An analysis of potential premium changes in states across the nation shows increases of 16 to 30 percent likely in 2019 if federal steps are not taken.
While the Patient Protection and Affordable Care Act’s subsidies would largely insulate subsidized consumers from these costs, millions of unsubsidized consumers would pay the full price of these increases. Many would likely be priced out of coverage.
Continued policy and premium uncertainty risks further carrier withdrawals, leaving more consumers with only one health plan and even the prospect of “bare counties.”
The analysis reviews three federal policy options that could stabilize markets and mitigate the impact of premium increases in many states.
Covered California’s open-enrollment period is still underway and consumers have through Jan. 31 to sign up for coverage.
The United States federal government shut down for the first 17 days of October 2013 because Ted Cruz and other Congressional Republicans, furious about the Affordable Care Act surviving everything they had thrown at it over the preceeding 3-4 years, thought that pulling the plug would torpedo the launch of the ACA's first Open Enrollment Period.
Rather, any defunding would be temporary, because of a government shutdown. On the day the exchanges were due to open, much of the federal government would go offline, including a big portion of the Health and Human Services Department that is running the coverage expansion. But legislative inaction cannot gut Obamacare in the way that legislative action could. During a shutdown, implementation would “substantially” continue.
That’s according to a Congressional Research Service report prepared for Senator Tom Coburn, an Oklahoma Republican. In no small part, the reason is that much of the Affordable Care Act’s financing comes from mandatory spending, rather than discretionary spending, and a continuing resolution concerns only the latter. Moreover, some of the law’s money comes from multiyear or “no-year” discretionary funds that do not get wrapped up in the continuing-resolution process either. The Health and Human Services Department says its reform implementation fund would not get touched by a lapse in appropriations.
A few days ago I reported that the Washington Health Benefit Exchange had enrolled 234,000 people in private policies for 2018 when they had just a couple of days left to go.
Today Hannah Recht provided a link to this WA state navigator meeting in which rough final numbers were included as part of the slideshow presentation, along with a bunch of other data points which should be of interest to other healthcare/navigator wonks. 242,800 is a rough number but assuming it doesn't get changed by much, it means the Apple State enrolled 7.6% more people in QHPs this year than last, with nearly 1/3 of them being new to the WA exchange.
Washington State was already beating their 2017 numbers anyway, so this update just pads their lead.
Last year, New York State of Health enrolled a total of 242,880 people in ACA exchange policies; this means they're slightly ahead of that number with two weeks left to go before the January 31st Open Enrollment deadline. This makes NY the fifteenth state to surpass last year's total...as well as the 7th State-based Marketplace (or the 10th if you include SBMs which are piggybacking on the federal exchange platform). I'll be writing something up about that later today.
LT. GOV. WYMAN: DEMAND FOR HEALTH INSURANCE ROSE, 2018 OPEN ENROLLMENT STRONGER THAN PREVIOUS YEARS
(HARTFORD, Conn.) – Lt. Governor Nancy Wyman and Access Health CT (AHCT) CEO Jim Wadleigh today provided the results of the Connecticut healthcare exchange’s fifth open enrollment period, which ran from November 1 to December 22, 2017. During this open enrollment cycle, 114,134 residents signed up for private health insurance coverage, reflecting a 2.3 percent increase compared to enrollment figures last year.
CMS Announces Additional Special Enrollment Periods to help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands
Agency provides extended special enrollment periods for 2018 Medicare and Exchange coverage
MNsure ends open enrollment with record number of signups
116,358 Minnesotans enrolled in private health plans through MNsure for 2018 health coverage
ST. PAUL, Minn.—Today MNsure announced that a record number of Minnesotans in the individual market signed up for health coverage through MNsure during open enrollment, breaking the previous year’s record of 114,810. Despite an open enrollment period three weeks shorter than 2017 and significant challenges stemming from the federal level, MNsure enrolled more Minnesotans than ever. Thirty percent of MNsure enrollees were new this year.
I've been operating ACASignups.net for over 4 years now. It started out as a nerdy hobby thing in my spare time, but quickly overtook my life. I always planned to shut it down after the first Open Enrollment Period ended back in April 2014...and then in March 2015...and again in 2016. Year after year, people clamored for me to keep it going one more year.
Connect for Health Colorado® Reports Plan Selection Totals for 2018 in Line with Target and Nearly Matching Longer 2017 Enrollment Period
DENVER — More than 165,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace by the close of Open Enrollment, according to new data released today by Connect for Health Colorado®.
