FINAL DEADLINE FOR MARCH 1 COVERAGE (11,649,631 Confirmed)

Time: D H M S

Charles Gaba's blog

 

(Update: Thanks to Griffin Cupstid, MD for the link to the CNN transcript, which allowed me to make some minor wording edits below).

I wrote up a long-ass Twitter thread last night. I've reformatted it for a blog entry this morning:

So, I watched the ACA-related segments of Republican House Speaker Paul Ryan's CNN Town Hall thing last night. He took several questions about the ACA (Obamacare, remember) and Medicare, but I'm just gonna focus on the first one here. The questioner was a self-described lifelong Republican who used to hate the idea of the ACA...right up until he was diagnosed with cancer and given just months weeks to live. Pre-ACA he would have been denied coverage for the pre-existing condition and would have died. He profusely praised the ACA and flat-out thanked President Obama for saving his life. The actual question was "why would Ryan repeal the ACA without a replacement in place."

QUESTION: I was a republican and I worked for the Reagan and Bush campaigns. Just like you, I was opposed to the Affordable Care Act. When it was passed, I told my wife we would close our business before I complied with this law. Then, at 49, I was given six weeks to live with a very curable type of cancer. We offered three times the cost of my treatments, which was rejected. They required an insurance card. Thanks to the Affordable Care Act, I'm standing here today alive.

Being both a small business person and someone with pre-existing conditions, I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?

RYAN: Oh, we -- we wouldn't do that. We want to replace with something better. First of all, I'm glad you're standing here. I mean, really -- seriously.

QUESTION: Can I say one thing? I hate to interrupt you...I want to thank President Obama from the bottom of my heart, because I would be dead if it weren't for him.

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.

For weeks now, I (and many others) have been crunching the numbers and making projections to see just what the fallout would be on the individual market (and the total uninsured rate) if the GOP were to follow through with their promise to repeal the Affordable Care Act.

There's a lot of variables at play, and there's also no way of knowing what (if any) replacement plan they'd come up with instead, but there are two main scenarios to consider: First, what would things look like if the ACA were to be fully repealed (without a half-decent replacement ready to swoop in); second, what would happen if the ACA were to be partially repealed via the reconciliation process (ie, killing off the subsidies, individual/employer mandates, Medicaid expansion and so forth, but keeping the guaranteed issue, community rating and other regulatory provisions in place, which is what would happen if the Republicans were to continue on their present course).

With the Republicans scrambling to come up with a plan, any plan to replace the Affordable Care Act at the same time that they repeal it (as opposed to, you know, simply not repealing it, at least until they actually have a reasonable plan, which they could certainly do if they wished to), there was a huge amount of buzz generated Sunday night over this story from Robert Costa and Amy Goldstein of the Washington Post:

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

Drug negotiations aside, the rest of the article is exactly what you'd expect:

 

No, I'm not accusing him of murdering anyone (well, unless his ACA replacement bill becomes law, that is), but it's starting to look like the Senate would have to be on drugs to confirm orthopedic-surgeon-turned-Congressman Tom Price as the new HHS Secretary:

Exhibit A, via Manu Raju of CNN:

Trump's Cabinet pick invested in company, then introduced a bill to help it

Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising new ethics concerns for President-elect Donald Trump's nominee for Health and Human Services secretary.

...Less than a week after the transaction, the Georgia Republican congressman introduced the HIP Act, legislation that would have delayed until 2018 a Center for Medicare and Medicaid Services regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.

OK. We're past the "mini-deadline" for February 1st coverage in 47 states (+DC). New York has extended their Feb. coverage deadline out until Wednesday (1/18), while Massachusetts, Rhode Island and Washington State are taking enrollments through next Monday (1/23).

The real "final" deadline to sign up for 2017 healthcare coverage is Tuesday, January 31st. Anyone who signs up between the dates above and the 31st will be enrolled in a policy starting coverage on March 1st.

After that, under the ACA, the only ones who are supposed to be able to sign up for 2017 coverage are people who qualify for:

A few days after the election, I posted:

Last spring, during the primaries, there was a month or so where there was still a small but not unreasonable possibility that Ted Cruz could have ended up pullling the nomination out of the grasp of Trump's hands. During that time, there was a lot of discussion among progressives (and some intellectually honest #NeverTrump conservatives) as to which one would be worse from a progressive/Democratic/liberal point of view.

After all, the reasoning went, Trump supposedly held strongly liberal positions on many key issues up until like 5 minutes ago (he was pro-choice, etc). He's promised a gargantuan infrastructure spending program (roads, bridges, etc)! Hell, during the very first GOP primary, he came right out and said that he thinks Single Payer healthcare is awesome in other countries! He later stated that whatever he came up with would "cover everyone" with "the government paying for it all". How awesome is that for a progressive!!

However, there are some major problems with this...

In Kentucky, assuming 80,000 people enroll in private exchange policies by the end of January, I estimate around 43,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 443,000 enrolled in the ACA Medicaid expansion program, for a total of 487,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

Back in mid-December, just about all of the ACA exchanges bumped out their enrollment deadlines for January 1st coverage by a few days. I was mildly surprised because improvements in the bandwidth, coding, layout and support staffing have meant a smoother process towards the big last-minute surge. Still, I wasn't blown away by the development or anything, as mid-December has always seen a massive spike in enrollment.

On the other hand, this announcement by the New York State of Health exchange is very surprising:

New Yorkers Now Have Until January 18 to Enroll in or Renew Health Insurance Coverage Beginning February 1

Consumer Demand Remains High Prompting Deadline Extension

ALBANY, N.Y. (January 12, 2017) – NY State of Health, the state's official health plan Marketplace today announced that consumers now have three additional days to enroll in a health plan with coverage starting February 1. The deadline has been extended through 11:59 p.m., January 18. The previous deadline was January 15.

Last week I noted that I overestimated the number of QHP selections in Connecticut by 9,900 (oops). Today they've reported that 818 of that gap has since been made up:

AHCT ANNOUNCES 105,313 CUSTOMERS ENROLLED IN 2017 HEALTH INSURANCE -  

CALL CENTER HOURS FOR MARTIN LUTHER KING JR. HOLIDAY

Call Center will be open Sunday, January 15 instead of Monday, January 16 in honor of Martin Luther King Holiday

HARTFORD, Conn. (January 13, 2017) - Today, Access Health CT (AHCT) CEO Jim Wadleigh announced that 105,313 people are enrolled for 2017 coverage as of January 12th.  In addition, Wadleigh announced that the AHCT Call Center will be open on Sunday, January 15th from 10:00 AM to 5:00 PM and closed on Monday, January 16th for the Martin Luther King Jr. holiday.

In Delaware, assuming 30,000 people enroll in private exchange policies by the end of January, I estimate around 20,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 10,000 enrolled in the ACA Medicaid expansion program (PPT), for a total of 30,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

In New Mexico, assuming 57,000 people enroll in private exchange policies by the end of January, I estimate around 25,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 260,000 enrolled in the ACA Medicaid expansion program, for a total of 285,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

In New Hampshire, assuming 58,000 people enroll in private exchange policies by the end of January, I estimate around 31,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 50,000 enrolled in the ACA Medicaid expansion program, for a total of 81,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

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:

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:

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