Charles Gaba's blog

Over at the Washington Post, reporter Yasmeen Abutaleb has a disturbing-sounding story which immediately caught my eye and raised major internal alarms within the healthcare wonk/advocate community:

Critics say ‘junk plans’ are being pushed on ACA exchanges

The Trump administration has encouraged consumers to use private brokers, who often make more money if they sell the less robust plans.

The Trump administration is encouraging consumers on the Obamacare individual market to seek help from private brokers, who are permitted to sell short-term health plans that critics deride as “junk” because they don’t protect people with preexisting conditions, or cover costly services such as hospital care, in many cases.

So far, this is nothing new; I've been warning people about this since day one...it's the 2nd item on my "Seven Important Things to Remember" blog post from November 1st:

The Week 3 HealthCare.Gov Snapshot Report from CMS should be released later on this afternoon, covering enrollment in 38 states from Nov. 10th - Nov. 16th.

As a reminder, here's what the Week 2 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around half of the 244,000 difference. The other significant difference is that Nevada split off from HC.gov this year, which accounted for around 12,000 of the gap the first 2 weeks.

If you assume around 130,000 of the difference is due to the missing day, that still leaves 2020 Open Enrollment around 100,000 short of the same time period last year on HealthCare.Gov.

Colorado

Connect for Health Colorado® Reports Coloradans are Shopping Around for 2020 Coverage

DENVER – Nearly 24,000 Coloradans have signed up for a health insurance plan through Connect for Health Colorado’s Marketplace between Nov. 1 and Nov. 15. for coverage starting Jan. 1, 2020.

More Coloradans buying their own health insurance are seeing lower premiums, largely due to the reinsurance program that passed this year. Reinsurance helps insurers with their most costly claims. However, given the complexities of how financial help available through the Marketplace is calculated, current customers should shop around to reduce monthly costs.

Heh. This is a pretty good layman-speak for #ReverseSilverLoading.

On average, those who qualify to automatically renew their plan would lower their premiums by 15 percent (compared to 2019) if they switch to the lowest-cost plan in their current level of coverage.

 

This story ran a few weeks ago, but I'm just now getting a chance to write about it, and it's critically important given that the 5th Circuit Court of Appeals is still expected to issue their ruling in the absurd Texas vs. U.S. (aka #TexasFoldEm) lawsuit brought by 20 Republican state Attorneys General.

The GOP has spent a solid decade trying to tear down the Patient Protection & Affordable Care Act. They started even before the bill was passed or signed into law, of course, which is why it ended up passing without a single Republican vote in either the House or Senate. After that, they filed lawsuit after lawsuit (a handful with merit, others utterly baseless, such as the current one, which may have the thinnest case in history to ever make it so far in federal court), while simultaneously voting to repeal the ACA either partly or fully dozens of times.

The recent elections in Virginia, Kentucky and Louisiana had two things in common: The first is that all three were huge victories for Democrats (they took control of both the state House and Senate in Virginia, flipped the Governor's seat in Kentucky and held onto it in deep red Louisiana).

The second is that all three elections were won in large part based on...Medicaid expansion.

As Greg Sargent notes in the Washington Post:

Yet Edwards won, in large part, by also stressing his implementation of the Affordable Care Act’s Medicaid expansion in the state during his first term. Indeed, Edwards’s lead pollster, Zac McCrary, told me during an interview that no single issue was more important in driving the governor’s victory.

Connecticut

OK, this is a bit confusing. Over the past few years, more and more of the state-based exchanges have shifted from waiting until the end of Open Enrollment to officially report auto-renewals of existing enrollees...to going ahead and auto-renewing everyone up front, and then subtracting those current enrollees who actively cancel their renewals.

This has caused a bit of confusion, since the exchanges don't always make it clear who's being counted and when.

Case in point: Access Health CT, Connecticut's ACA exchange. Last year they reported 12,777 enrollees during the first two weeks of Open Enrollment...and also noted that there were another 85,000 existing enrollees who hadn't yet actively renewed their policies as of 11/18.

This year, their press release page states the following:

Qualified Health Plans (QHP):

  • Net Total QHP Enrollment: 96,810
  • 2020 OE Acquisition Summary: 3,947

Overall Volume

via KLAS-TV:

CARSON CITY, Nev. (KLAS) — Nearly 60,500 Nevadans have enrolled in a Qualified Health Plan for plan year 2020 since open enrollment began on Nov. 1.

The Silver State Health Insurance Exchange, which runs online insurance marketplace Nevada Health Link, announced these numbers just 15 days into the enrollment period.

Nevada Health Link migrated 65,563 Nevadans from HealthCare.gov onto the State Based Exchange platform at NevadaHealthLink.com.

“At exactly one-third of the way into open enrollment, we are enthusiastic about the level of engagement we’ve seen from consumers and brokers,” said Heather Korbulic, executive director of Silver State Health Insurance Exchange, in a press release. “While we still have work to do to reach the uninsured populations throughout our state, we remain optimistic that we will see enrollment numbers continue to rise throughout the duration of this enrollment period.”

The agency says this is the first year Nevada Health Link will no longer rely on HealthCare.gov after the transition began in 2018.

I've written a lot over the past nearly three years about the damage caused to ACA policy enrollment caused by the Trump Administration's slashing of 90% of HealthCare.Gov's marketing, awareness and outreach budgets.

A significant portion of the reduction in ACA exchange enrollment in 2017, 2018 and 2019 can be blamed squarely on this.

That's not just my opinion; it's been supported by detailed analysis as well as the corresponding increase in enrollment on state-based exchanges, which operate their own marketing/outreach budgets.

The following graph compares the two over the first six Open Enrollment Periods. I've had to adjust for the fact that since 2014, several states have switched from state exchanges to the federal one or vice-versa, but even so, the contrast is dramatic and clear:

New York

Arrrrgh! Don't ask me why, but for some reason I forget about this weird policy of NY State of Health every year:

Press Release: NY State of Health Announces Annual Renewal Begins Saturday

  • 500,000 New York State Households Expected to Renew Their Health Plan for the 2020 Plan Year
  • Consumers Must Enroll or Renew by December 15 for Coverage Effective January 1

ALBANY, N.Y. (November 14, 2019) - NY State of Health, the state’s official health plan Marketplace, today announced that beginning November 16, the Marketplace will be open for individuals looking to renew or change their health plan for 2020. Open Enrollment for new customers seeking to enroll in a Qualified Health Plan began November 1 and runs through January 31, 2020.  New Yorkers must enroll by December 15 for coverage beginning January 1, 2020.

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