Charles Gaba's blog

Over at the Washington Post, Catherine Rampell has an article which confirms EVERYTHING that I and other healthcare wonks have been warning about for months (or years) regarding the real-world impact of imposing work requirements for Medicaid expansion recipients:

...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.

...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.

...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

OK, this is a bit embarrassing. I've made a point of calling attention to the widely varying Open Enrollment deadlines from state to state, and I also made sure to write up a blog post regarding Covered California, which started their 2019 Open Enrollment period a full two weeks earlier than everyone else, on November 15th.

However, I completely forgot that New York State of Health does things sort of the opposite way: While new enrollees could start signing up for 2019 coverage as early as November 1st, existing enrollees had to wait two weeks into Open Enrollment to actively renew or change their policies:

Press Release: NY State of Health Annual Renewal Begins Today!
Nov 16, 2018

2018 Qualified Health Plan Enrollees Can Renew Their Coverage for 2019 Now

We're over 1/3 of the way through the 2019 Open Enrollment Period in most states, so I figured this would be a good time to check in and see where things stand.

For the most part things are pretty close to where I estimated they'd be--HealthCare.Gov is running about 13% behind last year as of the same point, but Colorado is running 13% ahead; Minnesota and Washington State are both around 5-6% ahead; and Connecticut is running dead even. I still don't have any data from California, which holds around 13% of all ACA enrollees nationally, nor do I have data from any of the other 7 state-based exchanges (DC, ID, MD, MA, NY, RI or VT).

Connect for Health Colorado® Reports Increase in 2019 Medical Plan Selections

DENVER — More than 25,000 Coloradans selected health coverage through Connect for Health Colorado® between Nov. 1 and Nov. 15, a number 13 percent ahead of the pace one year ago, according to new data released today.

“This number of initial sign-ups is the strongest start to an Open Enrollment Period we have seen,” said Connect for Health Colorado® CEO Kevin Patterson. “By acting early, these Coloradans will ensure their health coverage is in place Jan. 1, 2019, protecting their health and their family finances.”

The two-week period saw 25,614 medical plan selections. The total was 22,650 medical plan selections for the comparable period in 2017. Twelve percent of the plan selections are by customers who are new to Connect for Health Colorado and 88 percent are renewing customers.

The midterms are over, and the Democrats won back the U.S. House, so the ACA is (mostly) safe at last, right?

Well...maybe. In addition to the ongoing regulatory sabotage by the Trump Administration to undermine, weaken and generally piss all over the law as much as possible, there's also still a little thing called Texas vs. Azar, aka the #TexasFoldEm federal lawsuit. Oral arguments were held way back in early September, and right-wing Judge O'Connor claimed that he'd rule on a preliminary injunction "quickly" afterwards.

Well, today is November 18th, and there's been nary a peep from Judge O'Connor. Does 75 days later count as "quickly"? In judiciary time, I suppose it might.

via Christine Stewart of CT News Junkie (11/15/18):

Access Health Enrollment Off To Steady Start

HARTFORD, CT — The number of customers purchasing plans through Connecticut’s insurance exchange is around what it was last year in the first two weeks of open enrollment.

Since Nov. 1, 12,777 customers have shopped and purchased a plan for 2019, according to Access Health CT officials. That means about 85,000 enrollees have yet to renew into a 2019 policy.

...Traffic on the website is trending about 18 percent higher than it was at this time last year, according to Access Health CT’s Director of Technical Operations and Analytics Robert Blundo.

...An estimated 60 percent of customers are picking plans that are different from their plan in 2018 and that’s compared to only 18 percent who were changing their plans last year. It also means there are a higher percentage of customers using brokers to help them make a decision about the health plan that’s right for them.

This is welcome news...

Illinois Senate voted unanimously to override the Governor's veto of a bill to limit short-term health plans to 6 months. Protecting consumers and insurance markets from long-term short-term plans does not appear to be a partisan issue. https://t.co/fJ4NVV4LRQ

— Dania Palanker (@DaniaPal) November 15, 2018

FULL DISCLOSURE: HealthSherpa has a paid banner ad at the top of ACASignups.net.

As I noted last week, HealthSherpa is indeed a paying advertiser on the site. However, since they happen to specialize specifically in selling ACA-compliant individual market policies through the ACA exchange (they're an authorized 3rd-party online brokerage), they're also an excellent "finger on the pulse" of Open Enrollment data, providing more-detailed weekly data than CMS usually does; I'd be posting their stats whether they were an advertiser or not.

According to HS's latest blog post, they've enrolled 78,684 people in ACA exchange plans for 2019 in the "first two weeks". I don't know if "two weeks" means as of November 14th or as of November 10th as CMS defines it (they run "weeks" from Sunday - Saturday, so Week 1 only included 3 days this year).

