Charles Gaba's blog

Last November, the Centers for Medicare & Medicaid (CMS) posted a whole mess of proposed ACA policy improvements for the 2017 Open Enrollment Period. They included a Public Comment period, then spent awhile reviewing all of the suggestions and making tweaks/changes to the proposals accordingly.

Just moments ago, they released the final parameters/rules for 2017...all 540 pages of it. Good grief.

Anyway, while there's a mountain of legalese to wade through here, the first one which leaps out at me is the one relating to the public Rate Review policy.

Yeah, I know it's extremely short notice, but if anyone happens to spend a half hour listening to me drone on about the whole Single Payer kerfuffle, feel free to tune into Netroots Radio tomorrow morning (Monday, Feb. 29th) at 8:00am EST, where I'm being interviewed by "Hopping Mad with Will McLeod and Arliss Bunny":

SEE IMPORTANT UPDATES AT BOTTOM.

Chris Jennings is a respected healthcare policy expert who worked for the Clinton administration for over 6 years and more recently worked for President Obama for a brief stint from 2013 - 2014. Neera Tanden is the President of the Center for American Progress, but before that she was a policy advisor for Hillary Clinton's 2008 campaign. Lee Fang is an investigative journalist for The Intercept whose work has been published and referenced in numerous respected national publications.

Unfortunately, Mr. Fang made a rather embarrassing false accusation the other day which he has yet to correct. [edit: see updates below]

After Scott Brown won in his election, Neera emails Hillary about secret plan to basically destroy health reform https://t.co/An008xLDjz

Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.

And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.

In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.

In my latest exclusive over at healthinsurance.org, I try to make something resembling sense out of the latest grunts and howls about Obamacare from the remaining Republican Presidential candidates.

Teaser: It included a discussion of the following scenario:

On September 26, 2013, just 5 days before the disastrous initial launch of HealthCare.Gov (as well as ugly rollouts of many of the state-based exchanges), President Obama gave a speech pumping up the impending start of the first Open Enrollment Period at Prince Geroge's Community College.

At one point in the speech, he touted how easy and handy the website would be to use:

Starting on Tuesday, every American can visit HealthCare.gov to find out what’s called the insurance marketplace for your state.  Here in Maryland, I actually think it's called MarylandHealthConnection.gov.  (Applause.)  MarylandHealthConnection.gov.  But if you go to HealthCare.gov, you can look and they'll tell you where to go.  They'll link to your state. 

Now, this is real simple.  It’s a website where you can compare and purchase affordable health insurance plans, side-by-side, the same way you shop for a plane ticket on Kayak -- (laughter) -- same way you shop for a TV on Amazon.  You just go on and you start looking, and here are all the options. 

From December 1, 2015:

Hey, remember the Risk Corridor Massacre? The one which is at least partly responsible (and in some cases, mostly responsible) for a dozen ACA-created Co-Ops (as well as at least one private insurance carrier in Wyoming) going out of business?

Well, there's two more rather interesting developments to the Risk Corridor mess.

...This fall, more than a dozen health insurers representing 800,000 people have dropped out of the ObamaCare exchanges, many out of fear that the administration no longer has the cash to cushion their losses in the costly early years of the marketplace.

In 2014, Open Enrollment officially ended on March 31st, but they allowed a 2-week "overtime" period for people who had started the process before the end of March but weren't able to complete it. The true deadline ended up being April 15th, although the official, final ASPE report ended up tacking on 4 more days (thru April 19th) for whatever reason. The final report was released 12 days later, on May 1st, 2014.

Last year, Open Enrollment officially ended on February 15th, but they tacked on a one-week "overtime" period, so the true deadline ended up being February 22nd. The official, final ASPE report was released 16 days later, on March 10th, 2015.

This year, Open Enrollment officially ended on January 31st, although the final Weekly Snapshot Report for the federal exchange tacked on 1 extra day (February 1st), so I assume that will be included. That means it's been 24 days so far, and the ASPE report hasn't been released as of yet...

To the best of my knowledge, the entire U.S. individual health insurance market should be roughly 19 million people this year. Of that, around 12 million are, of course, ACA exchange-based (I'm lopping off 700K to account for those who didn't pay their first premium, dropped out after the first month or otherwise aren't actually enrolled at the moment).

The other 7-8 million or so are off-exchange...people who enrolled directly through their insurance carrier, bypassing the ACA exchanges. Since off-exchange enrollees don't qualify for federal tax credits, the vast majority of these folks (a good 95% or more, I'd imagine) earn too much to receive them (officially over 400% of the Federal Poverty Line; realistically, some are in the 300-400% FPL range). The rest of them are presumably either undocumented immigrants, people who still don't know about the tax credits via the exchanges, or weren't able to find an exchange-based policy which they were satisfied with, even with the tax credits.

However, even then there are 4 different types of off-exchange policies:

*(OK, not really; I'm not the only one who was suggesting this, but it some people really do seem to think that I have dictatorial control over CMS...)

Some Guy, 11/22/15:

I guess the question here is just how much verification the HHS Dept. and/or the assorted state-based exchanges are doing of these claims. In cases like getting married/divorced, giving birth, becoming a citizen or getting out of jail, I would imagine the verification should be pretty easy. However, the "Tax Penalty Ignorance" exception was pretty much based on an honors system, and I don't know how easy/difficult it is for the feds to "verify" that your income has increased/decreased substantially...at least, not until you file your taxes the following year, which could be up to a year after the claim is made.

...So, what's the solution to this, assuming the problem is widespread? Well, I can think of some obvious tweaks to the rules, almost all of which involve simply reducing grace periods:

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