Charles Gaba's blog

Two Big ACA-related Announcements are coming up in the next 24 hours; one is pretty much meaningless, the other could be meaningful:

First, as reported by Dylan Scott over at TPM:

At 10 a.m. Tuesday, the Census Bureau will release a new report on health insurance in America.

...The problem with the new numbers, according to the Kaiser Family Foundation's Larry Levitt, is that the Census Bureau's survey cuts off at March 31. That means 3 million people-plus who signed up in the law's final weeks of enrollment will still count as uninsured, even though they have since been covered.

"I think it’s fair to say tomorrow’s release will be essentially meaningless in judging the effects of the Affordable Care Act," Levitt told TPM in an email.

  • 1. October 2013: "No one can enroll!!"

(ok, this one is a gimme; the technical mess at HC.gov and some of the state exchanges did make it almost impossible for anyone to sign up the first month.)

  • 2. November 2013: "No one will enroll!!"

...which was clearly already being proven wrong by the time Thanksgiving rolled around.

  • 3. December 2013: "Hah! They'll never break a million!!"

...that is, until the Christmas/New Years spike, which brought the total enrollee figure up to over 2.1 million.

  • 4. January 2014: "OMG!! 5 GAZILLION POLICIES WERE CANCELLED!!"

...which actually turned out to be only around 1-2 million people at most, the vast majority of which (including myself) simply swapped out their old policies for new ones.

Me, June 26:

As an aside, I also question the wisdom of not requiring everyone to re-enroll each year. Obviously HHS is trying to minimize the inconvenience/hassle factor, but it seems to me that this is just going to cause even greater confusion than it would if they simply issued a blanket statement: If you enrolled via an ACA exchange, you have to renew once a year even if nothing else has changed.

I don't see doing this as a big deal; people have to renew their license plates every year even if it's for the same car, for example.

Sam Baker, National Journal, August 6th:

"We get into a very dangerous situation if we just tell everybody they can just auto-enroll," Houchens said.

Again, all of this is avoidable. These are the risks of auto-renewal. Anyone who goes back in to HealthCare.gov to get a new eligibility determination will see their updated subsidy as well as the current list of available plans.

I'm about to show you a chart which demonstrates several noteworthy things about QHP enrollment in Oregon (which, in spite of the terrible technical problems their site has had, has managed to enroll a similar ratio of their uninsured residents in private policies (around 34%) via their exchange to Kentucky, which is considered one of the most successful exchanges).

First, here's the latest numbers, as of 4 days ago:

September 10, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon

Medical enrollments through Cover Oregon: 353,454
Total private medical insurance enrollments through Cover Oregon: 101,092

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 1: 20,686

Net enrollments 
Net private medical: 78,616
Net private dental: 14,603
 

1 Total numbers are the number of enrollments that have occurred through Cover Oregon.

Last week I noted that the "OMG!! GAZILLIONS OF POLICIES CANCELLED!!!" freakout over non-ACA compliant healthcare policies being sunsetted to be replaced by policies which are compliant with the law is about to raise its ugly head again this fall. Sure enough, we're off and running in Virginia:

After a year’s reprieve, up to 250,000 Virginians will receive notice by the end of November that their health insurance plans will be canceled because the plans do not comply with the Affordable Care Act and accompanying state law.

The affected policyholders were allowed to renew their old plans late last year, even though the plans did not provide all of the benefits required under the health care law, but they won’t have that option when the policies expire this year.

I went with 240K instead of 250K because later in the article it says:

OK, I admit that aside from tracking the actual enrollee numbers, I don't know a whole lot about the inner workings of Medi-Cal, California's version of Medicaid. However, if accurate, this just sounds...wrong:

California Governor Brown Still Wants to Steal My Home

I posted a diary here on August 26 about California turning Medi-Cal into a long term loan for recipients aged 55+ by billing their estates after they die for all of their Medi-Cal expenses.  The bureaucrats call that “estate recovery.”  I call it legal theft. A bill to remedy this situation and protect low income property owners has unanimously passed the California legislature. The bill has now gone to the governor to be signed. But he is  planning to veto it!

