Confirmed Exchange QHPs: 12,909,955 as of 8/28/15
Estimated: 13.45M (10.22M via HCgov) as of 8/31/15

Estimated ACA-Enabled Policy Enrollment: 32.2M
(10.4M Paid/Effectuated Exchange QHPs, 7.0M OFF-Exchange QHPs, 200K SHOP, 14.6M Medicaid/CHIP)

I spent most of July and August simply overwriting/updating the original version of this entry, but now that the approved 2016 premium rates are starting to pop up all over (the deadline for approval of exchange policy rates was a few days ago), I figured it was time to start fresh.

OK, so what I've done here is to take the overall weighted average 2016 rate increases for the ACA-compliant individual health insurance market for each state (requested in some states, approved in others) and plug those into a spreadsheet. Then, I've further weighted each state's average increase by that state's percentage of the national total, using 3 different criteria: Total Individual Market (as of 2014); ACA Exchange Enrollment Size (as of March 2015); and Total State Population Size (as of 2014). Again, the bold-faced/green states are ones where the 2016 rates have been approved; the rest are still requested only and could change dramatically in some cases.

Louisiana's Insurance Dept. website is refreshingly complete: It includes every company on the individual & small group market, lists both the requested and approved rate hikes, and includes direct links to the filings which list the actual total enrollment in a clear-cut, consistent fashion.

In fact, the only data missing is some of the approved rate hikes; they've only posted the approved numbers for 3 of the 5 small group listings and 1 of the 10 individual listings, making it impossible to plug in the approved weighted average. However, the requested average is complete: About 15.4% for the individual market and 9.4% for the small group market.

While the Republican nominee for governor says he would dismantle the state health-insurance exchange branded as Kynect, a GOP senator is talking about not only keeping it, but expanding it to other states to pay for the other big feature of federal health reform: expanded Medicaid.

Sen. Ralph Alvarado of Winchester made the suggestion at a legislative committee meeting where Kynect Director Carrie Banahan said it would be "disastrous" to move Kentuckians to the federal Obamacare exchange, as Republican gubernatorial nominee Matt Bevin has said he will do if elected.

Alvarado, a physician, said his concerns about Obamacare in Kentucky are mostly monetary because the state will have to start paying 5 percent of the Medicaid expansion costs in 2017, rising to the reform law's limit of 10 percent in 2020.

...Alvarado suggested that Kynect become a regional exchange and charge other states for its services, using the profit to pay for the expansion.

Last year, while most state-wide average premium rates increased somewhat (averaging around 5.5% overall nationally, give or take), there were a few states which actually saw rate decreases from the year before: Arkansas, Mississippi and New Mexico saw overall decreases on their individual markets, while the District of Columbia and Hawaii saw decreases on their Small Business markets.

As noted a few days ago, now that a judge has put the kibosh on a legal hold, Alaska Governor Bill Walker's executive order to expand Medicaid statewide via the ACA expansion provision officially starts today, bringing healthcare coverage to up to 40,000 low-income Alaskans:

Beginning today, low-income uninsured Alaskans can apply for health coverage because of Governor Bill Walker’s decision to expand Medicaid as part of health reform.  This makes Alaska the 29th state (plus the District of Columbia) to implement the expansion (see map).

Across the country, Medicaid expansion has produced state budget savings, and the historic gains in health coverage since health reform took effect have been greatest in expansion states.  Now Alaska is poised to reap immediate and positive benefits of expansion: the state projects expansion will make 40,000 people eligible for coverage and could save the state budget up to $6 million this fiscal year, with greater savings in future years.  

A couple of weeks ago, right after I left for vacation, both Marco Rubio and Scott Walker finally released "replacement plans" for the ACA. Rubio's was really just an op-ed sort of thing, but Walker's has received quite a bit of attention because it reminds people that he's still running for President and it actually bears some resemblance to an actual policy paper, which is more than anything else the GOP has come up with over the past 6 years.

I was planning on writing up my own analysis of each when I got back, but frankly, I'm too backlogged with other stuff (both ACA and day-job related...I need another vacation from my vacation now...). Plus, many, many others more knowledgable about these things than I have done fantastic writeups already:

In addition to today's announcement that there's been a net gain of 13.1 million Medicaid enrollees since ACA expansion launched in January 2014, the CMS Dept. also made another announcement which should improve those numbers further, while also streamlining the enrollment and renewal process considerably:

The CMS Dept. has quietly released their latest monthly Medicaid/CHIP enrollment report through the end of June...which happens to line up almost perfectly with what I was expecting:

  • Nearly 72 million individuals were enrolled in Medicaid and CHIP in June 2015. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.
  • 292,112 additional people were enrolled in June 2015 as compared to May 2015 in the 51 states that reported comparable May and April 2015 data.
  • Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both May 2015 enrollment data and data from July-September of 2013, nearly 13.1 million additional individuals are enrolled in Medicaid and CHIP as of June 2015, almost a 22.7 percent increase over the average monthly enrollment for July through September of 2013. (Connecticut and Maine are not included in this count.)

This is a huge story which I should have been following, but a) I was on vacation the past couple of weeks, b) I can't cover everything healthcare-related, and c) it's really not directly related to the Affordable Care Act. Fortunately, the Arkansas Times' David Ramsey has been all over it, so I'll let him lay it out for you:

...all three members of the household were among almost 36,000 Arkansans who were kicked off of their health coverage on July 31. Insurance for another 13,000 people across the state will terminate at the end of this month. The cancellations are the result of a statewide sweep of Medicaid performed by the Arkansas Department of Human Services in an attempt to weed out those beneficiaries whose incomes are too high.

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