Charles Gaba's blog

I've posted several times about the appalling shamelessness of Republican candidates trying to take credit for the Affordable Care Act's Medicaid expansion provision (which was only possible thanks to Democrats) while continuing to badmouth the law itself.

Then there's the ones who try to take credit for Medicaid expansion finally being put into effect even though it was their own ineptness which dragged the process the case of Michigan, needlessly putting hundreds of thousands of people through 3 months of unnecessary anxiety and medical risk while costing the state hundreds of millions of dollars in federal funds in the process:

I'm sure FOX News will find a way to spin this as a negative...

Washington hospitals provided nearly $154 million less in charity care in the first half of this year than in the first half of 2013, in many cases boosting the hospitals’ bottom lines.

Hospitals attributed the plunge in charity care — about 30 percent — to the Affordable Care Act’s focus on reducing the number of uninsured patients.

This year, for the first time, low-income and uninsured patients whose care was previously covered under hospitals’ charity-care programs were able under the ACA to qualify for Medicaid coverage or subsidized private insurance.

The HHS Dept. and Enroll America will be pushing individual stories as well as the increased financial penalty to increase enrollment this year:

The sales pitch for the health law is getting an overhaul for the fall.

Unfortunately, I don't know the market share breakdown, so I can't do a weighted average, but the DC Health Link exchange rates for 2015 have been released, and the unweighted average is only a 2.3% increase for the individual market. For the SHOP (small business) exchange the news is even better...a decrease of over 2% (again, unweighted). The SHOP rates carry a lot more heft in DC than in most states due to the unique rules in place there (like Vermont, all individual enrollment has to be done via the ACA exchange, and all Congressional staffers are required to enroll via the DC SHOP system):

The D.C. Department of Insurance, Securities and Banking today announced the approved health insurance plan rates for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2015.

Eight carriers through four major insurance companies – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – will have plan offerings for individuals, families and small businesses on DC Health Link when enrollment opens Nov. 15, 2014.

Ouch. While most states are seeing their list of insurance providers increasing this year, in a few cases some are dropping out...and in the case of Minnesota, it's the one with 59% of current enrollees:

The insurer with the lowest rates and most customers on Minnesota's health care exchange is pulling out.

Golden Valley-based PreferredOne this morning confirmed its exit from MNsure. It comes as a major blow to the exchange — the next open enrollment period starts Nov. 15 and runs through Feb. 15.

MNsure officials said the online insurance exchange would reach out soon to PreferredOne customers who bought coverage through MNsure last year with information on next steps.

They said consumers still have at least four, well-known, Minnesota-based carriers "who are committed to providing important health coverage" to everyone, including people who qualify for tax credits and public programs.

...According to a company statement, MNsure policies make up only a small percentage of PreferredOne's entire enrollment but take up a significant amount of resources to support.

Reposted with permission/by request.

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice – – -
though the whole house
began to tremble
and you felt the old tug
at your ankles.
‘Mend my life!’
each voice cried.
But you didn’t stop.

You knew what you had to do...

From The Journey by Mary Oliver is a pretty conservative outlet, but Peter Suderman has an entry which asks some refreshingly valid questions. He starts with an overview of the report released yesterday by the CDC, which noted an overall drop in the uninsured number by about 3.8 million as of the end of March. To his credit, he follows up by calling attention to the fact that this doesn't include over half of the total QHP enrollments (as well as a lot of Medicaid additions):

But this survey probably doesn’t measure the full impact of the law. That’s because the survey was conducted from January through March of this year, when Obamacare’s open enrollment period was still ongoing. So it wouldn’t capture much of the last-minute enrollment surge that accounted for a significant portion of the sign-ups under the law. People who signed-up at the end of March, or in the extended enrollment period in early April, wouldn’t have technically been insured for another month or more.

When I last updated Kentucky's numbers on August 8th, Gov. Beshear had just repeatedly stated the latest number of people enrolled via the Kynect exchange as 521,000. He didn't break this out between QHPs and Medicaid, but I used a conservative estimate of around 91K & 430K respectively. Today, the Lt. Governor gave a similarly non-broken-down update:

Kentucky Lt. Gov. Jerry Abramson talked about Kynect earlier today during an appearance at the Kentucky Medical Association's annual meeting. At the event, he said implementing an exchange was necessary because it increased access to health care in our very unhealthy state. He said 527,000 signed up for coverage, primarily through Medicaid, which was also expanded.