Today, many organizations are jointly sponsoring a call-in to the governor's office to put pressure on Governor Brown to sign SB 1124.  More information about the call-in is at the bottom of this diary.  But first, some background information.

Three important pieces of information about Nevada's exchange out of this article:

1. NV's move to HC.gov will be permanent. The original plan was to only move to the federal exchange for 2015, then moving back to their own (2nd attempt) platform for 2016, which frankly always sounded a bit silly to me. There were lots of reasons for the states to run their own exchanges originally (federal cash to do so, autonomy/local control, etc.), but the federal funding will have dried up by then, and if everything is running smoothly at HC.gov, I'm not sure I see the point in uprooting the whole system at that point. Frankly, there's really only one major reason I could see to move back to their own platform, but...

2. While NV will be using the HC.gov software platform, they'll still legally be considered a state-run exchange, which means that they're safe from any potential SCOTUS Halbig/King fallout. This is basically the entire point I was making way back on July 2nd with my "Domain and a Splashpage" solution.

SEE??? I KNEW IT!!!

Without an Obamacare critic to talk to, Klepper turned to a nurse who lost her free clinic job because her patients could finally get health coverage. And she was thrilled about that turn of events. Now, she told him, she was focusing her efforts on other causes, like human trafficking.

“‘Obamacare Forces Nurse into Sex-Slave Trade,’” Klepper said, imagining the headline. “That is great!”

On the one hand, I always thought that reducing healthcare spending was supposed to be a good thing. On the other hand, apparently to most economists, increasing spending overall is supposed to be a good thing. So...um...ok, then:

WASHINGTON (Reuters) - The U.S. economy likely grew at a much faster pace in the second quarter than previously estimated, according to data on Thursday that showed a big jump in healthcare spending.

The Commerce Department's quarterly services survey, or QSS, showed healthcare outlays increased at a much brisker clip than the government had assumed in its last estimate of gross domestic product in late August.

As a result, economists said healthcare spending could add as much as three-tenths of a percentage point to second-quarter GDP growth, taking it to as high as a 4.7 percent annual rate.

It's been awhile since I've beaten up on Mitch McConnell (R-Yertle) for his cognitive dissonance when it comes to somehow keeping "Kynect" (ie, the Affordable Care Act) while simultaneously repealing "Obamacare" (ie, the Affordable Care Act).

As I noted back on May 29th, "McConnell is utterly full of crap. He knows it, Grimes knows it, the Kentucky media knows it; he's just hoping that the voters of Kentucky are too stupid to know it."

At the time, the Kynect ACA exchange had enrolled around 413,000 people. Since then, the number of Kentuckians enrolled via "Obamacare" has risen to over 521,000 (and even that was over a month ago; it's likely past the 550K mark by now).

Back in May, California was contending with a whopping 2.2 million new Medi-Cal (Medicaid) enrollees being added to the system. The logjam resulted in a backlog of 900,000 people.

By July 23rd, the backlog had been reduced by 1/3 to 600K. By August 20th, it was down to 490K. And today, Health Access CA reports that...

Pending backlog now down to 350,000 Medi-Cal applicants (from 900,000)--from the DHCS Medi-Cal Stakeholders Advisory Committee. #ACA #HCR

— Health Access CA (@healthaccess) September 11, 2014

Still a long way to go, but they're getting there...

An Open Letter to Democratic U.S. Congressional Candidates:

As I've noted before (and as others, such as Greg Sargent of the Washington Post have confirmed), when it comes to the Affordable Care Act, the Republican Party has been reduced, at this point, to literally running against the word "Obamacare" instead of the actual law itself.

By this point in the 2014 campaign cycle, those of you with any sense have moved from running away from the Affordable Care Act to going on offense by not only defending the law but actively pointing out the benefits that it's bringing to your constituents (or at the very least actively countering bald-faced lies about it from your opponent).

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:

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