Charles Gaba's blog

Back in early January I noted that the DC Health Link had reported having 18,611 people enrolled in ACA individual market policies as of January 5th. DC's official deadline wasn't until January 31st, however, and even then they bumped it out by an additional five days (thru January 5th).

Unfortunately, they haven't issued an official final enrollment report yet, but I've been able to get the top-line numbers from an audio recording of their monthly executive board meeting on February 12th:

If you read through the transcript carefully, it boils down to this:

“The economy, stupid” is a phrase coined by James Carville in 1992. It is usually mistakenly rendered as “It’s the economy, stupid.” Carville was a strategist in Bill Clinton’s successful 1992 presidential campaign against incumbent George H. W. Bush. His phrase was directed at the campaign’s workers and intended as one of three messages for them to focus on. -- Wikipedia

The latest Kaiser Family Foundation tracking poll (considered the gold standards when it comes to national polling on healthcare policy issues) is out, and it's findings aren't terribly surprising to anyone who's been paying attention:

This Just In from the NY State of Health ACA exchange:

Press Release: NY State of Health Announces Record High Enrollment More than 4.9 Million New Yorkers Enrolled

  • One in four New Yorkers enrolled through NY State of Health
  • Enrollment through the Marketplace increased by over 150,000 from last year

ALBANY, N.Y. (February 20, 2020) - NY State of Health, the state’s official health plan Marketplace, today announced that over 4.9 million people, more than one in four New Yorkers, signed up for health coverage through NY State of Health during this year’s Open Enrollment Period. With an increase of 150,000 people over 2019, enrollment is at a record level, including more than 1 million people enrolled in Qualified Health Plans and the Essential Plan. Marketplace enrollment growth is consistent with New York’s declining uninsured rate, which reached a historic low of 4.7 percent. Open Enrollment ran from November 1, 2019, through February 7, 2020.

UPDATE 2/24/20: California and New York have come out with their final, official enrollment numbers, as have Vermont,Rhode Island and the District of Columbia, although the latter three are estimates on my part due to the way they're reporting their enrollment data:

via HealthSource RI (email):

Press Release: HealthSource RI sees another successful Open Enrollment with lower plan rates for 2020

  • State’s critical market stability initiatives drive decrease in cost for those without financial help
  • Rhode Island is already seeing the effects of market stability initiatives proposed by Governor Raimondo and enacted by the General Assembly in 2019.
  • HealthSource RI’s competitive marketplace offered the 2nd lowest-cost benchmark plan nationwide for 2020.
  • The average monthly cost of a health insurance plan without financial help went down from $441.91 in 2019 to $435.60 in 2020.
  • HealthSource RI’s individual and family enrollments increased this Open Enrollment, with 32,704 customers enrolled and paid compared to 32,486 last year.
  • The marketplace saw over 7,000 new enrollees including strong enrollment from the key “young adult” demographic. Nearly 43% of new 2020 customers were “young invincibles” age 18-34, up from 29% percent in HealthSource RI’s renewing population.
  • HealthSource RI customers took advantage of new customer service tools, including a new webchat service and a search tool that lists which prescription medications are covered by each health insurance plan.

Yesterday I posted a long, wonky explainer about the fallout of the ACA's Health Insurer Tax (HIT) being repealed in December 2019.

As I explained, the HIT is one of a several taxes/fees which were originally included in the Affordable Care Act which have either never actaully been enforced or whcih have only been enforced sporadically, and which have now been completely eliminated going forward.

The impact of repealing these taxes on the federal deficit/federal debt is obviously not good...this will collectively increase the already-runaway national debt by several hundred billion dollars over the next decade. That's a whole separate discussion.

In the short term, however, this raises a fascinating one-time opportunity for states to step in and generate some much-needed revenue to be used to reduce healthcare costs for tens of thousands of their residents.

During the 2019 Open Enrollment Period, Vermont enrolled 25,223 people in on-exchange ACA individual market policies.

