Charles Gaba's blog

Two weeks ago I reported that Access Health CT, Connecticut's ACA exchange, had enrolled 12,777 people in 2019 ACA exchange policies, running neck and neck with last year. This included active renewals and new enrollees only.

Last night, CT Post reported that as of November 30th, the CT exchange had gone ahead and auto-renewed all current enrollees as well, for a total of 101,054 people:

HARTFORD — Enrollment in Access Health CT is higher this year than it was last year at this time, but time is running out.

Officials said they’ve enrolled 9.685 customers who are new to the exchange this year, and they’ve auto-enrolled more than 91,000 customers who purchased plans with them in 2018. That brings total enrollment up to 101,054 individuals as of Nov. 30.

Last year, about 90,428 individuals had enrolled by this time.

A couple of weeks ago I reported that the Washington Health Benefit Exchange reported enrolling a seemingingly astonishing 190,000 people into 2019 policies in just the first 10 days of the 2019 Open Enrollment Period. This is highly misleading, of course, because only a small fraction of these are new enrollees, and a somewhat larger portion are current enrollees actively renewing their policies.

The vast bulk of that 190K are current enrollees who are auto-renewed into 2019 policies by the exchange itself...with the option to then actively go into the system and opt to cancel their renewals if they wish. There's nothing wrong with this, and in fact more and more of the state exchanges seem to be doing it this way as they improve and streamline their software (I've confirmed that Maryland, Massachusetts, Minnesota, Rhode Island and Washington State are "front-loading" autorenewals this year, although Maryland hasn't actually reported their data yet).

Earlier this week, a picture of a letter sent to a patient needing a heart transplant recommending that they find a way to raise $10,000 to cover some costs went viral on Twitter and Facebook, with various celebrities, politicians etc. reposting it.

I'm sure you've seen it already, but just for the record, here's one of the most viral variants, from freshman Congresswoman-elect Alexandra Ocasio-Cortz. It's important to clarify that the letter was not sent by the insurance carrier, and the $10K in question would not be going to pay an insurance company...or, in fact, even "Spectrum Health" aka the "Heart & Lung Specialized Care Clinics" noted in the letterhead.

Insurance groups are recommending GoFundMe as official policy - where customers can die if they can’t raise the goal in time - but sure, single payer healthcare is unreasonable.

HealthSourceRI hasn't posted any official press release yet, but this story by Rob Borowski in Providence Business News covers all the basics:

PROVIDENCE — HealthSource RI, the state’s health insurance exchange, reports 31,000 people have signed up for health care coverage about a month into the open enrollment period for the 2019 plan year ending Dec. 23, 3,600 enrollments ahead of where they were at this point last year.

Last year at about this time during open enrollment, HealthSource RI had counted about 27,400 people enrolled for health insurance through the exchange, according to HealthSource RI Director Zachary W. Sherman.

Sherman said the agency has seen many people renewing existing coverage either manually or automatically.

“We’re pleased with where we are with sign-ups,” Sherman said.

 

A month ago I posted a Red Alert about the latest regulatory attack on the ACA...this time coming directly from CMS Administrator Seema Verma. At the time, Verma had just announced a draft version of the new rules for Section 1332 Waivers...starting with changing the name from "State Innovation Waivers" to "State Relief and Empowerment Waivers", which sounds in no way like Orwellian doublespeak propaganda.

Here's the basic backstory on 1332 waivers:

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

A couple of weeks ago I noted that the Illinois state Senate unanimously overrode outgoing Governor Rauner's veto of their bill restricting the sale of non-ACA compliant short-term, limited duration healthcare plans.

Today, I'm happy to report that the state House has followed up and overrode the veto as well:

Breaking: Just got word that the Illinois legislature has overridden the veto on SB1737 which limits short term plans to 6 months and bans rescissions of short term plans. @GtownCHIR h/t @stephanibecker

— Dania Palanker (@DaniaPal) November 27, 2018

Hot off the heels of the Week 4 HC.gov Snapshot Report, CMS has also released another important ACA exchange enrollment report:

Effectuated Enrollment for the First Half of 2018

This report provides average effectuated enrollment and premium data for the Federal and State-Based Exchanges for the first six months of the 2018 plan year. The Centers for Medicare & Medicaid Services (CMS) publishes effectuated enrollment data semiannually to provide a more accurate picture of enrollment trends for the Exchanges than indicated by the number of individuals who simply selected a plan during Open Enrollment. For coverage to be considered effectuated, individuals generally must pay their premium for the given month.

