Charles Gaba's blog

Me on Monday:

Last year, during the third week of Open Enrollment, 618,548 people selected QHPs via the federal exchange (HealthCare.Gov). This year, I'm pretty sure that right around 500,000 people selected QHPs during the third week.

CMS, just moments ago:

Health Insurance Marketplace Open Enrollment Snapshot Week 3: November 15 – November 21, 2015

During the third week of Open Enrollment, consumers continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or or There are about three weeks remaining ahead of the December 15 deadline.

The ACA has had a string of bad headlines of late; between the dozen Co-Ops which are closing due to a variety of factors including the Risk Corridor Massacre, the High Deductible brouhaha and the peculiarly-timed announcement by UnitedHealthcare that they may decide to drop off the exchanges in 2017, there's been a lot of premature claims that the law is in trouble.

However, there's also some very positive news to report. 5 other major insurers have told UnitedHealthcare to chill out. Enrollments are chugging along nicely ( should have broken the 2 million mark on Saturday, and nationally we should be up to around 2.6 million). The exchange websites seem to be working smoothly across the board (or at least, if there've been any significant technical problems, I've yet to hear about them).

I've watched the original Star Wars trilogy countless times, but ever since my kid was born, every time I watch something catches my eye which I never noticed (or noticed but didn't think about) before.

So, my 9-year old and I are watching "Return of the Jedi" again today (in anticipation of The Force Awakens, of course). In an early scene in Jabba's palace, Princess Leia is sneaking around at night, in the dark, trying to remain undetected so she can free Han Solo from the Carbonite, right? So what does she immediately do?

She bumps head first into a large wind chime which is inexplicably hanging in the stairwell.

There's a lot of news stories of late about Colorado activists managing to successfully place a statewide initiative on the 2016 ballot which, if successful, would make Colorado the first state to move to a new Single Payer healthcare model.

I haven't written a whole lot about this so far, partly because we're still a year out, partly because I'm swamped with current Open Enrollment Period developments (believe me, I'll have more to say about it after the end of #OE3).

However, there's one meme which keeps coming up in the news which drives me a bit insane:

Hmmmm...over at Investor's Business Daily, Jed Graham looks at HealthCare.Gov's 3rd Weekly Snapshot report from a different angle: If you set aside renewals of current enrollees, how are things looking in terms of new additions?

As I noted in my detailed 2016 OE3 projection breakdown, nationally the HHS Dept. is projecting around 8.1 million renewals, plus around 4.5 million new additions, for a total of roughly 12.6 million QHP selections (expected to then dwindle down to roughly 10.0 million still enrolled/paying by the end of next year. In contrast, I'm more optimistic: I projected around 9.0 million renewals, plus 5.7 million new additions.

Ever since I posted my latest article on the growing Individual Mandate Penalty (again, it's up to $695 per person or 2.5% of household income this year), I've heard the same response from many ACA detractors (and even some supporters): Even with the increase in the mandate penalty (technically, it's called the "Individual Shared Responsibility Payment"), it's still too small for it to make sense economically for most people when compared to the cost of enrolling in a compliant policy.

Even with tax credits, the reasoning goes, even the least-expensive Bronze plan (or Catastrophic for those who qualify) is still more expensive than the mandate tax. Of course, if you pay the penalty, then you're still stuck with absolutely no insurance whatsoever, whereas if you enroll in even a basic Bronze plan, you're at least covered for major medical expenses (ie, the type which can wipe out even a $10K deductible*), while also receiving many basic medical treatments like checkups, immunizations and cancer screenings at no charge or for a nominal co-pay. However, it's true that in some cases, the up front dollars paid are indeed higher for the policy than the fee.

*UPDATE: D'oh! Thanks to Esther Ferrington for reminding me that the actual worst-case scenario might not be nearly as bad as this, due to the ACA's limit on total out of pocket maximums. For instance, a single, non-smoking 26-year old in Detroit making $20K/year would have an out-of-pocket maximum of $6,450 no matter how much they rack up in medical expenses. On the one hand, that'd still be a disaster on $20K/year. On the other hand, it's also still a lot better than $10K...not to mention the $100K+ which the expenses might rack up without any insurance at all).

Of course, much of this is subjective and, due to the very nature of insurance itself, inherently relies on unknowns. After all, if you knew for certain that you'll never need any medical treatment whatsoever over the next 12 months, paying anything for health insurance would technically be a waste of money. On the other hand, if you know for certain that you're going to rack up a million dollars in medical expenses next year, pretty much any ACA-compliant policy would still be money well spent. Unfortunately, no one knows one or the other for certain, which is kind of the point of insurance in the first place.

I cannot stress this point enough: I am in no way advocating that anyone NOT enroll. I'm basically just playing Devil's Advocate here as a thinking exercise.

The Maryland Health Benefit Exchange has released a new updated tally:

Nearly 25,000 people have enrolled in private qualified health plans (QHP) through Maryland Health Connection for 2016.

As of Nov. 23, 19,675 Marylanders had enrolled in private coverage with some or most of their premium costs next year to be offset by advance tax credits. Another 5,310 enrolled in qualified health plans without tax credits. Nearly 72 percent, or 17,960, were enrolled in SIlver plans.

