Charles Gaba's blog

A new, if not surprising, development in the Republican Party's absurd "Texas Fold'em" lawsuit against the ACA:

Attorney General Becerra Leads Coalition Seeking Supreme Court Review of ACA Repeal Case

Friday, January 3, 2020

SACRAMENTO – California Attorney General Xavier Becerra today, leading a coalition of 20 states and D.C., filed a petition to the U.S. Supreme Court seeking review of the Fifth Circuit’s recent decision in Texas v. U.S. The decision held the individual mandate of the Affordable Care Act (ACA) unconstitutional and called into question whether the remaining provisions of the ACA could still stand, including those that protect and provide coverage to Americans with pre-existing conditions. Because this decision causes uncertainty that may harm the health of millions of Americans, as well as doctors, clinics, patients, and the healthcare market, Attorney General Becerra and his coalition are petitioning the Supreme Court to take up the case and resolve it before the end of the Court’s current term in June.  

Some of you may have noticed that I haven't really posted much the past week or so. Part of it is because my whole family has been sick (nasty flu going around); part is because of the holidays, of course; and part is because I've been working on a couple of special projects.

One of those projects happened to require that I track down the official Twitter handles of every single member of the U.S. House of Representatives...all 431* of them. While I was at it, I also decided to compile some other key demographic information, such as gender, year of birth and so forth.

*(there's currently 4 vacancies)

You might think this would be easy enough to get ahold of, and most of it is...but the Twitter handles were tricky. There's several online lists already, but most of them seem to be incomplete, outdated, or include their personal handles instead of their official Congressional ones. I've gone through one by one and confirmed all 431 current members. In a few cases I did have to use their personal handles because they don't have an official one (and in a couple of cases, they appear to be one and the same).

A brief recap of ACA Medicaid expansion in the great state of Utah:

  • November 2018: Utah voters pass Proposition 3, a "clean" Medicaid expansion ballot initiative, by a solid margin, 53-47. "Clean" expansion means just that: The program would be expanded to every legally documented Utah resident earning up to 138% of the Federal Poverty level, without requiring additional barriers like work requirements, etc.
  • February 2019: The Utah state legislature, blatantly defying the clear will of the people, votes to effectively ignore Prop 3 by replacing it with Senate Bill 96, which would only partially expand Medicaid to those earning just 100% FPL (around 50,000 fewer low-income residents) while also tacking on work requirements to boot.
  • Adding insult to injury, while you might think this would at least save the state a few bucks (under ACA Medicaid expansion, the federal government pays 90% of the bill for the expanded population while the state has to pay the other 10%), this would actually cost the state around $50 million more, because the partial expansion, if approved by the federal government, would mean the state would instead pay the 32% portion they already pay for other Medicaid populations. The state put in a separate waiver request asking for the feds to agree to the 90% match rate anyway.

Well, for good or for bad, billionaire and former New York City mayor Michael Bloomberg is actually registering in the mid-single digits for the Democratic primary in recent polling, so he's a force to be reckoned with whether I'm a fan of his literally buying his way onto the national stage or not.

Anyway, he rolled out his official healthcare platform the last week, and it's not terrible, it's just not particularly impressive. In all honesty, it pretty much amounts to a watered-down version of Joe Biden, Pete Buttigieg & Amy Klobuchar's "ACA 2.0 w/Public Option" proposals (which are already considered "weak tea" by the more progressive members of the Democratic base, although I'm actually pretty impressed by each of them myself).

Here's Bloomberg's plan verbatim from his campaign website:

Public option

This Just In from Nevada Health Link:

Nevada’s State Based Exchange Announces Enrollment Figures for Plan Year 2020

Carson City, Nev. – The Silver State Health Insurance Exchange (Exchange), Nevada’s state agency that helps individuals get connected to budget‐appropriate health coverage through the online marketplace, Nevada Health Link, enrolled 77,410 Nevadans during Open Enrollment for Plan Year 2020. The Exchange's seventh Open Enrollment Period ended Dec. 15, 2019 and included an extension for consumers who started the enrollment process on or before Sunday, Dec. 15 to complete their application by Friday, Dec. 20.

This Just In from MNsure...

MNsure Reports Strong Enrollment Numbers in Seventh Open Enrollment Period

ST. PAUL, Minn.—117,520 Minnesotans signed up for private health coverage during MNsure’s seventh open enrollment period which ended on December 23, 2019—2,525 more sign-ups than the exchange received by December 23 of the previous year. 

That's a 2.2% enrollment increase year over year (114,995), although CMS's official total was slightly lower than that (113,552 QHP selections). I don't know if the 1,443 discrepancy is due to clerical error cleanup, standalone dental plans being included in the higher number or what, but assuming the 117,520 figure stands, that's actually a 3.5% increase.

MNsure’s operations were notably smooth, and consumers reported improved customer experiences with the new online shopping and enrollment tools MNsure unveiled this year.

Elections matter.

