Charles Gaba's blog

Thanks to Objective Politics for reminding me of this ugly moment from the 2012 GOP primaries...

The context was a Twitter discussion between LA Times reporter Michael Hiltzik, U of Chicago professor Harold Pollack, and CATO Institute healthcare guru/Halbig co-architect Michael Cannon. "Objective Politics" chimed in with the link to the infamous moment above, which pretty much tells you everything you need to know about the opposing points of view at play in the ACA debate.

There's nothing wrong with reminding people about this, but I'm pretty disappointed with both the author as well as PBS for treating this as if it's a "surprise" or something unexpected:

Consumers may soon find a surprise in their mailbox: a notice that their health plan is being canceled.

Last year, many consumers who thought their health plans would be canceled because they didn’t meet the standards of the health law got a reprieve. Following stinging criticism for appearing to renege on a promise that people who liked their existing plans could keep them, President Barack Obama backed off plans to require all individual and small group plans that had not been in place before the health law to meet new standards starting in 2014.

In other words:

Chad Terhune of the LA Times has a great story about how CoveredCA is ramping up their efforts for the 2nd year of open enrollment. It's a good read overall, but one number in the opening sentence leapt out at me:

Looking to avoid the pitfalls and confusion that surrounded the launch of Obamacare, California is gearing up to get 1.2 million people to renew their health policies for next year.

This caught my eye because the total QHP enrollment number for California was actually 1,405,102 as of 4/19.

Now, Peter Lee did state that 85% of that number had paid their first month's premium as of just a week later, by 4/27...and as it happens, 1.2 / 1.4 = 85.7%, so it's possible that this is what the "1.2 million" refers to.

For awhile there I was concerned that Oregon's uglier-by-the-minute legal/technical headaches had caused them to stop bothering with regular updates; fortunately, they seem to be back on track again, updating both QHP and Medicaid numbers:

September 1, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 353,120
Total private medical insurance enrollments through Cover Oregon: 100,758

Oregon Health Plan enrollments through Cover Oregon: 252,362*

*OHP enrollment data is current as of August 13, 2014. An updated number will be posted soon.

Dental enrollments 
Total private dental insurance enrollments through CoverOregon: 20,572

Net enrollments 
Net private medical: 78,683
Net private dental: 14,502

Net QHPs are down 31 due to what I presume is normal net attrition, but total enrollments have gone up by another 745 people.

Medicaid expansion, meanwhile, has shot up by another nearly 12,000 people.

Wow! The WA Health Benefit Exchange, which hasn't issued an actual enrollment update since the end of the Open Enrollment period, just came through in a big way:

OLYMPIA, Wash. – Washington Healthplanfinder today announced 11,497 Washingtonians have taken advantage of special enrollment periods since March 31 that allow them to enroll through wahealthplanfinder.org if they have a qualifying life event outside of the standard open enrollment period. The next open enrollment period starts on Nov. 15, 2014 for coverage beginning in 2015.

Data also shows that nearly 700,000 residents are now enrolled in new free or low-cost health coverage options, with more than 147,000 customers currently enrolled in Qualified Health Plans. Including customers who are renewing their existing Medicaid coverage, more than 1.28 million residents have enrolled in health coverage through wahealthplanfinder.org.

Yeah, yeah, I know; a test server for Healthcare.Gov was successfully hacked into recently; no sensitive data was stolen, but Security was Breached, etc etc etc.

No, I'm not shrugging the incident off. I'm the one who called Hawaii's state exchange website out for taking over a week to resolve their own Heartbleed SSL vulnerability last spring. Yes, security is very important, especially with personal financial, medical and citizenship data. Hopefully the HHS techies are eliminating vulnerabilities, beefing up security and so forth.

I'm swamped with my day job at the moment, so I don't have a whole lot to add to the discussion at the moment...

HOWEVER, this line from GOP Rep. Diane Black in Avik Roy's latest ACA attack at Forbes.com literally made me laugh out loud:

Presented without comment:

North Carolinians could have three insurance carriers to choose from when enrollment under the Affordable Care Act reopens in November.

The state Department of Insurance has approved individual plans from UnitedHealthcare for the online marketplace, but they still need to be approved by the U.S. Department of Health and Human Services because the federal government operates the exchange.

A reader forwarded this to me; I ran a search for the organization they referred to and sure enough, it's legit:

Email today from Texas Well and Healthy that might suggest another one of those "we have to craft a uniquely TX solution for a uniquely TX problem because Obamacare sucks" deal. Copy follows...

County Leaders Call for Insurance Solution as Texas Senate Commitee Discusses Alternatives to Medicaid Expansion

Our state leaders may be moving slow on health care, but local leaders are giving them a nudge in the right direction.

Leaders of six of the state's largest counties -- ranging from Harris County's Republican Judge Emmett to Dallas County's Democratic Judge Jenkins -- have joined together to call on the legislature to find a "uniquely Texas solution" to covering uninsured low-wage workers.

