Charles Gaba's blog

Of course it would've been even more "win, win, win all around" if they'd just done this 9 months ago, but I'll take it...

The Obama administration has agreed in concept to Utah’s novel alternative to expanding Medicaid, including the notion that able-bodied people who get insurance subsidies should accept the state’s help with finding work, Gov. Gary Herbert said late Tuesday.

The governor said after a meeting with Sylvia Burwell, secretary of the Department of Health and Human Services, that a final agreement is two or three weeks away.

HHS did not agree that insurance subsidies would be contingent on recipients holding a job or looking for work, but the agency did agree that employment can be a goal of Utah’s program, Healthy Utah.

"It’s a win, win, win all the way around," the governor said, describing the negotiations as resulting in federal approval of 95 percent of his Healthy Utah plan.

The estimate of how many Utahns would be eligible ranges from 54K - 75K; I have it down as 61K, right in the middle.

Michigan's ACA expansion program has understandably slowed down, adding only 2,573 more people over the past 2 weeks, but it still deserves kudos for breaking 75% of the total Michiganders eligible (500K) in only a bit over 4 months.

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 375,744
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 8, 2014 
*Updated every Monday at 3 p.m.

This is very good news all around. Not only is a 3% increase pretty small, it's a dramatic reversal of typical increase prior to the ACA kicking in in 2010:

Menlo Park, Calif. – Average annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, continuing a recent trend of modest increases, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey released today. Workers on average pay $4,823 annually toward the cost of family coverage this year.

This year’s increase continues a recent trend of moderate premium growth. Premiums increased more slowly over the past five years than the preceding five years (26 percent vs. 34 percent) and well below the annual double-digit increases recorded in the late 1990s and early 2000s.  This year’s increase also is similar to the year-to-year rise in worker’s wages (2.3 percent) and general inflation (2 percent).

There's a whole section which goes into the impact of the ACA on this trend:

Contributor ArcticStones forwarded this to me. I'm not in a position to either confirm or debunk many points in this article, but a quick search of this site for "Massachusetts Limbo" will bring up a number of references made in it. The author is a quite open Republican activist. However, if his claims are correct--and the bulk of them certainly seem to be--then those in charge of the first version of Massachusetts' ACA exchange should be held accountable for some rather appallingly bad decisions before, during and after the 2014 open enrollment period.

I generally support the Affordable Care Act, and states like Kentucky, Connecticut and (for the most part) Washington State, New York, Rhode Island and Colorado have proven that when the technology, budget, personnel and other project aspects are handled properly, it can be extremely successful. However, that also means not turning a blind eye or blaming the wrong source when things go wrong...and in the case of states like Oregon and Massachusetts, things did indeed go very, very wrong.

I've been shouting from the rooftops that auto-renewing your ACA policy is a bad idea, for a variety of reasons, since at least June.

Now it turns out there's another good reason to read the fine print before just blindly renewing (and this is a Good Thing®):

The benefit packages of lower-cost bronze and silver-level health plans — sold through the state's health insurance exchange — aren't as expensive as they might seem at first, they say.

Carolina Coleman, the project's research director, and John Connolly, the nonprofit's deputy director, say that many consumers who focus only on their high deductibles may be missing some gems hidden in their existing policies.

...With out-of-pocket costs rising, Weinberg of the Bay Area Council says, patients need to take a more active role in navigating their benefits.

In The Hill yesterday, Elise Viebeck posed 5 reasonable questions about the upcoming 2nd Open Enrollment period, set to run from 11/15/14 - 2/15/15:

  • Is ready?
  • Are three months enough?
  • What are consumers hearing?
  • What about cancelled plans?
  • Who will take the fall for problems?

Fair enough. I have my own questions to add to these, however:

Will the House GOP Commerce & Energy Committee finally admit that yes, around 90% of all QHP enrollees are actually paying for their first month's premium?

Will Avik Roy finally admit that yes, the majority of QHP enrollees are newly enrolled?

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

D.C.’s health exchange is still hampered by delays, glitches 11 months after launch

While Democratic partisans tout the latest conventional wisdom that Obamacare is finally going strong, the experience of many ordinary people who apply for it says otherwise.

The ongoing delays and irritation that consumers endure while navigating the District’s health insurance exchange offer a window into the reality on the street.

