Confirmed 2017 Open Enrollment Period QHP Selections: 2,638,473

Last week, in my latest exclusive entry at healthinsurance.org, I crunched the numbers to see just how many people would likely lose their healthcare coverage if congressional Republicans, along with Republican President-elect Donald Trump, were to follow through with their explicit promise to repeal the Affordable Care Act (otherwise known as "Obamacare") early next year.

As I noted, the GOP is still incredibly vague about what exactly they'd replace the ACA with. No matter what they claim, it's only the "repeal" part which they've been clear about so far. All indications are that they plan on pushing the "repeal" part through almost immediately upon Trump taking office. Therefore, I focused specifically on what would happen if the ACA were repealed, in full, in early 2017 with immediate effect (as opposed to this weaselly 2-3 year delay business they've been bandying about which could potentially be even worse for the healthcare market as a whole in some ways).

Remember, there are four categories of people who would lose coverage:

  • 11.3 million 12.3 million: People enrolled in Medicaid/CHIP specifically thanks to the ACA's expansion provision in 32 states + DC
  • 9.0 million: People enrolled in ACA exchange (Individual Market) policies who are receiving heavy federal subsidies via the ACA exchanges*
  • 1.4 million: Young adults 19-25 years old enrolled in their parents' plans (via group or non-group markets) specifically thanks to the ACA provision
  • 470,000: People enrolled in ACA-funded Basic Health Plans in Minnesota & New York

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head. For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions. Very likely no boots had been produced at all. Likelier still, nobody knew how many had been produced, much less cared. All one knew was that every quarter astronomical numbers of boots were produced on paper, while perhaps half the population of Oceania went barefoot.

Last week I attempted to figure out just how many Trump voters would lose their healthcare coverage if/when the ACA is repealed by the Republican Party. Paul Krugman took a "big picture" approach and came up with numbers in the 4-6 million range. My own back-of-the-envelope math came in higher, at perhaps 9 million. I concluded that the actual number is likely somewhere in the middle (4-9 million).

I mention this because this morning the Urban Institute issued their own detailed analysis of just how many people would lose coverage after a partial repeal of the Affordable Care Act shortly after my own projection of lost coverage from a full repeal. Ironically, a partial repeal would be even worse (29.8 million losing coverage) than the already-devastating numbers from a full repeal (23.1 million losing coverage).

Amy Goldstein in the Washington Post reports:

The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

The two main trade groups for U.S. hospitals dispatched a letter to the incoming president and Capitol Hill’s top four leaders, saying that the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients.

More specifically:

Findings:

In modeling the repeal of the ACA as laid out in H.R. 3762, we found that between 2018 and 2026:

The New York Times, December 2nd:

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

Having talked to a number of CEOs & states, @SabrinaCorlette is right, if not understating.https://t.co/Ri5TtkHz7Z

— Andy Slavitt (@ASlavitt) December 3, 2016

I'm stuck in a loop of:
1. Reading this article... https://t.co/QjH2Evfldw

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

Earlier today I posted fully broken-down estimates of just how many people would be directly impacted by a full & repeal of the Affordable Care Act this spring, assuming that the repeal took immediate effect and there was no replacement plan in place for the various provisions of the law.

The largest single category of enrollees in my estimates are those enrolled in Medicaid/CHIP due specifically to the ACA's Medicaid expansion provision. I estimated this to be roughly 11.3 million people nationally.

However, I was just informed of a new report released by the Foundation for Government Accountability, an anti-ACA think tank, which has compiled their own estimates of ACA Medicaid expansion enrollment on a state-by-state level. Here's what they've come up with:

Now that we're past Thanksgiving weekend and the big December 15th deadline (for January coverage) is coming up fast, OE4 enrollments should have started ramping up significantly, on the order of 250,000 per day or more nationally (around 190K via HC.gov).

As noted last week, so far, total enrollments have been pacing my overall projections almost perfectly...slightly ahead of my estimates for the first month, in fact. Assuming this continues, national QHP selections should have broken 4.1 million nationally sometime Monday night (12/05), with around 3.1 million of those coming via the federal exchange.

