Charles Gaba's blog

In 2015, Republican Matt Bevin campaigned for governor on two major healthcare-related platforms:

  • Eliminate the state's perfectly-functioning, award-winning, highly-praised and beloved ACA exchange, "kynect" for no particular reason other than spite.
  • Eliminate the state's ACA Medicaid expansion program, which as of this writing provides around 480,000 low-income Kentuckians with healthcare coverage.

For some inexplicable reason, voters in Kentucky elected him regardless. Once he got into office, he did indeed make good on the first promise, shutting down the state's perfectly good ACA exchange platform and shifting KY to the federal exchange at HealthCare.Gov.

When it came to eliminating Medicaid expansion, on the other hand, he found it to be a little bit tougher than expected; actually pulling the plug on nearly half a million people's healthcare coverage proved to be a tougher nut to crack than he thought.

via the Idaho Statesman:

About 35,000 Idaho residents have signed up for Medicaid under expanded coverage in the first few days it has been offered, state officials said Monday.

The Department of Health and Welfare said that's more than a third of the estimated 91,000 people who are eligible. The agency started taking applications Friday, and it is tracking numbers on its website.

That's the good news. Of course, Republican legislators couldn't leave well enough alone:

Voters authorized Medicaid expansion last year with an initiative that passed with 61% of the vote after years of inaction by state lawmakers. But lawmakers earlier this year added restrictions requiring five waivers from the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.

...Most recently, Idaho last month submitted a waiver requiring patients to get referrals from primary physicians before they can get family planning services such as birth control, abortions or pregnancy care.

The original purpose of this website was, of course, to do real-time (or close to real-time) tracking of how many people actually select Qualified Health Plans (QHPs) via the ACA exchanges.

Every year I start out with a "blank" with my projections for how I think the upcoming Open Enrollment Period (OEP) will play out. For 2020, however, I'm just overlaying 2019's enrollment patterns on the graph (for both the federal and state exchanges) to see how things play out year over year.

There's some important things to keep in mind for the 2020 OEP:

A few weeks ago, I said the following about Sen. Elizabeth Warren regarding healthcare policy:

  • I'm generally supporting Elizabeth Warren in the Democratic Primary (not a full endorsement, but I've been strongly leaning her way for awhile now)...

HOWEVER, for the time being at least, that seems to be where she's decided to lay her marker, so it is what it is.

(Note: Since then, I've publicly stated that I'm now leaning more towards Sen. Kamala Harris who was always my strong #2 choice. This doesn't mean I no longer like Warren--the two have simply swapped places in my #1 and #2 column.)

 

I'm very pleased to see this.

I've made quite a bit of fuss about California expanding availability of ACA financial subsidies to those earning 400 - 600% of the Federal Poverty Line ($75K for a single person, $154K for a family of four). The subsidies aren't massive for most people, but for hundreds of thousands of Californians--especially older folks earning between 400 - 450% FPL--this is a huge savings. In addition, they're sweetening the subsidies somewhat for those already receiving ACA tax credits.

The only real concern I had about this is whether enough people in California know about it. Just like with reinstating the mandate penalty (which California has also done this year), expanding & enhancing ACA subsidies isn't gonna cause a spike in enrollment if no one knows they're available. A lot of people who might have checked into it in prior years isn't likely to bother taking another look if they don't know that the income cut-off threshold has gone up, and many others have never bothered trying in the first place because they "heard somewhere" that they won't qualify.

This press release came out last week but I covered all the other state-based exchange Open Enrollment press releases so I figured I should include this one as well:

Covered California for Small Business Announces Expanded Choices and an Average Rate Change of 4.1 Percent for 2020

Like Jack Twist in Brokeback Mountain, I can't seem to quit playing around with the jaw-dropping possibilities which could impact future Medical Loss Ratio rebate payments in response to the ghosts of Open Enrollment Periods past.

Back in June, I reported that the Supreme Court of the United States had agreed to take up the long-simmering (4 years!) Risk Corridor Massacre class action lawsuit:

On Monday, along with posting their decisions on several important federal cases, the U.S. Supreme Court announced that, much to the surprise of many healthcare wonks, they will take up the long-gestating (and presumed dead) Risk Corridor Massacre lawsuit:

Big news: SCOTUS is taking up the ACA risk corridors case. GOP's decision to stymie that program arguably did the most damage to the ACA marketplaces. https://t.co/VeMRcd5MYn

Back in late June, right after the first Democratic Primary Candidate Presidential Debate, I posted an analysis & table to break out exactly where each of the then-20 (!) candidates stood when it comes to the Next Big Thing in U.S. healthcare policy. I posted a couple of updates as the summer and early fall progressed.

At the time, my main point was that regardless of their official campaign rhetoric, the truth was that nearly all of the candidates were open to multiple paths towards expanding healthcare coverage...both in terms of the number of people covered, the scope of that coverage and the cost of coverage to the enrollees, with a greater portion of the total cost being borne by the federal government.

via the Washington Healthplanfinder:

Washington Healthplanfinder Ready for Start of 2020 Open Enrollment

  • More health plans, new health insurance carriers, and lower premiums available in most counties

Washington Health Benefit Exchange (Exchange) announced today the start of the 2020 open enrollment period that will feature more plan options and the potential for lower premiums for the majority of customers.