Like some other states, Maryland has made some poor decisions when it came to setting up their ACA exchange last year, necessitating scrapping the original platform and replacing it with a customized version of Connecticut's much better system. While it remains to be seen how well the 2nd attempt will function, this is a very smart move on their part:

BALTIMORE (Tuesday, Sept. 16, 2014) — The second year of Maryland’s health insurance marketplace for individuals and families begins on Nov. 9 when consumers will have access to a newly redesigned website that enables “anonymous browsing,” the ability to compare plans — without registering personal information — before enrolling. This feature is being launched earlier than originally planned to enhance the shopping experience for Marylanders.

...Starting November 9, the redesigned exchange will be rolled out with a series of events, including a more intensive campaign of in-person assistance to help consumers and businesses during the upcoming season of open enrollment: 

On the one hand, Vermont's ACA exchange still has serious technical flaws heading into the 2nd open enrollment period this November. On the other hand, under the circumstances, this is probably the smartest move to make right now:

The Vermont Health Connect website went down Monday night and will remain offline for several weeks to allow for improvements to the user experience and data security, state officials said Tuesday.

Customers who need to report changes in income or make changes to their coverage or personal information will need to contact the customer service call center.

...None of the major functions that are still being developed will be launched when the website comes back online, said Lawrence Miller Chief of Health Care Reform.


The timeline for remaining elements, such as online changes to coverage or personal information or allowing small businesses to use the site has not changed.

Those functions are expected to launch sometime next year.

Old Reliable Minnesota comes through again...

latest enrollment numbers

September 14, 2014

Health Coverage Type Total Enrollments
Medical Assistance 200,548
MinnesotaCare 71,960
Qualified Health Plan (QHP) 54,646
TOTAL 327,154


Thanks for Chris Savage of Eclectablog for reminding me to check in on the latest Medicaid expansion numbers here in Michigan...

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 385,541
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of September 15, 2014 

Yup, that's up another 9,800 in the past week. With roughly 500,000 Michiganders eligible for the ACA Medicaid expansion program, my state has reached 77% of the total potential enrollment in just 5 1/2 months.

As expected, right on the heels of the CDC report comes the Census Bureau report:

The percentage of people without health insurance coverage for the entire 2013 calendar year was 13.4 percent; this amounted to 42.0 million people.

Remember, that's before any of the ACA exchange enrollments took effect starting in January 2014, and is also before any Medicaid expansion took effect (also January 2014 for most states; Michigan didn't start until April, and New Hampshire didn't start until July).

It's important to note that the Census Bureau has changed their methodology with this report, so it's difficult to do a true "apples to apples" comparison with prior years. However, they do include the following note:

According to the American Community Survey, the percent of people without health insurance coverage declined 0.2 percent between 2012 and 2013.

So, as Dylan Scott at TPM noted yesterday (and as I noted in kind), the Census Bureau is expected to release a Big Report at 10am with insurance coverage data. However, it turns out that the CDC (Centers for Disease Control) beat them to the punch by releasing their own report at midnight:

Obamacare cut the share of people in the U.S. without health insurance by two percentage points this year, the Centers for Disease Control and Prevention said in a report today.

In the first three months of 2014, 18.4 percent of adults under age 65 lacked health insurance, down from 20.4 percent last year, according to the CDCsurvey. The fall in the uninsured rate was helped by 3.7 million people who bought private health insurance sold under the Patient Protection and Affordable Care Act, the CDC said.

So, here's the big news from CMS/HHS today: Remember the 966,000 people whose citizenship/immigration data didn't match up last May? Well, they've managed to resolve about 851,000 of those cases, yay! Also, remember the 1.2 million households with discrepancies regarding their income levels? Well, that represented about 1.6 million actual people, and they're reporting having resolved about 897,000 households, leaving around 279K to go (representing 363,000 individuals).

Assuming these numbers don't overlap (and they probably do in a few cases), that means CMS has worked through about 2.088 million data discrepancies, leaving around 478K to go. So...yay, team and all that.

As for those who remain, the 115K with immigrant/citizenship status issues need to send their correct documentation to Healthcare.Gov by the end of September to avoid losing coverage. They did say that there would be some sort of special enrollment period for those folks as long as they keep paying their premiums, but they were pretty clear about the September 30th deadline.

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.