“These are positive results that show us holding steady and in line with our targets for the year,” said Connect for Health Colorado CEO Kevin Patterson. “Despite the uncertainty that created some confusion in the market, we have seen volumes that nearly match last year’s longer Open Enrollment Period. I am happy to see so many families and individuals put this protection for their health and financial well-being in place for the year. We will be reporting our results in coming weeks in our annual End of Open Enrollment Report.”
Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.
No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.
But several advocacy groups have said some of the changes — such as requiring some "able-bodied" adults to work or volunteer at least 20 hours a week — likely will be challenged in court because they violate federal law that establishes Medicaid purely as a health program and does not authorize work requirements.
Every quarter, Gallup posts the results of an exhaustive healthcare coverage survey (with over 25,000 U.S. adults). They just posted the latest update, which covers the fourth quarter of 2017, and the results are...striking.
Gallup has a rather annoying habit of not including the full Y-axis in their charts, so I've reformatted their quarterly survey results into a fuller version, noting a couple of key dates. The most obvious takeaway:
The U.S. uninsured rate among adults, which had reached 18% just before the major Affordable Care Act provisions (individual market exchanges and Medicaid expansion) kicked into effect, reached an all-time low of 10.9% last winter...
...only to reverse the trend since then, climbing back up again over the first year of the Trump Administration to end 2017 at 12.2%.
One important thing to keep in mind is that Gallup's surveys only include adults over 18, which means they only include about 77% of the population. Since children tend to have a much lower uninsured rate than adults (thanks in large part to programs like Medicaid and CHIP), this skews the results for the total population by several percentage points.
Over 2,500 people have watched my 17-minute 3-Legged Stool explainer video to date, and many have given it high praise (especially considering the utter lack of production value). However, there've been a few complaints about a couple of patches which are a bit slow or where the slides accompanying the audio are a bit confusing, so I've added some additional slides and reworked a few others to make it more clear. I've also noted the most significant update: That in the end, yes, the GOP did indeed repeal the Individual Mandate.
Later this week I hope to whip up a follow-up video which explains other recent developments, including how Silver Loading and the Silver Switcharoo worked to help salvage the 5th Open Enrollment Period; why the Alexander-Murray bill is no longer neccesary; what the doomed Collins-Nelson reinsurance bill was all about, and so forth.
With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:
Today, with one day left for people to sign up before the January 15th deadline, the Seattle Times reports that WA's tally is up to 234,000:
Washington state is on pace to increase the number of people with health insurance despite efforts by the Republican Congress and the Trump administration to gut the laws known as Obamacare that expanded insurance coverage across the nation.
*UPDATE: Some have accused me of hyperbole in the headline because a) it's a "state-approved health or financial literacy" course, not a "can you read" test and b) because it would only be required if they're unable to meet the requirements in other ways. I guess I can see their point, but it strikes me as splitting hairs:
First, "literacy course" was their wording, not mine (I guess there's a distinction between "completeing a course" and "passing a test"?).
Second, there doesn't appear to be any real description of the "courses" in question--how long it is, what the criteria for measuring "completion" is, who would be conducting the course, whether you'd have to attend classes in person (vs doing so online?), how many sessions there'd be and so forth. Here's the description as laid out in the waiver request itself:
...After trying — and failing — to get a high-profile lawsuit dismissed, Dave & Buster’s agreed to pay $7.425 million to settle the suit, which accused the restaurant and entertainment chain of illegally cutting staffers’ hours to prevent them from receiving healthcare benefits.
...As HR Morning covered previously, the ERISA lawsuit was the first case in which an employer was accused of intentionally interfering with employees’ hours to avoid the ACA’s employer mandate.
The lawsuit hinged on a very specific section of ERISA — the employees sued under ERISA Section 510.
Granted, ERISA was written primarily to apply to retirement plans. But Section 510 can be applied to a number of benefit plans as well — including healthcare coverage.
Section 510 says (the critical parts are in bold):
Whenever I write or talk about the 3-Legged Stool of the ACA and the actual flaws in the law (as opposed to the ones deliberately created by the GOP), I usually focus on two "gaps" in the legs: The APTC subsidies getting cut off at 400% FPL and being too stingy below that level, and the individual mandate not being large enough (and not being properly enforced). As it happens, part of the first problem has already been unintentionally "solved" thanks to Trump's ham-handed CSR reimbursement cut-off (which ended up increasing APTC tax credits for those below the 400% cut-off), while the second problem has just been made a whole lot worse thanks ot the GOP repealing the mandate altogether.
As shown, the tally as of 1/8/18 is 21,352 QHP selections, slightly below last year's 21,437 as of the same date. Since DC (along with California and New York) are sticking with the full 3-month Open Enrollment Period, it should provide a good apples-to-apples comparison (and the fact that very few DC enrollees have CSR assistance also means there's a nominal CSR loading impact, either).