Now through December 15, Washingtonians seeking health insurance plans for themselves and their families can visit Washington Healthplanfinder to review and enroll in coverage. This year customers will find a total of 66 qualified health plans (QHP) from nine insurance providers – a 65 percent increase in QHPs from the 40 plans available last year. And, for the first time ever, a bronze plan offering will be available in every county in the state.

via HealthSource RI:

Need health insurance in 2020? Now’s the time to pick or renew your plan

HealthSource RI announces 2020 Open Enrollment period Nov. 1st – Dec 31st

EAST PROVIDENCE, RI (October 31, 2019) HealthSource RI, the state health insurance exchange, helps connect Rhode Islanders to a wide range of high quality, affordable health coverage options. Residents are encouraged to select and pay for a plan through HealthSource RI by December 23rd for coverage beginning January 1, 2020. The last possible day to enroll and pay for a plan is December 31st, but customers may experience a delay in receiving ID cards if they enroll after December 23rd.

“HealthSource RI helps keep health care costs low while ensuring that Rhode Islanders have access to high-quality care,” said Governor Raimondo. “I urge Rhode Islanders to take time to explore HealthSource RI’s many coverage options this open enrollment.”

via NY State of Health:

Press Release: Governor Cuomo Announces the Start of NY State Of Health's 2020 Open Enrollment Period

  • New York's Uninsured Rate Continues to Decline, Among Lowest in the Nation
  • More than 4.8 Million New Yorkers Have Enrolled Through NY State of Health

Governor Andrew M. Cuomo today announced that on November 1, NY State of Health - New York State's Health Plan Marketplace and a national leader in enrolling people into quality, affordable health coverage - will begin its seventh annual open enrollment period for New Yorkers who want quality, low-cost health insurance coverage in 2020.

via the ALL-NEW Nevada Health Link:

Nov. 1 kicks off the Plan Year 2020 Open Enrollment Period. By now, we hope you’ve had a chance to explore the new website, and if you’re a returning customer, you’ve probably already claimed your account. Still have questions? No worries. We’ve compiled a list of the most frequently asked questions (FAQs) to make shopping for a qualified health plan through Nevada Health Link as seamless as possible.

What is Nevada Health Link?

Run by the state agency: Silver State Health Insurance Exchange, Nevada Health Link is Nevada’s online marketplace where eligible Nevadans can shop for, compare and purchase Affordable Care Act-compliant health insurance plans that fit their needs and budget.  Check out our video.

I’m a returning Nevada Health Link customer. What do I need to do to get ready for Plan Year 2020 Open Enrollment?

via Connect for Health Colorado:

Open Enrollment for 2020 Coverage Brings Savings for Coloradans Who Actively Shop

DENVER – The Open Enrollment period to purchase health insurance for 2020 kicks off Friday, Nov. 1, with rates lower across the board for the first time since the Marketplace opened for business in 2013. And while rates are lower, Connect for Health Colorado strongly encourages all customers to compare their plan options before making a selection.

With the complexities of how the tax credit is calculated, customers who qualify for financial help will likely see a decrease in the dollar amount of assistance. It’s important to know that customers who qualify for financial help can reduce premiums an average of eight to 19 percent by switching to the lowest-cost plan available in their current coverage level. 

via Your Health Idaho:

  • Open Enrollment for health insurance in Idaho begins November 1
  • New for 2020, Medicaid expansion could affect eligibility

BOISE, Idaho – Open Enrollment for 2020 health insurance coverage begins Nov. 1 and runs through Dec. 16. During this time, Idahoans can shop, compare, and enroll in a plan through the state health insurance exchange, Your Health Idaho.

A total of 116 medical and 13 dental plans from six participating insurance carriers are available at Your Health Idaho for 2020. Your Heath Idaho Executive Director, Pat Kelly, urges those seeking coverage to use the comparison tool and consider their options, as plans can vary by county.

“In 2020, every county in the state has at least three insurance carriers to choose from, and most have four. At YourHealthIdaho.org, not only can Idahoans shop and compare plans side-by side, but they can also search for provider networks and prescription drug coverage to make sure the plan they purchase really works for them,” Kelly said.

via the Maryland Health Connection:

HEALTH PLAN RATES HAVE DROPPED; OPEN ENROLLMENT BEGINS NOV. 1

  • “START HERE” AT MARYLANDHEALTHCONNECTION.GOV

BALTIMORE (Oct. 30, 2019) - “Start Here” will be the theme for 2020 health care open enrollment season that begins Nov. 1 with Maryland Health Connection.

The “Start Here” campaign will appear on social media, print, online and other venues, including gas station TVs, to emphasize where Marylanders can go to enroll and use the free, expert advisers located throughout Maryland. A TV ad will run to complement the campaign.

Open enrollment begins on MarylandHealthConnection.gov at 5 a.m. on Nov. 1. Dec. 15 is the deadline to sign up for 2020 coverage that begins Jan. 1, 2020.

New this year, Value Plans feature lower deductibles and increased access to primary care, mental health care, and generic drugs before deductibles apply. Value plans are designed to lower consumers’ out-of-pocket costs for the health care services the majority of people use most frequently.

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