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2018 MIDTERM ELECTION

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OK, that may seem like an awkward way of shoehorning the Halbig decision into what's otherwise a simple state-level enrollment update entry, but the two are joined at the hip, since the state in question (Arkansas) happens to be one of those being run through Healthcare.gov:

A total of 185,000 persons have enrolled in expanded Medicaid and another 40,000 have bought insurance in the Obamacare exchange—together nearly half of all the previously uninsured citizens in Arkansas. When the new governor takes office, some 215,000 will be enrolled in expanded Medicaid alone. Will Hutchinson and, indeed, most Republican legislators want to end medical coverage for so many of their neighbors and constituents?

OK, now that I've showered, dressed and eaten lunch, let's see what the latest Halbig developments are (I'll explain below just why I didn't pounce all over the story this morning):

First, the ruling itself, courtesy of the L.A. Times:

President Obama’s healthcare law was dealt a new blow Tuesday as a federal appeals court ruled that due to a wording glitch in the Affordable Care Act, some low- and middle-income residents are not entitled to receive government assistance to subsidize their insurance.

In a 2-1 vote, a panel of judges on the U.S. Circuit Court of Appeals for the District of Columbia rejected the Obama administration’s argument that the problem was triggered by imprecise language in the complex law and that Congress had always intended to offer the subsidies nationwide to low- and middle-income people who bought insurance through one of the state or federal health exchanges created under the law.

OK, I'll have much more to say about today's Halbig decision this afternoon, but for the moment, let me just repost a press release, verbatim, from the campaign of Mark Totten, presumptive* Democratic nominee for Attorney General here in Michigan:

(*ok, technically he's not the nominee until after the MDP convention next month, but I'm pretty sure he's uncontested).

Schuette Forces Massive Tax Hike on Working Michigan Families

July 22, 2014

FOR IMMEDIATE RELEASE

Mark Totten for Michigan Attorney General
July 22, 2014

Contact: info@marktotten.com / (269) 203-3520

Schuette Forces Massive Tax Hike On Working Michigan Families

Federal court backs Schuette’s crusade to raise taxes by nearly $5,000 on a half-million Michigan families, while shipping Michigan tax dollars to California and New York

...however, I just finished mowing the lawn and am grungy as hell at the moment. I'll read up on the decision and write something more substantive later on today.

In the meantime, here's the three posts I've written about it so far...

Speaking of which, my potential dumb-simple solution to the problem has been lent support by none other than Larry Levitt of the Kaiser Family Foundation:

If Halbig stands, the administration could try to make it easy for states to set up state exchanges with a http://t.co/GH5hnakhxX back-end.

With all my stories about the requested premium increases in various states not living up to the "sky is falling" hype, several people have called attention to the fact that in New York State, it's not looking good:

ALBANY—New York insurance companies are looking to raise health insurance premiums by an average of 13 percent, according to proposed rates released by the state's Department of Financial Services on Wednesday.

The requests come from the 41 insurance companies operating in New York's insurance market. Last year, 16 insurers offered plans on the state's health exchange, which was created by the Affordable Care Act.

The six most popular plans on the state’s exchange requested double-digit increases in their premium rates for next year, with an average request of a 14.6 percent rate hike.

A couple of weeks ago there was much ado about a new Commonwealth Fund survey which found that nationally, the uninsured rate had been cut by 25% (from 20% down to 15%). Well, buried in that study was this bit about California specifically:

The percentage of uninsured Californians has been cut in half since the federal health law began expanding coverage nine months ago, according to a new national survey.

In September of 2013, 22 percent of California adults were uninsured. By last month, that number had fallen to just 11 percent, the biggest drop among the nation’s six largest states.

After yesterday's flood of updates, I'm taking a moment to give a shout-out to Chris Savage. He's currently running a fundraiser to help support Eclectablog, the Michigan-centric political site which deserves far more attention than this one. Eclectablog isn't primarily healthcare-related (although there are occasional ACA-related pieces by Amy Lynn Smith and LOLGOP from time to time), but it would mean a lot to me if readers of this site would lend a hand to that one.

Full disclosure: Not only is Chris a friend and colleague, he also happens to be one of my hosting clients, so in that sense this may be a bit self-serving.

I just posted an entry noting that Washington State was reporting having exactly 156,155 paid exchange-based QHP enrollments as of June 1st.

Now, this is noteworthy because according to an earlier update, as of around a week earlier, the state had reported adding "between 2,000 - 3,000" exchange QHP enrollees between the end of open enrollment on 3/31 (WA did not offer an extension period) and May 27th; let's split the difference and call it 2,500. Add that to the official 3/31 total and you get around 166,500.

What accounts for the roughly 10,000 person difference? Well, the first number includes both enrollments and cancellations after the first month. Remember, Washington State only reports enrollments once the first month's premium has actually been paid, so these should be "clean" numbers.

WOW!! This article from last week is chock full of data-nuggety goodness, including the first solid updates out of Washington State in some time:

The share of Washingtonians going without health insurance has fallen by nearly 40 percent, thanks to factors put in play by the federal Affordable Care Act.