The final, official DC ACA exchange tally last year was 21,248, so technically speaking they've already surpassed that figure...but again, it was 21,437 as of 1/8/17, which means there were at least a few hundred people who were dropped off at the tail end due to cancelling or non-payment of their first premium.
Last week the Congressional Budget Office reported that funding the CHIP program for 5 years, which they had previously estimated would increase the federal deficit by about $8 billion over the next decade, would instead only increase it by about 1/10th as much: Roughly $800 million, a rounding error when it comes to the federal budget. The reason for this isn't that funding CHIP had suddenly become less expensive, it was instead, ironically, because due to the GOP repealing the ACA's individual mandate starting in 2019, NOT funding CHIP has suddenly become more expensive.
CMS announces new policy guidance for states to test community engagement for able-bodied adults
Will support states helping Medicaid beneficiaries improve well-being and achieve self-sufficiency
CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.
In other words, work requirements for Medicaid expansion enrollees are now officially on the table.
Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.
The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.
111,667 QHP selections bumps them up another 1,667, with 5 days left to go for Minnesota residents to #GetCovered for 2018. It's worth noting that enrollment in MinnesotaCare, MN's name for the ACA's Basic Health Program, has actually dropped slightly since the last hard number update I confirmed back in mid-November (93,049).
Michael Bertaut is a conservative healthcare economist in Louisiana. He and I disagree on most political issues, and he's obviously not a fan of the ACA, but he seems to be intellectually honest about his positions, and he and I have found some common ground over ACA-related stuff in the past.
Case in point: The individual mandate. Bertaut may not care for the ACA overall, but he does recognize, as I do, that if you're going to utilize the "3-legged stool" model for individual market enrollment, it has to include both a positive and negative inducement to encourage (or goad) people into enrolling...aka the Carrot and the Stick. More to the point, if you're going to have a Stick (i.e., the Individual Mandate), it has to be large enough and well-enforced enough to be effective.
Kreidler proposes bill to stabilize individual market, reduce premium costs
Contact Public Affairs: 360-725-7055
January 8, 2018
OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is proposing legislation to help provide stability and confidence that over 300,000 people are able to maintain coverage in Washington’s individual health insurance market.
Kreidler’s proposed reinsurance program would encourage more health plan options in the 2019 individual market and lower premium increases by up to 10 percent.
(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.
This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.
It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.
UPDATE 01/15/18: Since I originally posted this, the deadlines for 2 more states have passed (CO & MN), and I have minor, non-final enrollment updates for MA, MN, DC & WA. Everything in this post has been updated accordingly, including the table below.
UPDATE 01/16/18: Updated table and writeup to include final Colorado numbers, which just came out today.
UPDATE 01/17/18: Updated table & writeup to include final Maryland numbers, which just came out today.
As I keep stressing, the 2018 Open Enrollment Period is still going on across 6 states4 states 3 states (+DC). Colorado's deadline is Friday night. Minnesota's is Sunday, followed immediately by Washington State on Monday. Eight days later, Massachusetts closes the books on the 23rd. Finally, eight days after that, OE5 officially ends for the last three state-based exchanges in California, DC and New York State.
Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Deadline is Friday
Posted on Tuesday, January 9, 2018
DENVER — More than 158,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through January 8, 2018, a rate 2 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, days ahead of the enrollment deadline.
Yesterday morning I was using the snowblower when I hit a rolled-up newspaper buried under the snow (in a plastic sleeve) which promptly got jammed in the impeller and likely burned out the auger belt.
Then, I noticed my front driver's side tire was really low, but I had to pick up my kid from school so didn't have time to fill it with our air pump before doing so. I figured I could get there and back, but also turned out to be really low on gas, so on the way back, we stopped at a nearby gas station where I figured I'd use their air pump as well. Got gas but the air pump was broken.
Re: Updated Cost Estimate for S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017
Dear Mr. Chairman:
The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have updated their estimate of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017, to account for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and to account for administrative action. The agencies now estimate that enacting this legislation would increase the deficit by $0.8 billion over the 2018-2027 period.
This one is quite a head-scratcher, but let me see if I can peel the onion.
A week or so ago, there was some confusing news about how Donald Trump may or may not be planning on signing a new healthcare-related executive order. I didn't write about it earlier because at first it sounded like he was talking about a meaningless "sell across state lines" decree...meaningless because the ACA already allows carriers to sell ACA-compliant policies across state lines, as long as the states in question sign onto an interstate compact.
