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.
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Obamacare has miraculously shot up substantially now that there's a very strong possibility that it will actually be repealed for real.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analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.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.
Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.
Republicans' Struggles to Replace Obamacare Feel Like Deja Vu All Over Again
Republicans in Congress are hitting roadblocks as they try to devise a plan to replace Obamacare, stuck over issues like how to structure tax breaks they want to give people to buy insurance.
...Republicans, who have spent more than six years vowing to smash the Affordable Care Act, swept into control of the White House and Congress pledging a swift repeal. But they’ve made little progress in deciding how to do that, or what should come next.
...Republicans agreed on vague concepts such as tax breaks, letting insurers sell across state lines and letting states run Medicaid.
...In fairness, as Adam Cancryn noted in his epic Risk Corridor Autopsy piece, there were a lot of other factors which caused half of the Co-Ops to fail in the first two years. It's possible that some of them would have gone under even with the RC money, and there's no guarantee that all of the remaining ones will thrive or even survive. But there's no denying that the RC payments they were counting on were a major factor, and at least a few of them would almost certainly have survived if not for having the rug yanked out from under them.
So, to review, the end result of Marco Rubio's shenanigans are:
up to 800,000 people nationally lost their insurance coverage, on very short notice, and were forced to scramble to find alternate coverage
the new coverage these people ended up with is generally more expensive, and in many cases has worse networks
the federal government has to therefore pay out more in premium subsidies to cover the increased costs as benchmark plans were increased
over a dozen insurance carriers went out of business, meaning hundreds of people lost their jobs
the loss of over a dozen carriers means less competition in those markets, therefore less competition, therefore higher premiums, therefore even more cost to the federal government in subsidies to make up the difference
since all of the carriers which went out of business were little guys, this also means the big kahunas suck up even more market share
the original $2.5 billion which Rubio was supposedly trying to "save" taxpayers ends up being paid out anyway; and
it's possible that, in addition to all of this, assuming the government decides to just concede the point (which, by all rights, they should), it's conceivable that Marco Rubio's "genius" stunt from December 2014 could also very well end up costing taxpayers $2.5 billion MORE than it would have to just let the government make the payments they were supposed to in the first place.
...all so that Marco Rubio could earn a couple of political brownie points to help him win the GOP nomination for President...which he appears to be failing at anyway.