lobby enough lawmakers to get the proposal approved in the Statehouse, Daugaard announced in a statement that he wouldn't call lawmakers back to Pierre.

Citing the upcoming presidential election that could result in substantial changes to the federal health insurance program for needy people, Daugaard said a special session was off the table.

“We have a good plan that would increase health care access at no additional state cost and guarantee that the federal government won’t shift its responsibility to pay for Native American health care to the state,” Daugaard said in a statement. “Still, I have heard from legislators that they would like more time to study this plan and in particular want to wait to consider the issue until after the presidential election. For that reason, I will not be calling a special session to take up this issue.”

Today is my 46th birthday. Today also happens to be the 4th anniversary of the Supreme Court's decision in National Federation of Independent Business v. Sebelius, (NFIB v. Sebelius), otherwise known as the decision which--unlike the King v. Burwell decision, which could have only crippled the law had it gone the other way--saved the Affordable Care Act from oblivion on June 28, 2012:

The Supreme Court, in an opinion written by Chief Justice Roberts, upheld by a vote of 5 to 4 the individual mandate to buy health insurance as a constitutional exercise of Congress's taxing power. A majority of the justices, including Chief Justice Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, though they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.

In short, the SCOTUS made two major decisions:

UPDATE: This story has, thankfully, gone quite viral since I originally posted it yesterday morning. One important clarification: I estimated the monthly cost for treatment at around $5,200. According to Ms. Nichols in this local story about the situation in the Clarion-Ledger, the cost for her daughter’s treatment/medication is around $2,000; the balance appears to be for her husband, who also has diabetes. This actually makes the family more sympathetic, because she’s only asking for state assistance for her daughter’s portion of the bill.

In addition, according to the updated local story, the message appears to have gotten through to Rep. Guice (at least to the point that he's issued an apology, anyway): 

Guice, who told The Clarion-Ledger Tuesday morning "I don't do interviews" and declined to comment, issued an apology Tuesday night.

A couple of weeks ago, I noted that Louisiana had seen jaw-dropping success with their ACA Medicaid expansion launch, enrolling over 175,000 people in the program in the first 12 hours of the floodgates opening. It later turned out that there was a reason for this astonishing figure: 

1. Virtually all of those enrolled as of yesterday, a total of 189,000 by day's end, were transfers from existing limited-benefit public plans. These include 132,000 enrollees in Take Charge Plus, a program focused mainly on family planning, along with a few free office visits; and 56,000 from the Greater New Orleans Health Connection (GNOHC), a no-cost primary care program for low income people in the greater New Orleans area. GNOHC does not provide drug or hospital coverage.

...which is perfectly fine as well; it still lifts a huge financial burden off of the state while streamlining and consolidating enrollees into the larger Medicaid program itself.

As I've noted the past few times that I've posted Colorado enrollment report updates, the way they report their numbers can be very confusing...which is doubly frustrating since the reports are also chock full of useful data as well.

Anyway, according to their latest report, when you add up the "effectuated enrollments WITH and WITHOUT APTC/CSR" (medical only), it totals 143,430 people as of June 9th, 2016...a slight drop from the 146,000 figure as of the end of April. As I noted last month, however: