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:
Minnesota's "first-come-first-serve" enrollment cap system caused a massive surge in early QHP selections...so much so that they kicked things off by signing people up at a pace twelve times faster than last year in the first few days.
With more than four weeks of open enrollment in the books, more than 57 percent of Minnesotans enrolling in a private health insurance plan through MNsure are qualifying for financial help available only through the state-based health insurance marketplace. The average tax credit amount going to MNsure customers will be more than three times higher in 2017 than it was in 2016.
As I understand it, the trend in the individual market has been moving away from wide-network PPOs and towards narrower-network HMOs for some time now...and while the ACA has certainly accelerated this trend, it had already started before the ACA came around.
Anyway, as I've noted before, my own family was among those who received the Scary Cancellation Notices® back in October 2013 letting us know that our pre-ACA Blue Cross Blue Shield of Michigan policy was being terminated for not complying with full ACA requirements (I think it was mostly the lack of mental health coverage, but there might've been other stuff as well).
We managed to work our way through HealthCare.Gov (this was after the worst HC.gov technical problems had been resolved, but while the system was still pretty buggy) and ended up enrolling in the closest equivalent ACA-compliant policy: A BCBSMI Gold PPO plan.
However, there's also another important tidbit here (last slide below): While the average unsubsidized premium rates for Colorado exchange enrollees officially went up 16.9%, the final premium cost to the enrollees is actually dropping by 1.9%(from $214/month to $210/month):
In Colorado, the typical consumer who has already used Affordable Care Act subsidies to buy exchange plan coverage for 2017 is on track to spend less on premiums next year.
If President-elect Donald J. Trump wanted a cabinet secretary who could help him dismantle and replace President Obama’s health care law, he could not have found anyone more prepared than Representative Tom Price, who has been studying how to accomplish that goal for more than six years.
Mr. Price, an orthopedic surgeon who represents many of the northern suburbs of Atlanta, speaks with the self-assurance of a doctor about to perform another joint-replacement procedure. He knows the task and will proceed with brisk efficiency.
Mr. Trump has selected Mr. Price, a six-term Republican congressman, to be secretary of health and human services, according to a transition team official.
As I've noted before, Connecticut has an unusual policy for reporting 2017 QHP selections. Instead of reporting the number of renewing enrollees + new additions, they start out by assuming every current enrollee will be renewed for the upcoming year, add the new additions and the subtract those who actively choose not to renew their policy. Technically, this makes it look like Connecticut has already broken 100,000 enrollees for 2017--over 80% of their enrollment target number--even though we're only 4 weeks into the enrollment period. As a result, I can't really give an accurate "enrolled for 2017" number until the third week of December, when every state has officially entered their autorenewed enrollees into the system.
Last year I took a shot at predicting not only total Open Enrollment QHP selections nationally, but also on a state-by-state basis. Seeing how I ended up overestimating by a whopping 2 million people nationally (projection: 14.7 million; actual: 12.7 million...about a 16% difference), it shouldn't be surprising that I was also way off on most of the individual states.
Of the 50 states +DC, I was within +/- 5% in only 13 states. 6 states overperformed my projections by more than 5 points (MA, UT, MD, SD, MN and TN)...but 32 states underperformed by more than 5 points, and 17 states came in more than 15% lower than I was expecting. Ouch.
I was therefore understandably hesitant to put my neck out there again this year...and after the unexpected results of the Presidential election, all bets seemed to be off. However, seeing how the first couple of weeks of OE4 seem to be holding pretty closely to my national projections so far, I've decided to go ahead and post my state-level calls after all.
MIAMI — Dalia Carmeli, who drives a trolley in downtown Miami, voted for Donald J. Trump on Election Day. A week later, she stopped in to see the enrollment counselor who will help her sign up for another year of health insurance under the Affordable Care Act.
“I hope it still stays the same,” said Ms. Carmeli, 64, who has Crohn’s disease and relies on her insurance to cover frequent doctor’s appointments and an array of medications.
Mr. Trump and Republicans in Congress are vowing to repeal much or all of the health law, a target of their party’s contempt since the day it passed with only Democratic votes in 2010. If they succeed, they will set in motion an extraordinary dismantling of a major social program in the United States.
As of this writing, Hillary Clinton's national popular vote tally stands at exactly 64,478,925 to Donald Trump's 62,352,480, with an additional 7,169,272 people having voted for other candidates (Gary Johnson, Jill Stein, various other 3rd party candidates and a smattering of write-in votes). That means Clinton is ahead of Trump by over 2.1 million votes, and I understand there's still up to 1.5 million more left to count, mostly in California. By the time the dust settles, it's conceivable that she could lose the electoral college--and therefore the Presidency--while having beaten Trump by as many as 2.6 million votes.
UPDATE 12/16/16: OK, here's the latest numbers:
Hillary Clinton: 65,844,594 (48.2%)
Donald Trump: 62,979,616 (46.1%)
Others: 7,804,203 (5.7%)
Yes, Hillary Clinton now has a popular vote lead of 2,864,978 votes nationally.
And her final losing margin in the 3 closest states which caused her to lose anyway?
Total: 77,744 votes across 3 states
OK, that's reality. But what if you took this further?
Here's a list of states ranked by the number of Electoral Votes each has. As you can see, the first 11 states add up to exactly 270 electoral votes...enough to just barely win a majority of the Electoral College (538 total).
Remember, they would only have to win each of those states by as little as 1 vote...so, if we used 2016's turnout as an example (just over 135.2 million votes cast total), that would mean Candidate X could have received as few as 37 million votes across those 11 states (just over 50% in each of them) while their opponent received the other 49.9% in those 11, plus 100% of the vote in each of the other 39 states + DC (98.2 million total) and still have won the electoral college.
Yup, under our current system, Candidate Y could potentially receive as much as 73% of the vote and still lose the Presidency.
But wait, it gets even worse. Let's ramp up the theoretical even further.
IF the amount of excessive profit going into the kitty was greater than the amount of excessive losses, the federal government would have paid out what was owed and keep the difference, in which case it was conceivable that the feds would actually profit off of the program.
IF, instead, the profit was less than the loss, the government would have to pay out the difference.
Unfortunately, as it happens, the second scenario is how things played out in 2014...as well as in 2015, and, most likely, 2016 as well.
When I last checked in on Colorado, they were reporting 2017 enrollments at a rate 30% faster than last year (16,305 in 13 days vs. 12,496 in the first 13 days last year).
Today they didn't issue an official update, but did give enough to piece together an estimate via an email to their enrollees:
Dear Connect for Health Colorado Stakeholders,
As we approach the Thanksgiving holiday, we’re busy as ever enrolling customers. In fact, enrollments are outpacing our numbers by more than 25 percent over this time last year, with our biggest day falling the day after the election. And, this is a trend we’re seeing nationally.
While the recent election has raised a lot of questions about the future of healthcare, what remains constant and true is the importance of protecting the health and financial future of our customers. Broken bones, disease and other chronic conditions aren’t political, but can happen at any time and in some cases, are preventable with access to care and health insurance. Our dedication to helping customers remains as strong as ever.
Two months before President-elect Donald Trump begins his attempt to repeal the Affordable Care Act, the Obama administration and its allies are making an aggressive final push to sign-up some of the program’s most reluctant customers -- young people.
Healthy and new to the workforce, the “young invincibles” -- people aged 25 to 34 -- represent the highest uninsured rate of Americans, according to a survey released in November by the Centers for Disease Control and Prevention. While coverage of people in that range has grown under Obamacare, the group has for the last five years had the highest rates of uninsurance compared to other age bands.
It's a good story, but there's one section in particular with a line which will make anyone with the slightest idea about how insurance works wince:
On the one hand, starting in January, the Republican Party will have complete control over both the U.S. House and Senate, Donald Trump will be sworn in as President, and the entire lot have promised repeatedly to kill the Affordable Care Act, aka "Obamacare".
On the other hand, the GOP hasn't managed to figure out what the hell they plan on actually replacing the ACA with (if anything), even though they've had over 6 years to come up with something and have voted to repeal it dozens of times. They insist that the ACA is a complete disaster; for years they refused to admit that it helped anyone; more recently they've grudgingly admitted that it helps some people, although they still claim that it hurts more than it helps.
In light of this, the Center for American Progress Action Fund has whipped up a simple website, ACAWorks.org, in which they ask people who have been helped by the ACA to let them know what Obamacare has meant to them.
So, the day after the election, I noted that on top of the rest of the awful, there's another fun tidbit: Due to the nature and timing of the ongoing House vs. Burwell lawsuit, it's conceivable that President-elect Donald Trump (See? I'm starting to get used to typing that!) could effectively wipe out most of the ACA immediately upon taking office by simply giving up on fighting the lawsuit and stopping Cost Sharing Reduction subsidies as early as February 1st.
This, in turn, would not only cause havoc across the individual insurance industry, it would also trigger an "escape clause" among the carriers, potentially (subject to whatever the state laws allow) letting them immediately cancel their policies. As in, the currently-in-effect policies which people had just had go into effect a month earlier. And this would have nothing to do with any action taken on the part of the Republican-held Congress.
How many people could potentially see their policies yanked out from under them?
Just another update: I'm fairly certain that QHP selections via HealthCare.Gov (covering 39 states) has broken 1.7 million people, with an additional 500,000 having enrolled via the 12 state-based exchanges for a total of around 2.2 million as of tonight.
The confirmed tally stands at just over 1.4 million thanks to a small update out of Minnesota.
I expect things to slow down significantly over the holiday weekend (Thursday - Sunday) before ramping back up again next week.
UPDATE: As of Wednesday night (11/23/16), I estimate the grand total is now up to around 2.4 million nationally, 1.8 million via HC.gov.
Minnesota continues to enroll people at a breakneck pace (fortunately, broken necks are covered by Obamacare). Things have slowed down somewhat from the first few days, but they're still signing people up at a rate 3.5x faster than they did last year's 404/day due mainly to their unique "enrollment cap" situation:
28,000 Minnesotans Enrolled in Individual Plans Through MNsure Since the Start of Open Enrollment November 21, 2016
ST. PAUL, Minn.—Below is an update to MNsure's 2017 open enrollment period. Within the first three weeks of open enrollment, more than 28,000 Minnesotans have enrolled in health coverage.
Since the start of open enrollment, there have been:
A few days ago I noted that up to 50,000 South Dakota residents who previously held out at least had some hope that the state might expand Medicaid under the ACA next year have already had that hope yanked out from under them like a rug:
A proposal to expand a federal health insurance program for needy people could be off the table following the results of Tuesday's election.
The victory of Republican Donald Trump, who has called for a repeal of Obamacare, along with the increasingly conservative Republican make-up of the South Dakota state Legislature could thwart Gov. Dennis Daugaard's efforts to expand Medicaid in the state.
In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks
For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.
The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.
"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.
...But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.
With the repeal of the ACA supposedly looming next year, it's worth remembering that the ACA was based in large part on a state-level program in Massachusetts, implemented by, of course...Mitt Romney. Obviously there are a lot of differences beyond simply ramping "RomneyCare" up to the national level, but at least in terms of the "3-legged stool" of the ACA exchanges (guaranteed issue, individual mandate, subsidies to help lower income enrollees), it's essentially the same.
If the law really is repealed at the federal level, some blue states where it's working pretty well would likely switch back to their own state-level versions. In addition to Massachusetts presumably just reverting back to RomneyCare again, states like California, Washington State and Connecticut seem like likely contenders.
Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.
I'm taking a break from the national panic over Trump's election to announce two subtle but important modifications to The Graph:
First: In yesterday's release of CMS's Weekly Snapshot Report from HealthCare.Gov for the first "2 weeks" of open enrollment, they explained that instead of running the weeks from Tuesday - Monday, they're going to measure them by the traditional calendar week (Sunday - Saturday). This means that the first two "weeks" are being cut off by 2 days (Nov. 1st - 12th instead of the 14th).
Since all of the official reports going forward will be measured Sunday - Saturday, I've changed the graph to match. I've also modified my official Weekly Projections accordingly. It's important to clarify that the actual projections haven't changed at all, just the cut-off date (for instance, I originally projected 1.53 million people in the first 2 weeks (14 days); instead I now have it as 1.29 million in the first "2 weeks" (12 days). The actual projection itself hasn't changed at all.
Yesterday, the Access Health CT board meeting presentation gave the 2017 QHP selection tally as (I think) 9,455 renewals plus 6,630 new additions for a total of 16,085 people, though it's a little confusingly presented.
Total effectuated QHP enrollment as of September 2016: 166,098 people...or about 5% higher than they had in March, according to the official CMS report. This is unusual; almost every other state has seen a substantial drop-off in effectuated enrollment. The only other state which constantly increases effectuations during the off-season is Massachusetts, and that's mainly because they have special "ConnectorCare" policies which are available year-round to anyone. On the other hand, according to the WA exchange report, there has been a slight net drop since March...of around 4.5% (see 2nd slide below). Not sure what to make of that. Either way, however, the point is that attrition is unusually low compared to other states.
Individuals have selected health care plans as of November 15, 2016. This enrollment reflects a period in which Covered California did not conduct media or enrollment promotion until after November 12th .
Compares to approximately 50,700 for same period 2015 (when Covered California had conducted extensive media and “bus tour” efforts to promote enrollment).
OK, so new enrollments are down about 11% from last year, but as they note, they deliberately held off on actively promoting/advertising until after the election this year.
If I'm reading this correctly, it looks like they currently have 85,250 people enrolled in effectuated exchange policies. 9,455 have actively renewed/re-enrolled into either their existing policy or a different one, plus another 5,570 brand-new enrollees who have signed up, for a total of 15,025 QHP selections for 2017.
What's confusing me is that they also say that "100,275 are currently enrolled"...which you only get by adding all 3 of those numbers together, which makes little sense to me.
With 23,883 people signing up via MNsure for private coverage as of Nov. 13, the exchange is more than one-fourth of the way to its budget target of 83,000 enrollees at the beginning of next year.
That's 1,837 per day, vs. last year's 404 per day; while things are starting to slow down, they're still enrolling people at a rate 4.5x as fast for the moment. Again, this is mainly due to MNsure's unique first-come, first-serve enrollment cap on most of their carriers.
A proposal to expand a federal health insurance program for needy people could be off the table following the results of Tuesday's election.
The victory of Republican Donald Trump, who has called for a repeal of Obamacare, along with the increasingly conservative Republican make-up of the South Dakota state Legislature could thwart Gov. Dennis Daugaard's efforts to expand Medicaid in the state.
Daugaard for more than a year has worked with the Obama administration and the Indian Health Service to strike a deal, which stemmed the approval of a federal policy that allows the state to spend less on Medicaid-eligible Native Americans. And part of that bargain has been staked on South Dakota using the savings to cover an additional 50,000 South Dakotans under Medicaid.
Trump hasn't set a clear policy position on Medicaid expansion but has said he'd repeal the Affordable Care Act, though two of his closest allies, New Jersey Gov. Chris Christie and Indiana Gov. Mike Pence, have accepted Medicaid expansion.
Burwell's Tweet doesn't give the cumulative total to date, but her "best day yet" clarifier certainly helps. My pre-election model was projecting the following:
11/02: 92K (160K total)
11/03: 92K (252K total)
11/04: 92K (344K total)
11/05: 75K (419K total)
11/06: 51K (470K total)
11/07: 92K (562K total)
11/08: 92K (654K total)
11/09: 85K (739K total)
I then went on to note that the actual tally for 11/09 specifically (the day after the election) turned out to be "over 100,000"...later clarified as 105,000 people, which is 24% higher than my own one-day projection.
My projections for the next few days were around 85,000 per day, for a cumulative total of 993,300 QHP selections via HealthCare.Gov as of November 12th.
Today CMS issued their first bi-weekly "snapshot" report. Lo and behold:
Biweekly Enrollment Snapshot • WEEKS 1 AND 2, NOV 1 - 12, 2016
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.
I don't write a whole lot about Medicare, since just about all U.S. citizens over 65 are covered by it and therefore don't enroll via the ACA exchanges anyway. However, it does come up on this site from time to time, and a good 55 million or so are enrolled in the program, so this little story might be of some relevance:
"Possibly because of my love affair with ships and boats, the Titanic story has always fascinated and still grips me, but one scene in particular always gets to me: the sight of the ship's band, there on the decks as the ship was sinking, not panicking, not running for their life, but doing their duty by sitting there and playing and giving strength and comfort to those who were about to die with them and the lucky few in the boats."
As you may recall, there was a day or two last week where I was as despondent over the election results as anyone, and I was deeply concerned that Trump being elected—combined with his promise to join the GOP in wiping out the ACA—would cause people to abandon the currently ongoing 2017 Open Enrollment Period...thus making my pre-election projection utterly meaningless.
Instead, the exact opposite appears to be happening...or, at the very least, the election results don’t seem to be keeping anyone from signing up. Some people may be abandoning their plans to enroll via the exchange out of fear that it’s gonna get yanked away from them a few months into the new year, forcing them to scramble later...but many others seem to be realizing that the law, including the federal tax credits and CSR assistance, is still on the books and will continue to be through Jan. 20th at the very soonest...and, depending on how much squabbling and legal steps the GOP has to go through, could potentially stick around mostly as is for up to 2 more years. In any event, many have concluded that it’d be better to go ahead and sign up now so they’re covered for as long as possible.
I noted last week that contrary to my concern that OE4 might get off to a slow start due to people holding off until after the election, the early enrollment numbers appear to be right on pace with my official projections after all. In fact, the single day's worth of data provided for HealthCare.Gov ("over 100,000"* enrollments on 11/09 specifically) is 17% higher than what I was expecting it to be, although obviously that could vary widely day to day. The numbers from Minnesota are also extremely impressive, running over 6x higher than the same period last year, that's mostly due to their unique enrollment cap situation, so that's not much of an indicator of any other state.
Ever since Trump's stunning electoral college victory on Tuesday, there's been a lot of hand-wringing (including by myself) about the Republican Party finally getting to actually make good on their obsessive desire to kill off the Affordable Care Act.
At the same time, there's been a similar number of articles written about why doing so might be trickier than they think. Many of those articles focus on the actual legalities involved (which parts can be killed via reconciliation, which parts can't, what the timeline would be and so on), while others go into the political and economic impact of actually repealing the law and what their replacement might look like. This is what I'm writing about in this entry.
Just yesterday I noted that Minnesota's ACA exchange is full bore ahead, especially due to their unique first-come, first-serve enrollment cap cut-off for 4 of the 5 individual market carriers. They're still moving at a breakneck pace:
ST. PAUL, Minn.—More Minnesotans have shopped early and enrolled in comprehensive health care coverage though MNsure than ever before. In just the first nine days, more than 20,000 Minnesotans enrolled through the state's health care exchange. It took about six weeks to achieve this milestone last year.
The results of this week's elections do not change MNsure's focus on providing high quality customer service to Minnesotans shopping for health care coverage and encouraging Minnesotans to take advantage of the financial assistance available only through MNsure.
Unlike most states, the Massachusetts Health Connector has not only seen no net attrition since the end of Open Enrollment, but has actually seen a net increase in enrollment...mainly due to their unique "ConnectorCare" policies, which are fully Qualified Health Plans (QHPs) but have additional financial assistance for those who qualify and which are available year-round instead of being limited to the open enrollment period.
The amount of the increase depends on which "official" number you start with; the MA exchange claimed 196,554 people as of 1/31/16...while the ASPE report gives it as 213,883 as of the next day....yet their March report claims 208,000 effectuated enrollees as of February.
So, for about 24 hours or so I was feeling nearly suicidal, and this morning I expressed my own tiny bit of symbolic gloom by swapping out the normal header graphic for this one:
I was planning on leaving it like that for a day or so, then swapping it back again tomorrow...but since then I've received several emails/messages/comments from people along the lines of this one:
We are all devastated about the outcome of this election and that the ACA is on the line. Like so many others I wanted to crawl into a hole yesterday. I myself will lose my insurance as will so many of my family, friends and so many people that I assisted and encouraged in their own enrollment over the years.
More than 15,000 Minnesotans have Enrolled in Health Coverage in Six Days
November 7, 2016
ST. PAUL, Minn.— MNsure is providing an update on the 2017 open enrollment period. Within six days, more than 15,000 Minnesotans have enrolled in health coverage. This milestone took about six weeks to achieve during last year's open enrollment period.
The most recent hard current exchange QHP enrollment number I have for Massachusetts is 230,412 people as of September 1st. Due to MA's unique "ConnectorCare" program, they've actually seen a gradual increase in exchange enrollment during the off-season instead of net attrition like almost every other state.
Today I was informed that as of November 8th, they had a grand total of 2,942 new QHP selections via the state exchange...of which 510 are fully enrolled (i.e., they've paid their January premiums already). This does not, however, include any renewals / re-enrollments by current enrollees, which could be substantially higher.
UPDATE: OK, I have the total enrollment numbers now: 10,251 (7,309 renewals + 2,942 new additions). That's 1,281 per day, or about 4.8% of their total enrollment last season.
Minnesota and Massachusetts are the only state exchanges I have data for so far, and MN is a special case, so here's a simple extrapolation of MA's numbers:
Over the past day or so, in response to the shocking and horrifying news that a racist, misogynistic, xenophobic con-artist sexual predator moron has been elected our next President and who has also stated point-blank that he intends to help the now-100%-Republican-controlled Congress eliminate the Affordable Care Act, I noted that this would likely cause 2017 enrollments to plummet as a result.
I figured that a lot of people who were planning on enrolling for 2017 policies might decide not to bother anymore, reasoning that if the ACA is about to be repealed, why should they go through the hassle and bother of signing up for a policy which is likely to be scrapped within a couple of months of it taking effect anyway?
I even whipped up a crude modified version of The Enrollment Graph:
In fact, I was feeling so despondent that earlier today I even swapped out the header logo with this:
OK, so Mitch McConnell has now confirmed that yes, repealing the Affordable Care Act is indeed Priority 1 for the incoming 100% GOP-controlled Congress now that they know they'll have President Trump (good God, I'll never get used to writing that) ready to sign it with his big Sharpie.
Don't worry, I'm not gonna rehash the whole thing, but some of you may recall that way back in January (a lifetime ago, this morning), I caused a bit of a brouhaha (or a "bro-ha-ha") when I noted that Bernie Sanders' Single Payer Healthcare Plan (aka "Medicare for All"), while sounding awesome in theory, was not only absurdly lacking in detail even for a general campaign outline, but that there were simply too many logistical problems for it to go into effect within such a short timeframe (which I assumed would be perhaps the same 5-year timeline as the ACA, since Sen. Sanders didn't specify any sort of timeline himself).
The response from Bernie's supporters was, to put it mildly, negative.
While I knew that a national single payer system was a non-starter, I thought that perhaps it might be feasible to get one through at the state level (assuming the funding mechanism could be adequately resolved, which was the Achilles' heel of Vermont's failed attempt a few years earlier).
Margot Sanger-Katz of the New York Times and Sarah Kliff of Vox.com each take a crack at what the Republican Party and their leader and official face for the next generation, Donald Trump, repealing the Affordable Care Act would actually look like in practice.
The kind of partial repeal possible through the reconciliation process could lead to greater instability than total repeal. That means that it could lead to more people losing health insurance than the estimated 20 million who have gained it under the law. The health law was designed with a number of interdependent provisions devised to keep insurance affordable. By removing only some of them, a partial repeal could disrupt insurance arrangements not just for people newly insured under the law, but also for those who had purchased their own insurance before the law.
UPDATE: This comment (from a cross-post over at dKos) is exactly what I'm talking about:
Yeah, I don’t know what to do. I filled out the first part of the application last week. I guess I’ll finish the process. But what’s the point if it’s going to be repealed “Day One”?
I made a commitment to keep this site up and running through next spring, and I intend on keeping this commitment. Beyond that, I have no idea what my plans for the site are.
After yesterday's atrocity, however...I'm honestly dreading the thought of what most of my charts, graphs, spreadsheets and blog entries are going to look like.
You see those impressive-looking odometer-style numbers at the top of the home page? Yeah, forget about those. They're meaningless now.
A lot of people will still sign up, but I'm guessing many who were planning on doing so once they were certain the ACA would still be around next year are now going to take a pass. And that's simply the beginning.
Beyond that...it's 4:30am. I'm exhausted, my stomach hurts and my hands are shaking.
It's important to keep in mind that applications submitted are not the same as healthcare policies selected. A submitted application simply means you've created an account and filled out all of your personal data, household data, financial data and so forth; actually shopping around and selecting a plan is the next major step.
Having said that, how does this year compare with last? Well, as I noted the other day, the 150,000 applications submitted on Nov. 1st this year was higher than last year (HHS didn't provide a Day One total but did list it as 250K for the first two days).
I don't write about Idaho much, which is a bit surprising when you think about it because it's kind of a unique state when it comes to the ACA exchanges. Most states never set up their own exchange platform. A dozen or so set them up and are still using them. Two states (Massachusetts and Maryland) scrapped their original, failed platforms and completely overhauled them. Three states started out with their own platform but gave up when they failed, moving home to the mothership (HealthCare.Gov). One state, New Mexico, was supposed to move off of HC.gov after the first couple of years, but changed their mind and is still hosted by the federal platform. Oh, and there's also Kentucky, which is scheduled to scrap their perfectly-functioning tech platform for absolutely no good reason other than the petty whim of their new Governor, Matt Bevin.