The county leaders wrote to the legislature as the Senate Health and Human Services Committee met to discuss Texas alternatives to Medicaid expansion.

Last October, at the height of the botched HC.gov rollout, I repeatedly commented over at Daily Kos:

 I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

  • Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
  • California, Colorado, Connecticut and Delaware* are all state-run exchanges.
  • That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

So, the big news this morning is that the Kaiser Family Foundation has determined that the "benchmark silver plan" premiums in 16 major U.S. cities are expected to drop by 0.8% on average next year. Not a huge number, but the fact that they're dropping at all is astonishing given the "OMG!!! DOUBLE-DIGIT RATE HIKES!!" freakout which have dominated the most recent ACA critical attacks.

Of course, as has already been shown repeatedly, 1) premiums were already going up by 10-11% per year prior to the ACA exchanges launching anyway, and 2) many states have already reported in on their 2015 rates, and for the most part they're going up by...well, not much (and in some cases actually dropping):

Just two weeks ago, Sen. Mark Pryor (D-Ark.) surprised much of the political world with a powerful television ad. Though the conventional wisdom was that Pryor, facing a tough re-election fight, would avoid talking about the Affordable Care Act, but the senator neverthelessdid the opposite, boasting about the benefits he’s delivered for Arkansans through the ACA.
 
...Would Pryor back down? As it turns out, no. MaddowBlog received an exclusive first look at the Pryor campaign’s new campaign ad, which is the second spot in which the Arkansas senator boasts about ACA benefits.

BLAM! The infamous "$700B cut from Medicare!!" lie has been festering since well before the 2012 presidential election. The $700 billion in question refers to savings from cutting waste, fraud and abuse from the Medicare system (this is a good thing, folks).

Kudos to Sen. Pryor for debunking this garbage head on.

Greg Sargent has more:

Me, July 17th, re. Rhode Island's 2015 rate report:

The preliminary rate requests are just that: Preliminary. You can REQUEST anything; that doesn't mean you'll get it.

Me, July 22nd, re. New York's 2015 rate request report:

...as I noted last week, there's a huge difference between what the insurance companies are asking for and what they actually get approved. As noted in the article CNY article:

Last year, insurers requested 9.5 percent increases in premiums for their individual plans, but the state Department of Financial Services, which regulates insurers, approved, on average, only a 4.5 percent increase. 

Well, guess what?

This Just In from Ian Millhiser at Think Progress:

In July, two Republican judges on the United States Court of Appeals for the District of Columbia Circuit handed down a decision defunding much of the Affordable Care Act (ACA). This effort to implement Sen. Ted Cruz’s (R-TX) top policy priority from the bench was withdrawn on Thursday by the DC Circuit, and the case will be reheard by the full court — a panel that will most likely include 13 judges. In practical terms, this means that July’s judgment cutting off subsidies to consumers who buy insurance plans in federally-operated health exchanges is no more. It has ceased to be. It is, in fact, an ex-judgment.

(Bonus points to Millhiser for the Monty Python nod.)

OK, so this means that the case will simply get bumped up to the SCOTUS, right? Well, not necessarily:

If it seems like I keep posting Minnesota's latest every few days, that's because...well, frankly, I am, for two reasons: First, they're updating it every few days (almost odometer-like); and second, MNsure is pretty much the only one posting updates on a regular basis (again, Oregon is now the only one doing so more frequently than once a month).

On the up side, those MN numbers keep increasing at a pretty impressive rate, with another 294 QHPs added and 5,848 more added to Medicaid/CHIP in just the past 6 days:

latest enrollment numbers

September 2, 2014

Health Coverage Type Total Enrollments
Medical Assistance 191,568
MinnesotaCare 69,671
Qualified Health Plan (QHP) 54,354
TOTAL 315,593

For some perspective, this means that Minnesota's total ACA exchange enrollments have gone up over 5.1% in just the past 12 days.

Larry Levitt of the Kaiser Family Foundation tweets:

CMS actuaries are now projecting that health spending will be $529 billion lower in 2019 than they thought four years ago.

— Larry Levitt (@larry_levitt) September 3, 2014

I'm pretty sure this is related to this story:

In a historical aberration, out-of-pocket spending on health care is expected to decrease in 2014, according to a new report from the Centers for Medicare and Medicaid Services, because of expanded insurance coverage under Obamacare.

CMS actuaries, writing in Health Affairs, projected that Americans' out-of-pocket spending would decrease by 0.2 percent. While that's a small drop, it's a big change from the historical trend of steadily increasing out-of-pocket spending. Out-of-pocket spending increased by 3.2 percent in 2013. According to the Kaiser Family Foundation's Larry Levitt, such spending has only decreased in 1967 (Medicare and Medicaid took effect) and in 1994 and 2009 under slowing economies.

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