Week 4 via CMS:

Week 4, Nov 18-24, 2018

In week three of the 2019 Open Enrollment, 500,437 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

*"Not as bad as expected" depends on your perspective. Even the 6-7-point average premium increase caused by mandate repeal is still an average of $430 - $500 per unsubsidized enrollee for the year...or $1,300 - $1,500/year for a family of three.

Earlier this year, most healthcare wonks (along with the Congressional Budget Office) projected that Congressional Republicans repealing the ACA's individual mandate last December (effective January 1, 2019) would have a significant Adverse Selection impact on the ACA-compliant individual market risk pool. Projections of the premium increases imposed in response to the drop-off of healthy enrollees ranged from 10% (CBO) to as high as 16.6% (Urban Institute, although that also included a small increase due to Trump's expansion of short-term plans as well).

Last week, Bernie Sanders posted the following video (click to view) on Twitter. It tells the tragic story of a young Minnesota man named Alec Smith with diabetes who died soon after after no longer being able to afford either health insurance or the insulin and other medical supplies needed to keep him alive:

Alec Smith died at 26 because he was rationing insulin that was too expensive. The greed of the pharmaceutical industry is killing Americans and it has got to stop. (with @NSmithholt12) pic.twitter.com/xmryYm0Enr

— Bernie Sanders (@SenSanders) November 21, 2018

The main point of the video is the horrific price gouging on insulin, and a new drug price control bill which Sen. Sanders is pushing for which would tie U.S. drug pricing to that of a half-dozen other countries.

It's a genuinely depressing story, and the proposed drug pricing bill is interesting and worthy of discussion.

I just received an official 2019 ACA Open Enrollment Period report from the Massachusetts Health Connector...

As of today, we have 254,177 enrolled for January 1. That is up about 10,000 from last year's 244,308 at the same date. When you include people with plans selected but not paid, we are at 264,118.

The high number is again explained by the fact that Massachusetts, like several other state-based exchanges, front-loads their auto-renewals. 254K / 244K = around a 4% increase year over year, which is solid and right in line with other state-based exchanges to date...while the federal exchange (HC.gov) continues to lag around 11% behind last year. On the other hand, HC.gov doesn't front-load auto-renewals, so it's a bit of an apples to oranges comparison.

Week 3 via CMS:

Week 3, Nov 11-17, 2018

In week three of the 2019 Open Enrollment, 748,244 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

Last spring, both New Jersey and Maryland were among the states which were the most pro-active about passing lesiglation to cancel out Donald Trump's attempts to deliberately sabotage the Affordable Care Act. Both states passed laws cracking down on non-ACA compliant short-term and association health plans (NJ actually already didn't allow short-term plans before the ACA anyway), both states established robust reinsurance programs, and both states tried to pass bills reinstating the ACA's Individual Mandate Penalty which Congressional Republicans repealed last winter in different ways.

New Jersey was successful: They kept their mandate penalty restoration bill pretty much identical to the version repealed at the federal level and plan on using the revenue from it to help pay for the reinsurance program. The combined impact of all of their anti-sabotage efforts led to roughly a $1,500 annual premium savings for every unsubsidized individual market enrollee in the state.

(sigh) Just nine hours ago I posted the following about Kentucky's Medicaid expansion work requirement waiver:

A waiver was approved for Kentucky last spring, but has been (temporarily?) invalidated by court order.

I guess it's a good thing I included the "temporarily" caveat, because just moments ago...

.@CMSGov just re-approved Kentucky’s #Medicaid waiver. https://t.co/2Q16AKQoLS

— Dustin Pugel (@Dpugel) November 21, 2018

Sure enough, here it is:

With all the attention being paid to the midterm elections causing ACA Medicaid expansion to be passed in Utah, Nebraska and Idaho (while also now being at risk in Alaska and Montana), I've kind of lost track of the situation in Virginia, where it was expanded last May to over 400,000 Virginians.

Thankfully, Esther F. linked me to this article from the Virginia Mercury, which brings me up to speed on the actual implementation of the VA expansion program:

Less than two weeks after Virginia opened registration for its expanded Medicaid program, officials say they’ve already drawn thousands more applicants than initially anticipated.

The state had expected the new program to enroll 300,000 over the next year and a half. They now expect that number to reach 375,000. The new estimates won’t alter the total expansion population, which the state has said will be about 400,000.

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