More health insurance options increase choice — and possibly confusion

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

McAuliffe unveils 10-step plan to expand health coverage for Virginians

Beyond that [the 25,000 people being added to Medicaid], the strategy seeks to chip away at the ranks of the uninsured, by enrolling them in programs they already qualify but haven't signed up for. The state will launch a website to help Virginians enroll in health care coverage through existing programs such as Medicaid and will step up efforts to sign up more Virginians for the federal health insurance exchange,

Bill Straub: Kentucky GOP’s rendition of ‘I’m Against It’ may hit sour note on health care

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

Health Insurance: Enrolling Rural America

Americans living in rural areas will be a key target as states and nonprofit groups strategize how to enroll more people in health law insurance plans this fall.

Though millions of people signed up for private insurance or Medicaid in the first year of the Affordable Care Act, millions of others did not. Many live in rural areas where people “face more barriers,” said Laurie Martin, a RAND Corp. senior policy researcher. Brock Slabach, a senior vice president at the National Rural Health Association, said “the feds are particularly concerned about this.”

More legislators want to shut down Cover Oregon

That's 156 more QHPs in the past 6 days, and 5,681 more added to Medicaid:

latest enrollment numbers

September 8, 2014

Health Coverage Type Total Enrollments
Medical Assistance 196,027
MinnesotaCare 70,893
Qualified Health Plan (QHP) 54,510
TOTAL 321,430

Woo-Hoo! My son's fever finally broke, and my internet service is back on; things are looking up!

I can post a couple of updates now:

At the end of July, Connect for Health Colorado had enrolled just over 140K people in QHPs via the individual exchange, plus around 2,400 small business employees/dependents in SHOP plans.

As of the end of August, these numbers are up to 143,524 and 2,470 respectively.


a) My son has a 102° fever & is home sick from school
b) My ISP connection is down and I'm posting this from my iPhone
c) I'm swamped with work from my day job and have to focus on that the best I can
d) All of the above

If you picked d), Mazel Tov!

Back in action tomorrow (I hope).

My last official update of Medicaid expansion in Arkansas (via their "private option" system) had the number at 192,210 as of 8/08. They've added nearly 13,000 more since then:

Thru 8/31 205,097 Arkansans have gained coverage via the "private option" for Medicaid expansion.

— David Ramsey (@ArkDavey) September 8, 2014

UPDATE: More details from Ramsey re. the 205K breakdown:

  • 172,761 are enrolled in private QHP plans via Medicaid funding (the "private option" part)
  • 21,496 were routed over to "regular" Medicaid due to the specifics of their situation
  • 10,840 are still being processed; they're covered by Medicaid until their status is resolved

The headline certainly seems like a Bad Thing, as does the opening paragraph...

Shift in Oregon Health Plan cuts funds to Eugene shelter program

EUGENE — One of the last resorts for mentally ill people in Eugene suffering a crisis will be closed this month after a change in state health care policy took one-third of a shelter's money.

Bummer. See? Obamacare is hurting people...wait, what's that??

Lane County public health spokesman Jason Davis says the expansion of the Oregon Health Plan means there are fewer indigent, uninsured mentally ill people who need short-term crisis housing.

With fewer clients forecast to be in indigent programs, the state is reducing contracts with agencies.

Oh. Never mind.

Reminds me of the "joke" that if Barack Obama cured cancer, Republicans would attack him for hurting oncologists.

The Republicans controlling the Virginia state legislature have been fighting tooth & nail to prevent 400,000 of their fellow Virginians from receiving healthcare, but Democratic Governor Terry McAuliffe has finally found a way to squeeze 25,000 people onto Medicaid anyway by reshuffling the deck of existing executive regulatory rules:

RICHMOND — Gov. Terry McAuliffe (D) on Monday unveiled a plan to insure an additional 25,000 Virginians, a measure that falls far short of his vow to defy the Republican-controlled legislature and find a way to expand coverage to 400,000.

After losing a months-long Medicaid fight in June, McAuliffe declared that he would close the “coverage gap” on his own.

On Monday, he announced a much more modest series of proposals, primarily designed to improve care for people already in Medicaid and boost outreach efforts to people who already qualify for it, but are not enrolled.

The plan would change enrollment criteria for about 25,000 people, including 20,000 who are severely mentally ill and 5,000 children of state employees.