Last year, MNsure, Minnesota's technically (and actuarially) troubled ACA exchange enrolled "several hundred" people in Qualified Health Plans (QHPs) in the first day, and exactly 6,864 people in the first 17 days...which breaks out to an average of 404 per day for the first couple of weeks.
With improvements at the call center and on the website, MNsure has enrolled a record number of Minnesotans in coverage, O’Toole said.
“We’ve helped more Minnesotans than we have in any two day period in our history,” she said. “We’ve now enrolled more than 10,000 Minnesotans. That’s a benchmark that we didn’t hit until after Thanksgiving last year.”
Last week, ahead of the launch of the 2017 Open Enrollment Period, I took a look at what's new over at HealthCare.Gov this year. For the most part I was pretty impressed; they've made it more mobile-friendly, added refinements and changed the plan filtering interface so that it's consistent across both desktop, laptop and mobile devices.
The actual enrollment process itself also appears to be running smooth as silk; here's a comment from just this morning:
However, there are still a few user interface glitches which need to be addressed, at least on the "Window Shopping" tool. Here's two of them (three, really, although two are the same problem for different functions):
Modern Healthcare has an OE4 Launch roundup of sorts; most of the data is stuff I've already written about, and there isn't much in the way of hard enrollment data, but in general it sounds like things are off to a pretty promising start. First they note the 150,000 submitted applications on Tuesday which I wrote about earlier today; after that:
Open enrollment so far “has been going really well,” said Ambar Calvillo, national director of field and partner engagement at Enroll America, a D.C.-based not-for-profit group that helps people sign up for coverage. Calvillo said the group, which works with enrollment assistors across the nation, hasn't seen any major obstacles. Before open enrollment, exchange shoppers scheduled more than 5,400 appointments for in-person enrollment assistance through Enroll America's Get Covered Connector tool, up 80% over last year.
...State-run exchanges in California, Colorado, Idaho and Massachusetts reported no problems on the first day of enrollment.
Every year I keep trying to stress the importance of EVERYONE who's considering enrolling in an individual/family healthcare policy making sure to shop around on either HealthCare.Gov or your local state exchange website to see what the situation is each and every year.
I'm not just talking about people who are currently uninsured; I'm also talking about those already enrolled. I'm talking about those who plan on keeping the same policy. I'm talking about those who enrolled in an off-exchange plan because they think they don't qualify for subsidies (or they assume the subsidy would be nominal at best).
As I noted this morning, I'm expecting roughly 87,000 people to either enroll or renew their healthcare policies nationally via the assorted ACA exchanges (either HealthCare.Gov or one of the state-based exchange sites like Covered California, New York State of Health and so on) in the first 24 hours of the 2017 Open Enrollment period...which is to say, by midnight tonight.
I mention this because just moments ago in my post about Minnesota's exchange website and phone lines being attacked, I closed by light-heartedly noting that a straight national extrapolation of MNsure's enrollment figures from their first 2 hours of operation would suggest over 180,000 people enrolling nationally in just a few hours. I then brushed off that possibility as being extremely unlikely; my official projection has total 2017 exchange enrollments hitting around 785,000 the first week.
Remember three years ago when HealthCare.Gov launched with all sorts of horrible technical problems, and many people were speculating that at least some of the tech issues may have been the result of deliberate, malicious attacks (hacking, DDoS attacks, etc) by those opposed to either President Obama, the ACA or both?
Well, that turned out to be mostly hooey; while I'm sure there were some attempts at messing with the system, the technical problems were for the most part good old fashioned unintentional screw-ups by either the vendors, the HHS management or a combination of both. The Obama administration quickly brought in the Code Red crash team to fix the problems, and for the most part the federal exchange started working pretty well. Further improvements the past few years have completely transformed it into a pretty quick, easy, seamless experience for most people, to the point that it's now literally operating 100,000 times better than when the website first launched.
There you have it: The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.
Those which implemented only one or two of the above provisions come in at around 26%. In a possibly coincidental quirk, all five fo the "halfway" state exchange states (Hawaii, Oregon, Nevada, Kentucky and New Mexico) just happen to also fall into this category as well, which is completely appropriate.
Finally, states which are fighting the ACA kicking and screaming (no Medicaid expansion, no state exchange and allowing transitional plan extensions as long as possible) are averaging around 30%.
The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding Medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.