Health Action 2018 Kicks Off the Hottest Ticket for Assisters
by Heather Bates & Liz Hagan
If you work on enrollment or support enrollment-related work, we are excited to announce new opportunities available at Health Action this year! Thanks to our host, Families USA, the National Association of Health Access Assisters (NAHAA) will launch officially at #HA2018. With four in-depth workshops and several networking opportunities, trust us that this year is not to be missed.
The Washington HealthPlan Finder issued a press release today urging people to #GetCovered before their upcoming January 15th Open Enrollment deadline. At first glance it looks like a pretty disappointing update ("over 231,00 QHPs"), since their previous update as of 12/15 was already 230,591, suggesting only a few hundred more people enrolled between December 16th - January 2nd...
Washington Healthplanfinder Reminds Residents It’s Not Too Late to Get Covered
Customers have until 11:59 p.m. on Jan. 15 to sign up for 2018 health and dental plans
The Washington Health Benefit Exchange is reminding residents there is still time to sign up for 2018 health and dental coverage through Washington Healthplanfinder. Customers have 12 more days to make their plan selections before the open enrollment period closes at 11:59 p.m. on Jan. 15.
With less than two weeks remaining until the deadline, more than 231,000 Washingtonians have already used Washington Healthplanfinder to secure their coverage for 2018.
BALTIMORE (JAN. 4, 2018) – A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, the state-based health insurance marketplace.
In an open enrollment period that was about half as long as a year ago, average daily enrollment in qualified health plans was up 69 percent compared to the prior open enrollment. There were an average of 2,953 enrollments each day during the recent 52-day period, compared to 1,752 average daily enrollments during a 90-day enrollment period a year ago.
“We are thrilled by the robust turnout for 2018 coverage,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which administers Maryland Health Connection. “Our hats are off to our call center, consumer assisters and brokers who helped process roughly as many enrollments as last year during a much shorter open enrollment period. We believe the result will be better access and better health outcomes for Maryland families.”
Health spending growth has slowed, and is now more on pace with economic growth
From 1970 – 1980, the average annual growth in the U.S. economy was 9.2% per year, compared to health spending growth of 12.2%. Although health spending growth has since moderated, it generally continued to outpace growth of the economy, though by a somewhat smaller margin. The 2010 – 2013 period, however, saw an average annual growth rate in health expenditures that was similar to growth in GDP. Health spending did pick back up in 2014 and 2015 with the coverage expansions of the Affordable Care Act.
The Affordable Care Act (ACA) includes several provisions that change the way private health insurance is regulated in an effort to provide better value to consumers and increase transparency. One such provision – the Medical Loss Ratio (or MLR) requirement – limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in 2012.
Between November 1 and December 31, 2017, 33,021 individuals selected a plan through HealthSource RI. Though Open Enrollment has ended, customers who began, but did not complete, the enrollment process by December 31 will be able to finalize their 2018 enrollment process between January 1 and January 23. HealthSource RI is communicating directly with customers who are eligible for this opportunity. For this reason, final 2018 Open Enrollment figures will not be available until later in the month.
At HealthCare.Gov, around 66,000 stragglers/special case enrollments were added to the total between 12/16 - 12/23, which would translate into around 250 more people in Rhode Island, give or take. Of course, HC.gov also lost 145,000 enrollees due to people dropping their renewals/etc, but RI's exchange is structured a bit differently, with auto-renewals being added on day one, so most of those folks likely already dropped out before the 12/31 tally anyway. My guess is the final total will end up around 33.2K.
Minnesotans benefiting from tax credits averaging over $7,000 per year
January 2, 2018
ST. PAUL, Minn.—With just under two weeks left in the 2018 open enrollment period, MNsure is reminding Minnesota residents of important money-saving tax credits. The statewide household average for tax credits is around $7,000 per year. Approximately 62 percent of enrolled households are receiving tax credits.
“Minnesotans are saving an average of over $7,000 per year from tax credits when purchasing coverage through MNsure,” said Allison O’Toole, MNsure CEO. “This is real money for Minnesota families, and can help make the unaffordable, affordable.”
UPDATE 1/13/18: Colorado's deadline passed last night, so we're now down to 5 states + DC: 79.9 million people, or roughly 24.5% of the population.
UPDATE 1/15/18: Minnesota's deadline passed last night, so we're now down to 4 states + DC: 74.3 million people, or roughly 23% of the population. (Note: I had a miscalculation in an earlier version of this post)
UPDATE 1/16/18: Washington State's deadline passed last night, so now we're down to 3 states + DC: 69 million people or roughly 20.6% of the population.