Odds 'n' Ends: 2 Year Plan Extension, AR Medicaid Program Saved, CA Grandfathered Data

Yesterday the Obama administration announced several new modifications to ACA implementation. The one that's getting the most attention is a 2-year extension on non-compliant, pre-ACA healthcare plans. After getting criticized for "lying" about his "if you like your plan you can keep it" statement last fall, Pres. Obama gave individual states the option of extending existing plans by 1 year if they wanted; this just extends that period further, out to pretty much the end of Obama's term of office:

Americans with health coverage that predates Obamacare can stay on their plans for two more years, insurers will have an extra month to enroll customers next winter and states will get more time to decide whether to manage the law themselves, officials said. Also, a program aimed at covering financial losses for insurers will be adjusted to help ensure it doesn’t cost taxpayers, the Obama administration said.

However, the article also has a couple of interesting tidbits about the "OMG!! 5M PLANS CANCELLED!!!" attacks from last fall: First of all, I was never sure if the "5 million" figure referred to policies or people (ie, households or individuals). According to Bloomberg News, that 5M number is people, assuming about 2 people per household (I use a more conservative 1.8x multiplier for household cases, but the point is the same). More interestingly, according to the CBO, those 5 million have been reduced down to only 1.5 million people on noncompliant plans so far anyway. The other 3.5 million presumably either switched to a new, compliant plan via the exchanges (my own family falls into this category) or directly via the insurance company (the mysterious off-exchange enrollments that I'm still trying to document with limited success):

About 4 million people have enrolled in new health plans offered through insurance exchanges under the Affordable Care Act, while about 1.5 million people remain in plans that don’t comply with the law, according to the Congressional Budget office. An estimated 2.5 million people received letters as the exchanges opened in October from insurers saying their noncompliant plans would be canceled, triggering a political firestorm for the president, who had repeatedly promised that people with plans they like wouldn’t have to change them because of the health law.

In other words, as far as I can tell, the Obama administration has realized that by the time the 3-year extension has run out, just about all of those 5 million people will have moved on to a compliant policy one way or another anyway, either on purpose, by aging into Medicare age, getting a new job that includes a compliant policy, etc. They've figured that by the time 2016 rolls around, it should be a moot point anyway.

Meanwhile, in Arkansas, the state legislature finally (after 4 failed attempts) voted to keep their unusual "Private Medicaid Option" program running. This is a program in which public Medicaid funds are used to pay for private QHP enrollments for people who fall into the Medicaid expansion pool. I'm not sure I fully understand it, but it really sounds like the equivalent of enrolling in a private QHP through the exchange yourself and receiving a 100% subsidy...except that you have to go through the process via the Medicaid system. Anyway, it's safe for another year:

The Arkansas experiment to use federal Medicaid dollars to help low-income people buy private health insurance plans will survive another year.

This “private option” of Medicaid expansion — which narrowly passed in the state’s House of Representatives on Tuesday after being rejected in four previous votes – allows those below 138 percent of the poverty level to enroll in plans like Blue Cross and Blue Shield through the state’s insurance exchange.

Back to non-compliant plans: Ruth37 contacted the California Insurance Commissioner's office in an attempt to get some data on off-exchange enrollments. While they didn't provide that data, they did provide a link to the 2012 report, which includes one interesting data point: Apparently CA was keeping track of how many non-ACA compliant policies were in place well before the exchanges launched. According to the report, there were about 1.9 million non-compliant policies as of the end of 2012 in California, but there were also around 880,000 policies that were already fully compliant a full year before the new ones were required. Not going anywhere with this, just thought it was noteworthy.

GF: Grandfathered Health Plans. This column represents the number of covered lives under a health benefit plan that is a grandfathered health plan as defined in Section 1251 of Patient Protection and Affordable Care Act (PPACA).

NGF: Non-grandfathered health plans. This column represents the number of covered lives under a health benefit plan that is identified by the company as not grandfathered.