Just a few minutes ago I noted that the state of Oregon is once again strongly considering taking a second crack at establishing their own, fully state-based ACA exchange after spending the past five years piggybacking on top of HealthCare.Gov.
Steps like a mandate for Oregon residents to buy health insurance and relief for exchange customers who earn too much to receive tax credits under the Affordable Care Act could help reverse premium hikes that have shot up amid attempts by the Trump administration to roll back the law, OSPIRG, the Oregon State Public Interest Group, argued in a report released Wednesday.
Lost amidst all the other overwhelming ACA-related news this week is one other important nugget: The Affordable Care Act's "individual mandate penalty", which was lowered to $0 in December 2017, was still the law of the land until December 31, 2018. It may have been changed at the time, but that change didn't become effective until January 1, 2019.
ELIMINATION OF SHARED RESPONSIBILITY PAYMENT FOR INDIVIDUALS FAILING TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.
(a) In General.--Section 5000A(c) <<NOTE: 26 USC 5000A.>> is amended--
(1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' and inserting ``Zero percent'', and
(2) in paragraph (3)--
(A) by striking ``$695'' in subparagraph (A) and inserting ``$0'', and
(B) by striking subparagraph (D).
(b) <<NOTE: 26 USC 5000A note.>> Effective Date.--
The amendments made by this section shall apply to months beginning after December 31, 2018.
Shoutout to James Medlock for digging up this relic from the 2008 Presidential primariy race: A lit piece from then-Senator Barack Obama's campaign slamming then-Senator Hillary Clinton over her insistence on her proposed healthcare policy bill including an Individual Mandate Penalty. How many Republican talking points can you spot below?
There's a lot going on here. For starters, the couple on the first page are basically 2008 versions of "Harry & Louise"...it's a white, middle-age, middle-class suburban couple poring over their finances. Considering that the 1993 "Hillarycare" proposal was destroyed in large part due to the health insurance lobby's successful series of Harry & Louise "there's got to be a better way" ads, Obama using this same tactic had to sting.
Back in early December, I noted that while I applauded both New Jersey and the District of Columbia for creating their own individual healthcare coverage responsibility requirements (aka, The Individual Mandate) in response to Congressional Republicans repealing the ACA's federal penalty, doing so also required making sure that residents of NJ/DC *knew* they had done so:
There's only one problem with this: The impact of the mandate penalty is completely psychological in nature. It only works (to the extent that it does at all) if people know that they'll be penalized financially for not complying with the mandate.
Last night, in response to CMS Administrator Seema Verma taking shots at both Covered California (for blaming their drop in new enrollment on the federal mandate being repealed) and New Jersey (for seeing a 7.1% exchange enrollment drop in spite of reinstating the mandate), I wrote a long analysis which noted that:
Verma may have a valid point, but...
There's not nearly enough data available to know one way or the other (especially the missing off-exchange data for this year), and...
Even if she turns out to be correct about NJ's total enrollment drop, NJ reinstating the mandate still resulted in a substantial premium drop for well over 100,000 residents.
Today, I was able to fill in some of that missing data...although some of it is still frustratingly absent.
So, a couple of hours ago, CMS Administrator Seema Verma tweeted out the following:
.@coveredca blames subpar enrollment on no federal mandate penalty, but NJ kept penalty and saw much, much bigger drop. Forcing Americans to buy insurance they can’t afford isn’t the answer.
Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.
Covered California Plan Selections Remain Steady at 1.5 Million, but a Significant Drop in New Consumers Signals Need to Restore Penalty
Covered California finishes open enrollment with 1.5 million plan selections, which is virtually identical to 2018’s total, despite federal changes.
A key reason for the steady enrollment is that more people entered the renewal process for 2019 coverage after a strong enrollment period for 2018.
The federal removal of the individual mandate penalty appears to have had a substantial impact, leading to a decrease of 23.7 percent in new enrollment.
SACRAMENTO, Calif. — Covered California announced that more than 1.5 million consumers selected a health plan for 2019 coverage during the most recent open-enrollment period, a figure in line with last year’s total. There was a 7.5 percent increase in the number of existing consumers renewing their coverage and a 23.7 percent drop in the number of new consumers signing up for 2019.
State government plays a critical role in today’s health care system. Every policy decision we make has an impact on the individuals, children and families who need care. The Governor’s FY20 budget proposal builds on this momentum, preserving vital ACA protections that promote market stability and help to keep uninsured rates low. There are no eligibility cuts or broad-based benefit impacts proposed.
Last week I acquired the DC Health Link enrollment data for the first two weeks of 2019 Open Enrollment. It showed that DC, unlike most of the other state-based exchanges, was lagging behind last year for the first two weeks (although not as much as most of the HC.gov states).
Well, I just received updated data out of DC and the enrollment situation over the following four weeks didn't improve (if anything they dropped off slightly more):
Nov. 1 - Dec. 11, 2017: 19,252 QHP selections
Nov. 1 - Dec. 11, 2018: 17,825 QHP selections
That's a drop of around 7.4% year over year so far.
As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC has already reached 92% of that as of 12/11. Keep in mind that DC's Open Enrollment Period does not end on Saturday the 15th; it continues for another 47 days after that, through January 31st.
Things weren't looking great as of two weeks in: Total enrollments were down 6.8% (1,202 people) year over year as of the same date. We'll have to see whether things have picked up since then.
As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC had already reached 85% of that as of 11/13.
DC's report also includes all sorts of wonky demographic breakout data, and even closes with currently effectuated numbers for both the individual and small business (SHOP) markets. Remember, DC's SHOP market is unusually high (especially compared to the individual market) because the ACA requires all members of Congress and their staff to enroll using it if they want their 72% FEHB subsidy.
