So one important practical question Halbig raises is this: what makes a state exchange a state exchange? If the view of the 2-1 majority in Halbig were to prevail at the Supreme Court (a prospect I’d still consider unlikely, because the reading of the statute is so wildly implausible), then what is the minimum a state can do that counts as a “state exchange” for purposes of receiving the federal subsidies?
Nice find by Esther F. The main focus of the story is that a 5th insurance company has decided to join 4 others on New Mexico's ACA exchange, which is of course good news for competition, the free market and so forth...
The newest insurer is CHRISTUS Health Plan of Texas, Franchini said during a meeting of the NMHIX board in Santa Fe.
“CHRISTUS is a nonprofit and they will be on the exchange. They will be the fifth carrier on the exchange,” Franchini said.
CHRISTUS will join New Mexico Health Connections, Presbyterian Health Plan, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico as the firms that will sell in the individual exchange.
...however, Esther notes a potentially far more significant section of the story farther down. The backstory is this: New Mexico has been planning on running their own exchange for the 2nd year of open enrollment, but has more recently been having second thoughts given the various technical issues faced by some of the other state exchanges. Therefore...
So, this morning's big Halbig-related development is that Reason.com has dug up a video of a presentation by MIT economist Jonathan Gruber from January 2012. Gruber was one of the main architects of the health insurance law in Massachusetts (RomneyCare) and the national version (the ACA, aka Obamacare). In his presentation, Gruber states:
What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this. [emphasis added]
Some of the various state-run exchanges continue to experience assorted technical issues, ranging from minor to serious. I may be rooting for the ACA to work, but as a website developer and a member of the Reality-Based Community, I do need to fully acknowledge that it's not all sweetness & light on the tech side these days. These issues will be resolved eventually, but you can't just ignore them either. So, without further ado...
Snowballing technological problems at Vermont’s online insurance exchange are drawing new scrutiny. And advocates warn that the situation for many customers who bought plans through Vermont Health Connect is becoming increasingly dire.
OK, with all the fuss about the Halbig decision, people have been flooding me with a bunch of stories about both that as well as other ACA-related topics. I can't address them all fully, so here they are in bite-sized format:
Millions of Americans can expect to get a refund from their insurance companies this year, at an average of about $80 dollars per family, thanks to a little-known Obamacare provision that’s helping people save money on their premiums. According to a new report released by the Health and Human Services Department on Thursday, Americans across the country have received a total of $1.9 billion dollars in rebates since this provision first took effect in 2011.
Normally this would be a lengthy entry, but given that there have already been 4 other major national surveys saying the same thing, the latest news is just locking things down.
The New England Journal of Medicine just published a new report which concludes (shocker) that there's been a net reduction in the number of uninsured U.S. adults by around 10.3 million since the ACA exchanges went into effect:
As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.
OK, I've had a chance to download the actual Excel file with the raw data and a handy graph already set up; I've cleaned up and color-coded the graph, and it's fascinating to look at, both during open enrollment as well as since it ended The things which stand out the most:
The obvious dead zone in October and most of November, finally coming to live around Thanksgiving time
The gradual rise in December, culminating in a large spike on Christmas Eve (the "official" deadline for January 1st coverage, although that varied in some states)
The massive spike in late March, culminating in a nearly off-the-chart peak on the "official" open enrollment deadline of March 31st, which saw over 200,000 transactions by itself
Yes, I'm quoted in this breaking story; Mr. Ornstein contacted me earlier today to ask my thoughts on his scoop, and I agreed to keep mum until it went public:
For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using Healthcare.gov by April 19, the end of the open-enrollment period.
But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.
Now, before everyone jumps on the "1 million" figure, a few important things:
When I posted my dumb-simple solution/workaround to resolve the Halbig decision back on July 2nd (assuming that it's upheld, which is by no means guaranteed), I meant it seriously, but figured that no one else would. I mean, really...the salvation of the most important healthcare law of the past 50 years and the single most important accomplishment of the Obama administration could end up being as simple as registering 3 dozen domain names and putting up a splashpage?
For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems.
Regular readers of this site know that I have a checkered history with Forbes writer Chris Conover. It's been mostly on the hostile side, but he's also occasionally brought up a valid point which I've incorporated into my estimates; in particular, the "Sub26er" estimate has been changed from a flat 3.1 million to a range between 1.6 - 3.1 million in part due to his information (as well as Glenn Kesslers'). I believe the term which applies on both of our parts is "grudging respect" though I could be wrong at his end.
Thanks to the Washington Post's Greg Sargent for the heads up on a new national CNN poll about the ACA. Here's the key findings...and kudos to CNN for clearly distinguishing between those who oppose it for being "too liberal" (which basically means they don't like Medicaid expansion and tax subsidies) and those who oppose it because they want Single Payer (which includes myself, although that doesn't mean I oppose the law, since I see it as a path towards single payer):
According to the poll, only 18% of the public say they or their families are better off now that the major provisions of the health care law have been implemented. Another 35% report that, while their lives have not improved, the Affordable Care Act has benefited other people in the U.S. Add those two numbers together, and that means 53% say that Obamacare has helped either their families or others across the country.
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?
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