Charles Gaba's blog

Three weeks ago I posted an entry called "Greg Sargent: GOP claims 3-legged stool won't collapse if you take away 2 of them", about the corner that the Republican Party has painted themselves into when it comes to the King v. Burwell case.

As I noted at the time, the Affordable Care Act is primarily based on a "3-legged stool" approach (as outlined by the now-infamous Jonathan Gruber back in 2010):

At the health law’s core is a “three-legged stool” approach to reforming these markets: new rules that prevent insurers from denying coverage or raising premiums based on preexisting conditions, requirements that everyone buy insurance, and subsidies to make that insurance affordable.

A few weeks ago, the Detroit News posted a story gushing praise all over Michigan's implementation of the Affordable Care Act's Medicaid expansion provision, known locally as "Healthy Michigan", and somehow managed to not mention the ACA once until the 9th paragraph...and even then, failed to explain the connection between the two (as in, HM only exists because of ACA).

A couple of days ago, the editiorial board of the News posted an editorial which correctly calls for the renewal of Healthy Michigan, which requires a federal waiver once a year (I think) in order to continue because it includes modifications from simply increasing the eligibility threshold to 138% of the Federal Poverty Level.

Just a quick reminder: The tax filing season special enrollment period is still going on for 1 more week 5 more days in 45 states (+DC), and all the way until the end of May in Vermont:

To date, there have been at least 95,000 confirmed QHP selections specifically due to the #ACATaxTime SEP:

Y'know, sometimes I don't even have to add anything myself:

California's insurance commissioner criticized healthcare giant Anthem Blue Cross for imposing an "excessive" rate increase on nearly 170,000 customers statewide.

Dave Jones said Wednesday that Anthem had failed to justify its 9% average rate hike that took effect April 1. Premiums are going up as much as 25% for about 4,000 policyholders.

"These rate hikes have real financial impact on Californians," Jones said. "It means less money for other essentials like food, clothing, housing and education." 

But state officials have no power to stop health insurance rate increases that are deemed unreasonable.

Jones lost his bid to change that last fall when Californians rejected the Proposition 45 rate-regulation measure by a wide margin.


As an aside:

Presented with minimal comment:

Satisfaction with the Health Insurance Marketplace exchange enrollment process among new enrollees has significantly increased from 2014, and health plans obtained through the Marketplace exchange generate levels of member satisfaction equal to or higher than plans not obtained through the Marketplace exchange, according to the J.D. Power 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) StudySM released today.

The study measures satisfaction with Marketplace health plans obtained for the 2014 plan year by examining six attributes (in alphabetical order): claims processing; communications; cost; coverage and benefits; customer service; and provider selection. The study also measures the enrollment experience of both new Marketplace enrollees and re-enrollees by examining seven attributes (in alphabetical order): amount of time to complete the renewal/enrollment process; clarity of instructions for completing enrollment application; courtesy of the representative; ease of navigating the Marketplace website; ease of renewing/enrolling; ease of understanding benefits and coverage; and variety of information available about health insurance plan choices.

For months now, whenever I've crunched the numbers to figure out how many people would be screwed by an adverse King v. Burwell ruling by the Supreme Court (answer: around 6-7 million directly, plus another 6-7 million indirectly), I've always made sure to include one caveat: A small percent at the upper range of the federal subsidy range wouldn't really be impacted much:

  • Assuming that NM, OR & NV are "in the clear" for federal subsidies (and this still isn't clear), you'd have to subtract around 175K from the total; call it 6.5 million who would actually lose their federal tax credits.
  • Of those, let's assume that perhaps 5% are at the upper end of the tax credit limit and are therefore only receiving nominal credits (say, $30 or less per month). For those folks, losing these credits, in and of itself, would be annoying but hardly devastating; I have to imagine they won't drop their coverage if that was the only change (which it isn't, but I'll get to that in a moment).

However, I was just spitballing that 5%; I didn't do the actual math to see just how many people at various income levels would be seriously hurt. Fortunately, over at the Huffington Post, Jeffrey Young has done exactly that:

I had read something about this a week or so ago but I didn't really think about the implications at the time.

Now that I've read it...I can't for the life of me figure out why it hasn't gotten more press. Perhaps because it hasn't actually become a law yet?

Calif. Senate bill to give health coverage to undocumented passes committee

SAN MATEO, California— A landmark bill to extend subsidized health care to some 1.25 million undocumented immigrants in California — more than one third of whom are Asians and Pacific Islanders, passed the California Senate’s Health Committee on April 15.

Senate Bill 4, also known as the 2015 Health for All Act, sponsored by Sen. Ricardo Lara (Dem-Bell Gardens) passed 7-0, according to reports by the Orange County Register.

Capital Public Radio’s KXJZ News said the bill was supported unanimously by the committee’s Democratic members, Republican members of the same committee, however, abstained from the vote.

Earlier today I posted updated exchange enrollment numbers out of Washington State; as of 4/17, ACA exchange QHPs were up to 170,000 currently enrolled out of about 177K paid enrollments and perhaps 200K total selections.

This evening, another piece of the puzzle is filled in : OFF-exchange QHPs in WA:

The office of the state insurance commissioner estimated 170,000 people bought private insurance outside the state marketplace during the open enrollment period. That’s about the same as last year.

Well, now. After all my dead ends, that was remarkably...simple and to the point.

This Just In...

Washington Healthplanfinder Enrolls 170,000 in Qualified Health Plans; 16,000 Enroll through Spring Special Enrollment Period
Enrollment Continues for Residents with Qualifying Life Events


OLYMPIA, Wash. – Washington Healthplanfinder today announced that 170,101 Washingtonians have currently signed up for a Qualified Health Plan or renewed their health coverage through Of the total number of Qualified Health Plan enrollees, more than 16,000 enrolled during the spring special enrollment period.

The spring special enrollment period, which ran from Feb. 17 to April 17, was previously available to Washingtonians who recently became aware of the tax penalty for not having health insurance or were unable to complete their applications due to technical issues by the Feb. 15 deadline.