2018 MIDTERM ELECTION

Time: D H M S

Bad news in Arkansas, Surprising (Potentially Good) news in California

Hat Tip To: 
Mike W., Dee, Ivan Williams

Two late-breaking news items, one negative, the other potentially positive:

Arkansas: The good news a few weeks ago was that newly-elected Republican Governor Asa Hutchinson did not kill off AR's unique "private option" Medicaid expansion program as many had feared; instead, he actually proposed extending it pretty much as is for another 2 years, to the relief of decent folks, and the state legislature seemed to be OK with that (another surprise).

The bad news today is that, while the program looks safe for 2 more years...the same legislation kills the program after the 2 years are up:

LITTLE ROCK, Ark. (Reuters) - Governor Asa Hutchinson of Arkansas has signed legislation that will end by 2017 the state’s innovative but controversial adaptation of the Affordable Care Act, which has provided nearly 190,000 residents with health coverage.

Arkansas' "private option" plan uses federal funds from the Affordable Care Act, also known as Obamacare, to purchase medical insurance for some low-income individuals, rather than assigning them to the state's Medicaid program.

The new legislation requires a task force to study state funded health care spending and find alternatives to the program. Hutchinson, a Republican, signed it late on Wednesday.

Yeah, I'm thinking that this "task force" will most likely be a sham which doesn't end up coming up with any sort of concrete proposal (or that whatever recommendations it ends up making will be summarily tossed in the trash bin by the power that be).

Anyway, it is what it is. This blows, but the entire healthcare/insurance landscape will look very different 2 years from now anyway. Who knows? Perhaps they'll even follow Pennsylvania's lead and replace this "private option" thing with regular Medicaid like they were supposed to in the first place (yeah, right lol...)

In more positive (and surprising) news...

California: Earlier today, CoveredCA announced that they'll be allowing a 5 day "extension period" after Sunday night's official deadline. It would work similarly to last April's national "overtime period"...as long as you started the application/enrollment process at CoveredCA by midnight on 2/15, you'll have until 2/20 to actually select a plan and get out of Dodge.

I'm expecting at least a few other states to make similar announcements (most likely Washington, Vermont and Minnesota, I'm guessing; WA & VT are still having serious technical issues, and WA & MN are still lagging well behind on their enrollment targets anyway).

However, this evening there was another type of "extension period" which was discussed openly by Peter Lee, Executive Director of CoveredCA:

...advocates have long been frustrated with the timing of open enrollment. That’s because of how penalties for lacking insurance are assessed — on your taxes. The tax deadline is not for another two months, April 15.

It’s easy to imagine that plenty of people will discover the penalty as they file their taxes over the next two months — and simultaneously discover they are locked out of buying insurance.

In a surprise, Peter Lee told me Thursday afternoon that Covered California is considering “contingency plans.”

He said the agency will be “looking actively” at people who might not have understood there was a penalty. “Do we make a special provision for them between now and the end of tax season?” he said.

Lee stressed there has been no decision, that Covered California is focusing now on getting through open enrollment, “but this is a major issue and we’re going to be looking at this in the next week or two.”

It's not at all surprising that CoveredCA (and/or the other exchanges, including HC.gov) are considering a special "Tax Season Enrollment Period"; various reporters have asked about or discussed the possibility for weeks now. What is surprising is that the head of one of the exchanges would discuss it publicly...before Sunday's deadline passes. The HHS/CMS folks were very tight-lipped when asked about this very thing in yesterday's conference call:

Rachana Pradhan:    Hi, everybody.  I'm wondering - I know we hadn't talked about this before - has there been any more talk or movement toward creating a special enrollment period for people who didn't - who filed taxes after February 15th and then find out that they're going to owe the government next year because they haven't gotten coverage.

Andy Slavitt:    Yes, thank you.  Thank you for the question.  Really same answer that we gave last year, which is consumers should consider February 15th as their last opportunity to get coverage and we'll be considering - we won't be considering anything until we get through this open enrollment period.

This makes total sense. If they announce any sort of extra enrollment period now, a bunch of people will blow off this weekend's deadline, increasing the stress later this spring. They may announce something like this next week (but probably not until early March, I would think). The fact that Lee brought it up is indeed surprising.

One other interesting sidenote from the article:

Anthony Wright, executive director of Health Access, an advocacy group, seemed intrigued by the idea. “We were never big fans of the open enrollment period to begin with,” he said.

...Wright said there was no federally mandated open enrollment period.

Now this did surprise me. I've been operating on the assumption that, while the specific start/stop dates were at the discretion of the HHS Dept or the individual exchanges, there was some sort of built-in maximum number of days for open enrollment baked into the wording of the ACA. Something along the lines of "...not to exceed 200 days the first year, not to exceed 100 days each calendar year after that" or whatever.

I figured that some sort of official cut-off point was one of the concessions made to the insurance industry in return for them agreeing to guaranteed issue.

If this guy is correct, it sounds like the deadlines/cut-off points for open enrollment are completely at the discretion of those running the exchanges...and that they could, theoretically, even make open enrollment year-round if they chose to do so.