That’s the word from the state Office of the Insurance Commissioner, which estimates that the overall 970,000 of uninsured residents had fallen by 38 percent to about 600,000. That drops the uninsured rate to 8.65 percent of the state, down from about 14 percent, OIC spokeswoman Stephanie Marquis said Wednesday.

...OIC has said the individual market has grown to more than 327,000 – which was about 81,000 more insured people than were in the individual market on Oct. 1, the date that the Washington Health Benefit Exchange opened for enrollments for 2014 coverage. The individual market included 156,155 people buying private insurance policies through the exchange and 171,286 who bought policies outside the exchange.

VERY interesting news out of Oregon. On the one hand, the gross QHP enrollment figure, which had been cut in half from 300/day down to 156/day is back up to over 200/day, right in line with the rebounds from Hawaii and Minnesota!

On the other hand, unlike last week when the net enrollment figure dropped from 280/day down to a measely 10 in an entire week, the number today is actually lower than it was a week ago!

July 14 NET enrollments: 82,637; July 21 NET enrollments: 82,183...a drop of 454 people.

July 21, 2014

Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 322,707
Total private medical insurance enrollments through Cover Oregon 1: 95,115 
Oregon Health Plan enrollments through Cover Oregon: 227,592

Net private medical: 82,183

Contributor deaconblues provides a very nice catch today: A story about Wisconsin's enrollment figures which gives all the tools necessary to calculate the state's total and paid QHP enrollments as well as the off-exchange total to boot...all without actually providing any of those numbers, which is kind of a neat trick!

Let's break it down:

Wisconsin’s Office of the Commissioner of Insurance has released information concerning the number of people that have acquired health insurance coverage as of June 1 of this year. The state’s Governor, Scott Walker, intends to cut the number of uninsured people throughout Wisconsin in half within the foreseeable future. According to state officials, the number of uninsured people in the state as of March of this year stood at 556,000.

Some 166,000 Wisconsin residents have purchased health insurance over the past several months, according to the Office of the Insurance Commissioner. Of these, some 134,000 people purchased coverage from the state’s health insurance exchange.

Hmmm...as a follow-up to the last Hawaii update, I've taken a look at Minnesota (the 2nd of the 3 states which caused me to issue a dramatic off-season forecast drop). The results are...inconclusive:

latest enrollment numbers

July 16, 2014

Health Coverage Type Total Enrollments 
Medical Assistance 156,032
MinnesotaCare 55,941
Qualified Health Plan (QHP) 52,325
TOTAL 264,298

That's 61 more QHP enrollees in 3 days (7/13 - 7/16), or about 20 per day. On the one hand, that's still way down from the 52/day that the state had been averaging from late April through the end of June. On the other hand, it's way up from the 2 (yes, 2) per day that MN was averaging over the first 2 weeks of July.

Huh. A week ago I posted a Hawaii update which noted that exchange QHPs for Hawaii had actually dropped by 156 people from 6/28 through 7/05. This was quickly followed by similarly huge enrollment drop-off figures out of both Oregon and Minnesota.

However, check it out today...

Connector Updates for July 12, 2014

Total since October 1, 2013

32,991 Applications completed in the Individual Marketplace
9,675 Individuals and families enrolled in the Individual Marketplace
675 Employers applied to SHOP Marketplace
1071 Employees and dependents enrolled via SHOP Marketplace*
* as of July 15, 2014

As I noted way back in October (seriously, I made a note of it at the bottom of the spreadsheet the very first week), the ACA situation in Guam, American Samoa, Puerto Rico, the U.S. Virgin Islands and the Northern Mariana Islands is, to put it mildly, kind of screwed up. Due to some massive oversights, they were stuck with some of the ACA's provisions (no denials for pre-existing conditions, having to accept everyone, etc.), but didn't get the other key provisions (no exchanges, no subsidies). As a result, it's been a bit of a mess.

Thankfully, the problem has been "solved", although not quite the way the Obama administration intended:

Guam and the four other American territories got some good news this week: they will no longer be held hostage by a byzantine set of Obamacare rules and regulations.

As deaconblues notes, a mixed bag. Scott Walker kicked 63,000 people off of Medicaid, of which 38,000 weren't able to receive coverage of any sort. On the plus side, over 97,000 additional people were added to Medicaid coverage.

So, if I'm reading this correctly, it sounds like Wisconsin's Medicaid program added around 160,000 people but lost 63,000 to get the net of +97K.

Coverage ended in April for 62,776 people who earn too much to remain on Medicaid; they had until June 1 to buy the federally subsidized insurance offered through the federal online marketplace where applicants can shop for plans.

The new DHS numbers show that 30 percent, or nearly 19,000 people, purchased a plan through the exchange by the June deadline. Nearly 5,900 more, or 9 percent, either became Medicaid-eligible and received coverage through the state's BadgerCare Plus program or were enrolled in both Medicaid and the exchange.

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