01/12/17: PLEASE NOTE: I know there's a whole bunch of updates/revisions below; this is because I'm constantly updating both the Medicaid expansion and exchange policy numbers daily, in real time as I'm able to compile the most recent enrollment numbers. In most cases the numbers are quietly increasing, although in a few cases I've revised them downward.
I operate this site by myself and I do have a day job, family, etc, so if I haven't updated your state, be assured I'll get to it as soon as possible.
Last week, the House majority released an outline for repealing the Affordable Care Act, or ACA. Although the document provides no new details, it does provide enough information to evaluate the adequacy of financing, the likely policies needed to pay for new tax credits for health insurance, the likely effects on tax credit levels, and the political hurdles to such an approach. This analysis is based exclusively on numbers from the nonpartisan Congressional Budget Office, or CBO.
Here's CAP's main findings; in short, Ryan's repeal bill would....
Those still enrolled in the same policy they had been as of March 2010 (when the ACA was signed into law)
Those who enrolled in policies between April 2010 - September 2013
Those in the first category were allowed to hold onto their existing policies for as long as they wished (or at least until they died or their carrier voluntarily chose to discontinue them). These policies were "grandfathered" in pretty much forever.
As I noted earlier, much of this falls into the category of "You don't know what you've got 'til it's gone". Fully 85% of Democrats and 53% of Independents now "approve" of the ACA, with only 2% and 15% wanting to scrap it. Meanwhile, while Republicans still don't like Obamacare as it stands now much at all (only 10% want to keep it), only 44% of them now want it fully repealed.
Over the past few weeks, a whole bunch of polls have come out showing that support for Obamacare has miraculously shot up substantially now that there's a very strong possibility that it will actually be repealed for real. Obviously there's a lot of "You don't know what you've got 'til it's gone" stuff going on here.
For all the arguing and debate about the benefits and downsides of the ACA, however, there's one major positive which received some attention when it first passed but hasn't been talked about much of late: Rescission.
Rescission, as you may recall, was an ugly little gimmick that insurance companies used to use in order to utterly screw over people who had been paying them premiums for years or even decades. Here's how it would work:
Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.
In Nevada, , 89,000 people enrolled in exchange policies as of the end of January. Of these, I estimate around 62,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus the additional 320,000 enrolled in Medicaid expansion, for a total of 382,000 Nevadans kicked to the curb.
The last official ACA Medicaid expansion enrollment number I have recorded for Indiana (via their modified "Healthy Indiana 2.0" program) was 290,000 people way back in July 2015. At the time, the maximum potential HIP 2.0 enrollment total was 680,000 Hoosiers, made up of 350,000 newly covered plus another 330,000 being transferred over from the HIP 1.0 program.
This NPR article from a couple of weeks ago states that as of January, "the Healthy Indiana Plan that he established in 2015 as the state's governor has brought Medicaid coverage to more than 350,000 people." However, that number is a bit confusing given that they were also supposedly transferring the other 330K over from the other program as well. I'm not sure if 350K refers to total HIP 2.0 enrollment or only those who were previously uninsured.
Yesterday was supposed to be a Big Day for Congressional Republicans, as they were set to finally reveal their Master Plan to replace the Affordable Care Act. Speaker of the House Paul Ryan held a press conference about it, and they even released a 19-page "Policy Brief" which purported to explain it to everyone. Hooray! They were hoping that the entire news universe would be singing their praises all day long.
That didn't happen, however, for two reasons. FIrst, because Donald Trump's bizarre, surreal press conference, complete with racist and anti-semetic incidents, pretty much sucked all the oxygen out of the news cycle. The other reason is that their "policy brief" didn't really include much that we hadn't seen before. As Jeffrey Young of the Huffington Post put it:
It was basically the same as what Ryan and the leadership outlined over the summer with “A Better Way” proposal.
IMPORTANT: This is my county-level estimate for California. The congressional district breakout will be following soon.
Update 2/17/17: (SEE BELOW: CONGRESSIONAL DISTRICT BREAKOUT ADDED!!)
Regular readers know that I started out the "How Many Could Lose Coverage..." project at the state level, then moved into analyzing the county-level data, before finally tackling the hardest challenge: Breaking them out by Congressional District.
The state level table includes all 50 states (+DC), while I managed to break out the county level data for 34 states so far before moving into the Congressional District analysis by popular demand. There, I've managed to crunch the numbers for 43 states so far.
So, All Around Awesome Dude @LOLGOP tweeted out a link to my "How many could lose coverage in YOUR Congressional District?" project, created as a resource for progressives, Democrats and others who support saving and improving the Affordable Care Act to use to provide quick, easy and reasonably accurate estimates to utilize for Congressional town hall meetings, social media and so forth.
Countless hours of painstaking research and analysis have gone into this project (and is still ongoing...I have about a dozen states left to go). In order to avoid even the slightest claims of exaggeration, I've bent over backwards to error on the conservative side with my estimates as follows:
Over at Politico, Paul Demko has an extensive article (with an assist from Adam Cancryn, Jennifer Haberkorn and Rachana Pradhan) which confirms many of the things I've been saying for awhile now...although it also weakens one of my arguments as well. In an odd way, that's entirely in keeping with the overall theme of the article itself. That is, every one of the following statements appears to be true simultaneously:
The Trump administration is deliberately sabotaging the ACA exchanges.
The Trump administration is sort of trying to shore up the ACA exchanges.
Congressional Republicans are full-speed ahead on repealing the ACA.
Congressional Republicans are putting the brakes on repealing the ACA.
The Individual Market isn'tin a Death Sprial yet, but could be next year.
The Individual Market is already in a Death Spiral in some states but doing just fine in others.
A full replacement plan is ready to go at any moment.
A full replacement plan hasn't even made it past the first stages yet.
In a classic case of trying to have it both ways, the Trump Administration is simultaneously taking every action it can to damage/kill the ACA while also taking actions which are supposedly attempting to stabilize it. This is leading to some very...interesting...results, such as this press release sent out an hour or so ago:
CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.