 

Hey, remember this? That's Zombie-Eyed Granny Starver Paul Ryan and his motley crew yucking it up right after voting to strip away healthcare coverage from 23 million people on May 4, 2017 by passing the American Health Care Act (AHCA), which not only most repealed the ACA but also gutted Medicaid spending and a bunch of other nasty stuff.

Well, what goes around comes around, which the House Democrats clearly knew at the time; as you can hear in the video, they were actually singing "Hey, hey, goodbye!" to the House Republicans immediately after the vote, because they knew exactly what the consequences would be of passing that pile of elephant poop.

Sure enough, exactly 551 days later, the 2018 Midterm Elections caused a Big Blue Wave to crash over the House GOP.

Week 2 via CMS:

Week 2, Nov 4-10, 2018

In week two of the 2019 Open Enrollment, 804,556 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.

This Just In via MNsure, Minnesota's ACA exchange...

More than 97,000 Minnesotans have signed up for private health plans through MNsure since the start of open enrollment
Open enrollment runs until January 13, 2019

ST. PAUL, Minn.—Today MNsure announced that over 97,000 Minnesotans have signed up for private health plan coverage through MNsure during the first two weeks of open enrollment.

MNsure's open enrollment runs until January 13, 2019. For coverage that begins January 1, 2019, Minnesotans must enroll by December 15, 2018.

“We are excited with our smooth start to open enrollment and that over 97,000 Minnesotans have signed up for private health plans,” said CEO Nate Clark. “With rates decreasing from 7 to 27 percent across the state, we encourage Minnesotans to visit MNsure.org to see if they can save.”

BY THE NUMBERS—

Over at Bloomberg News, Aziza Kasumov has written up what is, for the most part, an excellent profile of a middle-class family who crystalize the single biggest real flaw in the design of the Affordable Care Act (as opposed to the bullshit ones made up by opponents over the years): Those enrolled in individual market policies who earn more than 400% of the Federal Poverty Level (around $48,000/year for an individual, or $98,000 for a family of four):

David and Maribel Maldonado seem the very definition of making it in America. David arrived in the U.S. from Mexico as a small child...His wife Maribel, whose family is also from Mexico, worked as a hairstylist while caring for the couple’s two children. David’s annual salary reached about $113,000 by the time the children were in their teens. It was more than enough to live in a pretty suburban house outside Dallas, take family vacations, go to restaurants and splurge at the nearby mall. And to afford health insurance.

The bold-faced bit above has some relevance later in the story.

With the 2018 Midterm Elections mostly out of the way (there's still at least 7 statewide races which haven't been called yet in Georgia, Florida and Arizona which are currently in the process of various counts, recounts and/or run-off elections), the Democratic Party has indeed retaken the U.S. House of Reprentatives by a solid margin, adding anywhere from 33 - 40 House seats when they only needed a net gain of 23 to take control. Starting in January, the House Democrats will be able to vote on and pass pretty much whatever bills they want, presumably under the leadership of Nancy Pelosi as Speaker of the House.

Last year, the Washington Health Benefit Exchange reported enrolling roughly 4,500 new ACA exchange enrollees in the first 8 days, which was a whopping 53% increase over 2017. This was in addition to what I estimated was roughly 13,000 current enrollees actively renewing their existing policies or switching to a different one, for a total of perhaps 17,500 QHP selections.

This year, the WA exchange hasn't posted any official press release yet, but the Seattle Times claims that they've already enrolled over 190,000 people:

Despite changes to the Affordable Care Act during the past couple of years, local health-insurance officials are optimistic that the state’s health-insurance exchange will flourish in 2019.

Since enrollment for 2019 began Nov. 1, about 190,000 people have signed up for health insurance through the Washington Health Benefit Exchange, which is about 5 percent more than the same period last year.

Press Release: NY State of Health Drives Home the Importance of Affordable Health Coverage with Ridesharing Partnerships
Nov 9, 2018

Collaborations with Lyft, Uber, Independent Drivers Guild Reach Drivers Across NYS 

ALBANY, NY (November 9, 2018) – NY State of Health, the state’s official health plan Marketplace, today announced it is partnering again during the Open Enrollment Period with ridesharing companies Lyft and Uber, and with the Independent Drivers Guild. Through the partnership, tens of thousands of drivers throughout New York State will be urged to visit the Marketplace to shop for and enroll in quality, affordable health insurance. Open Enrollment for 2019 coverage began November 1. Consumers must enroll by December 15, 2018 for coverage beginning January 1, 2019.

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