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Charles Gaba's blog

(note: too many updates in too short a period for me to even keep track of...)

At first, most healthcare reporters thought this was a fairly meaningless "mission statement" without much impact...

Trump also issued a memo to all agencies requesting that they begin to "ease the burden of Obamacare as we transition from repeal to replace," Spicer said. He declined to provide specifics on what various agencies might do in response to the president's directive.

HOWEVER, David Anderson (formerly Richard Mayhew) notes that Section 2, which instructs the HHS Secretary to "waive, defer, grant exemptions from or delay" any "fiscal burdens" o sounds an awful lot like telling them to be absurdly lenient regarding granting "hardship exemptions" from the individual mandate:

@annaedney @ZTracer yes individual mandate exemptions will be passed out like pacifiers at a rave

— David Anderson (@bjdickmayhew) January 21, 2017

01/12/17: PLEASE NOTE: I know there's a whole bunch of updates/revisions below; this is because I'm constantly updating both the Medicaid expansion and exchange policy numbers daily, in real time as I'm able to compile the most recent enrollment numbers. In most cases the numbers are quietly increasing, although in a few cases I've revised them downward.

I operate this site by myself and I do have a day job, family, etc, so if I haven't updated your state, be assured I'll get to it as soon as possible.

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've recently updated the enrollment numbers out of Idaho, Connecticut and New York. None of them have moved the needle much, but the latest New York number did finally goad me into making a decision: Going forward, I'm going to start including Basic Health Plan enrollments in my Open Enrollment Period totals.

I'll still be separating them out, since the "official" number which is generally counted by everyone (including myself) only includes exchange-based Qualified Health Plans (QHPs)...but unlike standalone dental plans, BHPs are full medical insurance policies, enrolled in via the ACA exchanges, and while they may resemble Medicaid in some aspects, they aren't in either category or funding source. Furthermore, BHPs are also "cannibalizing" quite a few enrollees who would otherwise be enrolling in QHPs anyway, so it's important to recognize their impact on the numbers.


I've been warning for over a month now that with the ACA poised to be gutted or completely repealed in the near future, the Republican Party's new healthcare buzzword, "universal access" (their attempt to put a spin on "universal coverage") is a huge red flag which should be setting off klaxon alarms for anyone paying attention.

In my latest exclusive for, I focus on just one example of this: The GOP-controlled Minnesota state legislature, which just passed a rather nasty bill with profound implications for the type of healthcare policies which people on the individual market could be facing in the near future.

Check it out here.

In their first enrollment update report two weeks ago, the NY State of Health exchange reported these numbers as of Christmas Eve:

The breakdown of enrollment as of December 24, 2016, is as follows:

  • Total cumulative enrollment: 3,472,214
  • Total Medicaid enrollment: 2,332,683
  • Total Non-Medicaid enrollment: 1,139,531
  • Essential Plan: 635,909
  • Qualified Health Plan: 217,995
  • Child Health Plus: 285,627

On Saturday they updated their numbers through January 19th:

Another 1,578 people have selected exchange QHPs via Access Health CT since the last update on January 12th:

1,192 enrolled in dental care, 1,519 enrolled through the Small Business Program

HARTFORD, Conn. (January 20, 2017) – Today, Access Health CT (AHCT) CEO Jim Wadleigh announced that 106,891 individuals have enrolled in health insurance in 2017. In addition, 1,192 individuals enrolled in dental coverage and 1,519 enrolled via the Small Business Program.

“As we head towards the final days of Open Enrollment, which ends on January 31st, we want to remind Connecticut residents that Access Health CT offers many ways to get free help choosing a plan,” said AHCT CEO Jim Wadleigh. “We are also very happy to see people taking advantage of the dental coverage we offer.”

"The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. The Republicans are the party that says government doesn't work and then they get elected and prove it." --P.J. O'Rourke, Parliment of Whores

As I noted on Friday, Donald Trump's executive order essentially orders the incoming HHS Secretary (presumably Tom Price), along with other relevant agency heads, to do everything in their power to sabotage the ACA regardless of any repeal legislation (whether partial or total) on the part of Congress. Since the ACA grants the HHS Secretary pretty wide authority about how (and whether) to enforce various components of the law, this gives ample room for the Trump administration to make the individual mandate (among other ACA provisions) effectively meaningless.

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

Earlier today I noted that a bunch of Republican--yes, Republican--governors have chimed in in defense of the Affordable Care Act (or, at least the Medicaid expansion provision). They had a big powwow with GOP Congressional big shots to air their case.