That's 24,985 QHPs total in 23 days, or 1,086 per day.

In addition, 1,708 people have enrolled in stand-alone dental plans and 5,235 more have enrolled in dental along with health coverage for a total of 6,943 with dental coverage next year.

Also, 87,941 were enrolled in Medicaid since Nov. 1 through Maryland Health Connection.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Three is no diffferent:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, November 21, 2015, for Open Enrollment.


31,012 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.

Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan. 920 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

My latest exclusive piece for is mainly a quick reminder that the tax penalty for not having ACA-compliant heatlhcare coverage in 2016 is up to 7x as high as it was for 2014, depending on your income and situation.

The Carrot refers to the federal tax credits available to more than 8 out of 10 of those who enroll; the Stick is the increasing Shared Responsibility Tax Penalty, aka the Individual Mandate tax.

I've been quick to crow about improving national support for the ACA in the past, so it would be disingenous of me to ignore it when there's a negative development:

Views on Obamacare have taken a negative shift, according to a November Kaiser Family Foundation poll released Tuesday.

Forty-five percent of Americans now say they have a negative view of the Affordable Care Act, while 38 percent have a positive view. This represents a reversal from earlier this year when, for the first time in three years, a greater number of Americans were in favor of the law than against it.

In October, a KFF poll found opinion evenly split on the law at 42 percent. The foundation's September poll showed a more narrow divide, with a 41 percent favorable to 45 percent unfavorable rating. A KFF survey conducted in August showed opinion skewed more favorably, with 44 percent of Americans stating they had a positive view and 41 percent stating they had a negative one.

From an email I received today:

FROM: (name)
Organization: Sinclair Broadcast Group

Mr. Gaba,

I am working on an article about UnitedHealth Group saying it may drop out of Affordable Care Act exchanges in 2017. I am trying to get a sense of how significant this and other recent news surrounding the law really are. I see you have written several posts about these developments. If you are interested and available to talk about that on the phone for a few minutes today, please let me know. Thank you.


My response:

Dear (name)--

I appreciate your interest.

Unfortunately, I couldn’t help but notice that your organization is the same one which produced and broadcast the anti-John Kerry propaganda film “Stolen Honor: Wounds That Never Heal” [ie, part of the infamous "Swift Boating" smear] in 2004.

...and various reporters will breathlessly report about how this is 20% lower than the same third week during last year's Open Enrollment Period, and OMG THIS MEANS OBAMACARE IS FAILING!!!

Yep, it's true: Last year, during the third week of Open Enrollment, 618,548 people selected QHPs via the federal exchange (HealthCare.Gov). This year, I'm pretty sure that right around 500,000 people selected QHPs during the third week.

However, here's what you have to keep in mind: The first week was 17% higher this year than last (543K vs. 462K). The second week was a whopping 77% higher than last year! (535K vs. 303K).

Why the massive discrepancies? Simple: The calendar. Last year, Open Enrollment started on November 15th. The second week was also Thanksgiving week, which meant that enrollments dropped off to practically zilch for that Thursday and Friday.

This year, Open Enrollment started 2 weeks earlier, on November 1st. That means two important differences:

Presented Without Comment:

U.S. adults are slightly more likely to say it is the responsibility of the federal government to ensure all Americans have health insurance coverage (51%) than to say it is not the government's responsibility (47%). The percentage who believe the government has that obligation is up six percentage points from 2014. This year marks the first time since 2008 that a majority of Americans say the government is responsible for making sure all citizens have health insurance.

Hat tip to someone named "Chuck" (no last name or organization given) for the tip.

Yet Another Post® about UnitedHealthcare, I'm afraid. Healthcare pundits/reporters have found last week's United announcement extremely oddly-timed, especially given that they were giving a very positive outlook for the ACA exchanges just a month earlier.

In short: UHC sat out the ACA exchanges in 2014, dove into half the states head first for 2015, expanded into another 11 states for 2016...but then suddenly announced that they "may" drop out of the exchanges completely in 2017? Furthermore, they made this announcement a month after painting a glowing outlook in their official quarterly report and did so in the middle of the 2016 open enrollment period? Something doesn't sound right here.

Well, today I've learned another tidbit which seems odd to me, although it's possible that there's nothing amiss here:

Over at Inside Health Policy, Amy Lotven takes a deeper look at one part of last week's UnitedHealthcare announcement which slipped by a lot of people:

United Notes Customer Churn As It Mulls Exiting Exchanges

...United in a Thursday morning call said it is seeing a high number of people who are purchasing exchange plans, receiving services, and then dropping their policies. Aetna, which last month announced it would scale back its offerings in 2016, also recently said is has seen an increased number of enrollees coming in and out of the exchange, especially through the special enrollment periods.

...Aetna Chief Financial Officer Shawn Guertin made similar comments in a Nov. 10 investors meeting at Credit Suisse. The phenomena that really we're seeing now is a lot more people coming in and out of the system, and in particular people coming in during a Special Enrollment Period and then staying for only a few months and dropping, is really part of what's draining the system, Guertin said.