The Connecticut ACA exchange, AccessHealthCT, issued a press release today reminding Connecticut residents in general of the December 15th deadline for January 1st coverage. They also stressed, however, that while most current enrollees will be automatically renewed into either their existing policy, there are about 26,000 current enrollees who can't be auto-renewed because their carrier is leaving the exchange in 2017:

On December 1st, AHCT’s automatic renewal process began. The AHCT eligibility system will automatically enroll into 2017 coverage customers who have selected auto-renew and whose plans are still available. “But, there are 26,000 people who currently have coverage through AHCT who cannot auto-renew and must take action to renew their 2017 plans,” Wadleigh noted. Wadleigh reminds all customers “they should shop around and compare your options for 2017– that’s the purpose of the marketplace.”

NOTE: I've toned down the title a wee bit.

Read this (12/01/15):

Hey, remember the Risk Corridor Massacre? The one which is at least partly responsible (and in some cases, mostly responsible) for a dozen ACA-created Co-Ops (as well as at least one private insurance carrier in Wyoming) going out of business?

Well, there's two more rather interesting developments to the Risk Corridor mess.

Connect for Health Colorado just posted an official enrollment update:

DENVER — More than 37,000 Coloradans selected healthcare coverage for 2017 through the state health insurance Marketplace in November, a rate 23 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®.

“The pace of sign-ups during the first month of this Open Enrollment has been very heartening,” said Connect for Health Colorado CEO Kevin Patterson. “We know that there is a lot of discussion now about the future direction of healthcare, but what remains constant and true is the importance of protecting the health and financial future of all Coloradans. I encourage everyone who needs health insurance to check to see if they qualify for financial assistance, review the available plans, and complete an enrollment before the last-minute rush.”

In the first month of the annual Open Enrollment period, Coloradans selected 37,948 medical and dental insurance plans. That compares to 30,777 such plan selections in November 2015.

 

Every month, the Kaiser Family Foundation conducts an extensive national survey about various issues, mostly having to do with healthcare for obvious reasons. Their November survey results are both facepalm-inducing and completely predictable at the same time.

Plenty of other outlets are doing full analysis of the survey, such as this one by Jonathan Cohn of the Huffington Post, and I'm swamped today, so I'll just focus on a couple of the charts.

Yesterday, over at the NY Times, Paul Krugman, writing about the supposedly imminent repeal of the Affordable Care Act, tried to answer the question "How many people just shot themselves in the face?"

After giving it several shots, a Twitter follower of mine suggested that he bring me in on the issue:

@paulkrugman You really need state-level data (hint: @charles_gaba). Trumpier states didn't expand Medicaid or encourage/support exchanges.

— (((MikeRose))) (@MikeRose2d) November 29, 2016

In my latest exclusive post over at healthinsurance.org, I did my best to come up with the answer. Check it out!

Last week I decided to once again take a crack at projecting not only the final number of 2017 Open Enrollment Period QHP enrollments nationally, but on a state-by-state basis. I started with a simple assumption of "2016 + 8.7%" (to match the national 13.8 milliion vs. 12.7 million projection made by both myself and the HHS Dept.), and then adjusted each state higher or lower based on various factors.

Now that CMS has broken out the first 4 weeks' worth of QHP selections via the federal exchange, in addition to the partial data I have on hand for some of the state-based exchanges, it's time to see where things stand compared to my personal projections. The only states where I know of an official projection are California and Connecticut, and even these have some wiggle room as they're more ranges than exact numbers.

With that in mind, here's what it looks like at the moment. Click the graph below for a high-resolution version. Things to note:

Some Guy, 11/28/16:

#ACASignups MEANWHILE, I'm pretty sure #ACA enrollments have hit 2.07M via HCgov, 2.69M nationally: https://t.co/D2fr0eBSEx #Obamacare #OE4 pic.twitter.com/BDHSVqVLuI

— Charles Gaba (@charles_gaba) November 28, 2016

HHS Secretary Sylvia Burwell, moments ago:

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