Just today, the state's ACA exchange, Vermont Health Connect, released a breakout of their January 2020 individual and small group market enrollment data as compared with January 2019.​​​​​​

The total number of Individual Market enrollees is 33,982 enrollees as of the end of January. It's important to understand that this is not the same as the number of people who enrolled on the ACA exchange during Open Enrollment, for two reasons: First, 2020 OEP in Vermont ended on December 15th, 2019; this data is as of January 31st. Second, the tables below include both on- and off-exchange enrollees, as opposed to on-exchange only.

I already called attention to this in my last post, but it's so long & filled with data wonk stuff that I'm reposting a separate entry to specifically highlight the SEP specifically:

  • Covered California is announcing a special-enrollment period through April 30 to address concerns that many Californians remain unaware of the new financial help or the new state penalty.

Hmmmm....the Special Enrollment Period is interesting. HealthCare.Gov and some state exchanges did something like this in spring 2015 (the first year people had to actually pay the mandate penalty) and managed to get around 210,000 more enrollees nationally. Of course, the penalty for 2014 was only $95 or 1% of income at the time...now it's up to $695/person or 2.5% of household income, so it's a bigger deal.

New Special-Enrollment Period Announced

When I last checked in on Covered California a couple of weeks ago, they still had two days left before their 2020 Open Enrollment deadline, and had managed to rack up 1.51 million on-exchange enrollments. This included 1.15 million renewals of existing enrollees, plus another 364,000 new enrollees.

I noted at the time that they had just barely beaten 2019's total with two days to go, and would have to add about 7,500 more to break 2018's total, and another 43,000 to beat 2017.

Well, they ended up in between the two, partly due to an overestimate of the renewal figure:

New California Policies Make Huge Difference, Increasing New Signups During Covered California’s Open Enrollment by 41 Percent

New Special-Enrollment Period Announced to Continue to Get Word Out on New Subsidies and Penalty

Back in December, Congress passed, and Donald Trump signed, a $1.4 Trillion federal spending package which included, among other things, the permanent elimination of several taxes which had been established to help fund the Affordable Care Act:

The Cadillac Tax: As Newsweek reported in 2017, the so-called "Cadillac tax" would have capped the tax deductions individuals could claim based on their health insurance benefits. It would have imposed a 40 percent excise tax on employer-sponsored plans that exceeded $10,000 in premiums per year for a single person or $27,500 for a family. The Cadillac tax was set to take effect in 2022.

I've written several times before about the multi-state scam being run by "Trinity Healthshare", aka "Aliera Healthcare":

New Hampshire:

The court also found that Aliera is a for-profit company and cannot qualify as a health care sharing ministry under state or federal law. The Insurance Department is concerned about potential fraudulent or criminal activity on the part of Aliera. Since the company may be an illegitimate health care sharing ministry, consumers should be aware that if they remain in an Aliera product, they may be covered by an unlicensed insurance company.

Unity Healthshare, now known as OneShare Health, was authorized by the court to reach out to Unity members about their options, and consumers who have purchased a Unity/Aliera product should be aware that they may be receiving this communication.

Washington State:

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

This just in from DC Health Link:

DC Health Link to Offer Even More Opportunities for Residents to Get Covered 

  • DCHBX Executive Board Votes to Allow Pre-Natal Special Enrollment Period and Four Other New Opportunities

Washington, DC – With Open Enrollment recently concluded, District residents and small businesses have new opportunities to sign up for health insurance coverage through DC Health Link. The DC Health Benefit Exchange Authority (DCHBX) Executive Board recently adopted recommendations from its Standing Advisory Board to create four Special Enrollment Periods (SEP) and an extended open enrollment period for DC small businesses.

This just broke moments ago, so I don't have a lot of details, but the bottom line is this:

US Appeals Court in DC rules today that Trump admin. unlawful in approving Arkansas Medicaid work requirement

— Stephanie Armour (@StephArmour1) February 14, 2020

Here's the opinion itself.

As always, University of Michigan Law Professor Nicholas Bagley has the skinny:

It's a clean win for the plaintiffs, and it comes in a short, decisive opinion written by Judge Sentelle -- a very conservative Reagan appointee. 

Before: PILLARD, Circuit Judge, and EDWARDS and SENTELLE, Senior Circuit Judges. Opinion for the Court filed by Senior Circuit Judge SENTELLE.

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