2018 MIDTERM ELECTION

Time: D H M S

In-Box-Purgeapalooza Part 2

As I noted this morning, between the impending election on Tuesday, the upcoming 2nd Open Enrollment Period (henceforth to be designated "OE2" or hashtag #OE2), and a serious technical crisis with my day job which I've had to spend the past few days cleaning up, I have upwards of 150 ACA/Obamacare-related emails clogging up my In Box.

Most of them are worth a mention, but there's no possible way I can do a full entry/commentary/analysis on most of them, so I'm just doing roundup-style summary mentions:

Consumers in Georgia and three other states who were helped by navigators for the 2014 insurance exchanges tended to be people of color who were not financially secure, a recently released report says.

Navigators, who are specially trained in the provisions of the Affordable Care Act, popularly known as "Obamacare," provide face-to-face, in-person help for consumers seeking information about health insurance policies in the state exchanges, also called marketplaces.

There are still a few states where we don’t know what the 2015 rates are going to be, but it certainly appears that the final numbers are coming in considerably under the 100 percent increase that was being projected by ACA opponents back in March. And not only are carriers agreeing to very modest rate hikes for 2015, there’s also a significant influx of new carriers joining the exchanges, increasing competition and further stabilizing rates.

In some states, rates have been approved by regulators without changes. But in states with particularly strong regulatory oversight, the proposed rates that were submitted early in the summer were significantly higher than the final approved rates. New York is an example: insurers in the state requested an average rate hike of 12.5 percent, but ultimately the state only approved an average rate increase of 5.7 percent.

Rhode Island’s health insurance exchange, HealthSource R.I., has outperformed most other states’ systems in the year since it opened to the marketplace but faces challenges of balancing competing stakeholder interests, budget problems and collaboration with state agencies, said invited speakers of a Taubman Center for Public Policy and American Institutions panel discussion Wednesday afternoon.

Health insurance exchanges were hard pressed for any positive media coverage this time last year, due largely to hastily planned and inadequately tested websites that left consumers frustrated -- and sometimes uninsured. But as the months wore on, contractors were shuffled, leadership changed, and even the most notorious failures seemed on some kind of path to turning things around.

Enter open enrollment, which starts on Nov. 15 and spans the three months that follow. Stakeholders across the spectrum are busily preparing for the onslaught. Among them is call center operator Maximus Inc., under contract for five state exchanges -- Connecticut, Hawaii, Maryland, New York and Vermont -- the District of Columbia exchange, and as a subcontractor to General Dynamics, two of the federal government’s 17 call centers. All told, several thousand workers trained by Maximus stand ready to help consumers answer questions and get covered.

In March, it seemed improbable if not impossible that carriers could avoid double-digit rate hikes for 2015 policies sold on public insurance exchanges. With the health insurer tax, reinsurance fees, a marketplace user fee and scant information about their new enrollees, several actuaries told HEX that big rate hikes were almost certain (HEX 3/20/14, p. 1). But proposed and approved premium increases being touted by state regulators, so far, have been in the low single-digits. Why?

The folks at Washington's health insurance exchange recently issued a news release touting the automatic renewal that will be available for about 80 percent of the customers who are currently enrolled.

That means if you have insurance through the state's Healthplanfinder and you like what you have, there's a good chance you'll be able to keep the same insurance next year.

Across the state, about 147,000 people are now enrolled in a private plan through the state's health insurance exchange. Many are eligible for premium subsidies based on their income level.

The news release notes that health insurance consumers may also want to shop for a new plan that may better suit their needs and budget. Enrollment begins Nov. 15, and the first payment must be received by Dec. 23  for coverage to begin Jan. 1, 2015. You can continue to enroll through Feb. 15.

With midterm elections looming, the politics of Obamacare are again coming to the fore—only this time it’s not just Democrats making the case that the law’s Medicaid expansion is good but also some leading Republicans, chief among them Ohio Gov. John Kasich.

...Still considered a potential contender for the Republican nomination in 2016, Kasich now finds himself in position that requires both defending his Medicaid expansion and condemning the increasingly unpopular healthcare law. Either he’s woefully ignorant about Obamacare, or he knows he’s being disingenuous but has chosen to defend Medicaid expansion because repeal would mean kicking thousands off the Medicaid rolls in Ohio.

Despite the many problems Vermont Health Connect has had, joining the federal exchange would be far worse for Vermonters. Under a federal exchange, insurance would cost more and we would weaken our ability to develop a consumer protection system that works for Vermonters. We would receive less federal money for providing in-person assistance to Vermonters.

These are among the reasons why consumer advocates urged the Vermont Legislature to develop its own exchange and not use the federal exchange.

It has been well documented that coverage through Vermont Health Connect isn't affordable to tens of thousands of working Vermonters. This is why Vermont became one of only two states in the nation to give additional subsidies on top of what the federal government provides to enrollees in the state exchange.

While some seem fixated on telling us the rollout of Obamacare has been a disaster, the actual facts are that enrollment is above expectations, costs are lower than expected, and the number of Americans without insurance has dropped sharply. Did you know that?

I serve on the board of one of our local hospitals. It is a volunteer position with often intense responsibilities. Hospital costs make up about 40 percent of what we spend on health care, by far the largest single segment.

...Last fiscal year, according to the Hospital Association of Rhode Island, our hospitals amassed an operating deficit of about $50 million. This year, they achieved a remarkable turnaround, with a surplus of about the same amount. This $100-million swing is remarkable and a welcome change to those who care about having a hospital conveniently located in their community.

UnitedHealth and other publicly traded insurers are expanding their exchange presence for the 2015 open enrollment period, which lasts three months. Experts say insurers recognize the shift toward a more individual consumer-oriented market, with the likelihood that an increasing number of employers will have their workers shop for plans on public and private exchanges. In addition, insurers expect a more balanced pool of healthier and sicker enrollees as the exchange population grows larger and the tax penalties increase for not buying coverage. 

Until recently it was seen as the political equivalent of Ebola. Yet President Barack Obama’s Affordable Care Act – known to friend and foe alike as Obamacare – is rapidly settling into America’s landscape. In politics, its virulence is receding: Republicans are far more muted in their attacks than anyone expected a few months ago. The outcome to next week’s midterm US elections will not hinge on the public’s ambivalence about the law. On the ground, its impact is spreading like an inkblot. Obamacare is messy and ugly. But it is starting to cover the map.