Well, Republican U.S. Senator John Cornyn, the Majority Senate Whip (and therefore one of the biggest shots in the Senate) shot off quite a promise about the concerns regarding up to 32 million people potentially losing their healthcare coverage in the event the ACA is repealed:

One of the top concerns is what will happen to individuals who became eligible for Medicaid with its expansion under Obamacare. The Senate's No. 2 Republican, however, promised that no one who got coverage under Medicaid expansion will lose it.

When Conrnyn was asked if he was concerned about people who've benefited from Medicaid expansion losing coverage, he said it was a shared concern.

I've decided that for all future ACA enrollment data reports, I'm going to tack on "...on brink of possible ACA repeal" to the headline. Seems appropriate.

It's been quite awhile since I've written much of anything about the ACA's SHOP programs, which are the small business counterpart to the individual/family exchanges. The reason is pretty simple: SHOP enrollment is mostly a rounding error compared to either the ACA's Individual exchange enrollments or Medicaid expansion numbers.

SHOP enrollment (a mere 120K - 170K nationally, as far as I can tell) is even dwarfed by BHP program enrollment (around 700,000)...and that's only available in 2 states (Minnesota and New York). Heck, I don't even bother tracking them on my spreadsheets or graphs (I tried in 2014 but gave up on it the following year).

Still, once in awhile there's a bit of SHOP news to report, and this press release out of Minnesota is such an occasion:


Record Number of Idahoans Select Insurance through Your Health Idaho
Lawmakers Get Update on State’s Health Insurance Exchange

BOISE, Idaho – Your Health Idaho (YHI) executive director Pat Kelly went before lawmakers on Wednesday to give them an update on the third year of operations for Idaho’s state-based health insurance exchange. YHI set new records for enrollment during 2016 and led state-based exchanges across the country in per capita enrollment.

“Lawmakers’ choice to keep the federal government out of Idaho’s health insurance decisions and to do things our way has benefited Idaho immensely,” said Kelly. “Your Health Idaho gives consumers options when it comes to selecting a health insurance plan and we keep more money in Idahoans’ pockets by having lower assessment fees than the federal government.”

In federally managed states, consumer fees are set at 3.5percent. In 2016, YHI’s board of directors set the state’s assessment fee at 1.99 percent. To date, lower health insurance assessment fees have saved Idahoans more than $15 million.

I, and many others, have suggested (sometimes jokingly, sometimes not) that Donald Trump and the GOP's "terrific!" replacement for the Affordable Care Act could very well be to simply rebrand it as "TrumpCare", declare victory and call it a day.

I'm realize that Paul Ryan and Tom Price have other (terrible) ideas, but reading the latest goat entrails which make up Donald Trump's blathering suggest that he's now decided to do pretty much that (granted, that could have easily changed while I was typing that last sentence). Via Maggie Fox of NBC:

President-elect Trump just promised that private insurance companies can help lower costs and get health insurance to more Americans.


I embedded this song into a blog post back on April 30, 2014, after the dust had settled from the first Open Enrollment Period.

I posted it again on May 4, 2015, after the second enrollment period...and then a third time on June 29, 2015, right after the King v. Burwell Supreme Court decision was announced.

I was debating whether to hold off on doing so yet again until after January 31st, since that's the last day of the 2017 Open Enrollment Period...but upon further reflection, today is really more appropriate.

I've committed to keeping the site operating through at least April 30, 2017...which is also around the point that pretty much all of the final reports from HHS, CMS, ASPE and so forth documenting the OE4 numbers should have been released. I'm also assuming that we'll have some idea about just where the hell the ACA repeal/replacement direction is at that point...although who the hell knows?

Anyway, the answer to the question "Where do we go from here?" is, quite the fuck out of me.

To everyone who has donated in the past...or submitted data, or offered suggestions, or reposted/retweeted links to the site over the past 3 1/2 years...thank you.

I'm not closing up shop or anything (yet)...but if anyone's in a position to pony up a few bucks to help keep the site going for as long as possible, this is as good a time as any to do so.

Not sure if the sender wants public credit or not, but a few Republican Goverors have some things to say about repealing the Affordable Care Act...especially Medicaid expansion:

Today, Republican Governors will meet with GOP Congressional leaders in DC to discuss – you guessed it –the Affordable Care Act. Medicaid expansion is a key factor in this discussion because, as Governors will tell you, Medicaid expansion is leading to lower uninsured rates, higher rates of care, and critical treatment for people fighting opioid use disorders. And if Republicans repeal the ACA without a replacement plan in the same bill, CBO would score a subsequent bill restoring Medicaid expansion funding as an almost $1 trillion spending increase over 10 years. Interestingly, a number of GOP Senators broke with their party on expansion related vote-a-rama measures last week, and Governors from both parties have spoken out about this issue, as well as about the dangers of repeal and delay.