True to his word, newly-inaugurated Democratic Kentucky Governor Andy Beshear has indeed eliminated the state's controversial and much-litigated Medicaid work requirement provision for the 400,000 state residents who are on the low-income healthcare program thanks to the Affordable Care Act:

Former Republican Gov. Matt Bevin’s controversial plan to impose work requirements and monthly premiums for many Kentucky Medicaid recipients is no more, Democratic Gov. Andy Beshear announced Monday.

(Monday = Last Monday; this is from a week ago)

In one of his first major moves as the 63rd governor of Kentucky, Beshear signed an executive order Monday rescinding Bevin’s Kentucky HEALTH plan, which sought to impose strict work requirements for able-bodied, working-age adults. It would have ended health coverage for an estimated 95,000 Kentuckians.

A couple of weeks ago, Covered California reported that as of December 7th, over 486,000 residents were taking advantage of their newly-expanded & enhanced state ACA subsidies:

...More than 486,000 individuals have been determined eligible for the new state subsidy, including about 23,000 in the 400 to 600 percent range of the federal poverty level, which could extend to an individual making up to $74,940 and family of four with a household income of up to $154,500. Of those in this income range who have signed up through Covered California, 44 percent have been found eligible for the state financial assistance.

...If I'm following correctly, the total breakout is:

  • 777,000 = either 138 - 200% FPL or not eligible for any subsidies
  • 463,000 = 200 - 400% FPL; receiving both federal & state subsidies
  • 23,000 = 400-600% FPL; receiving state subsidies only

The press release also broke out the household average for the new/expanded subsidies:

Your Health Idaho, the states' ACA exchange, reminds residents who completed their enrollment applications that they still have until midnight tonight to actually select a policy:

Last chance to #GetCovered!
For those Idahoans who submitted an application for 2020 health insurance coverage by December 16, you have one more day to pick a plan! Do not wait! Find your perfect plan today at YourHealthIdaho.org!

— Your Health Idaho (@YourHealthIdaho) December 23, 2019

The lastest 2020 Open Enrollment Period data was released last week by most of the exchanges, including HealthCare.Gov, Covered California, Connect for Health Colorado, Access Health CT, Maryland Health Connection and the Washington HealthPlan Finder. When combined with the existing data from the MA Health Connector, MNsure, New York State of Health and the brand-new Nevada Health Link, we should now have over 95% of the total 2020 Open Enrollment QHP selections locked in.

Update 12/23: I've updated the text and graph to include the final numbers from Minnesota & Nevada.

This is by no means the final version of The Graph for 2020, of course; there's still no data at all from the District of Columbia, Idaho, Rhode Island or Vermont, and the deadline is still days, weeks or even a month away for nine states.

Having said that, with the Week 7 HC.gov Snapshot Report being released earlier this afternoon, this is a good time to pause and take a look at how the 2020 Open Enrollment Period is shaping up. Remember, even HC.gov's total will change slightly when the dust settles...they're still missing the final 3 hours of the extended Open Enrollment Period (I'm guessing perhaps 30,000 more?), plus an unknown number of "callbacks" to people who were unable to get through on 12/15 but left their contact information (perhaps another few thousand?).

This just in via the Washington HealthPlanFinder:

Washington Healthplanfinder Reminds Customers to Make First Premium Payment

  • Payment options available online and by phone or mail through insurance companies.

Washington Health Benefit Exchange (Exchange) is reminding customers who selected a plan during 2020 open enrollment to make the first month’s premium payment to their health insurance company.

“It is critical that customers make their first premium payment associated with their 2020 health insurance coverage,” said Pam MacEwan, chief executive officer at the Exchange. “This simple action will prevent unintended loss of health coverage or delays in accessing care in the new year.”

Normally the Weekly HC.gov Snapshot Reports are released on Wednesdays. This week it was delayed until Friday in order to include the extra 2 1/2 days:

  • The final official day (Dec. 15th) fell on a Sunday this year
  • The additional 36 hour extension from 3pm on Monday 12/16 - midnight Eastern on Wednesday 12/18*

Not only is "Week 7" actually 9.5 days, but the final week of Open Enrollment also always includes a last-minute enrollment surge as people scramble to beat the deadline (both the original and the extension). In addition, it's also traditionally the week that CMS adds all of the auto-renewals to the report for current enrollees who neither actively selected a policy for 2020, nor did they cancel their coverage for the new year.

As a result of these factors, the numbers for Week 7 understandably dwarf each of the previous snapshot reports:

Week 7, Dec 8-17, 2019

via DC Health Link by email:

Healthcare Open Enrollment Going Strong in Washington, DC!

  • DC Residents Can Sign Up for Quality Affordable Coverage Through Jan 31, 2020

WASHINGTON, DC – District of Columbia residents still have more than six (6) weeks to sign up for quality, affordable health insurance through DC Health Link, the District’s state-based health insurance exchange established under the Affordable Care Act. While the final deadline has passed for individuals across the country to sign up for health insurance through the federal marketplace (HealthCare.gov), DC Health Link’s Open Enrollment for individuals and families continues on until January 31, 2020.  

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