Charles Gaba's blog

For years now, I (and many other healthcare wonks) have been arguing that one of the most important fixes/improvements that the ACA needs regardless of the Next Big Thing® is to #KillTheCliff...that is, to eliminate the infamous "subsidy cliff" which hits those who earn just over the 400% Federal Poverty Level income cap for Advance Premium Tax Credit (APTC) assistance.

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

This happened while I was out of town, but it's welcome news nonetheless...

Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year

RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.

“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”

OK, with the FINAL HC.gov Report having been released, I can now fill in even more blanks in the 2019 Open Enrollment Period: A grand total of 11.24 million 11.3 million QHP selections nationally so far. That includes 8.41 million on the federal exchange, plus another 2.82 million 2.9 million on the 12 state-based exchanges.

If the counting were to stop right here, the total would be 3.9% 3.8% lower than last year nationally, which would actually be pretty good all things considered.

HOWEVER, it isn't over yet. Deadlines in several state-based exchanges haven't expired yet. New York and DC are open for business until January 31st, and many people in Alaska, Georgia and Florida still have time to enroll due to last fall's earthquake and hurricanes.

Here's what it looks like as of right now:

New York State of Health just became the 6th State-Based Exchange (SBE) to officially surpass last year's final Open Enrollment Period total:

Press Release: NY State of Health Announces Qualified Health Plan Enrollment Tops January 31, 2018 Level
Jan 4, 2019

  • Still Time to Enroll
  • Consumer Demand for Affordable Coverage is High

ALBANY, N.Y. (January 4, 2019) - NY State of Health, New York’s official health plan Marketplace, today announced that as of January 1, 2019 more than 254,000 New Yorkers have enrolled in a Qualified Health Plan (QHP). With less than one month to go in the 2019 Open Enrollment Period, the number of QHP enrollees has already exceeded QHP enrollment at the end of the 2018 Open Enrollment Period.

Minnesota's ACA exchange, MNsure, last reported having enrolled over 113,000 people in Qualified Health Plans (QHPs) as of the first December 15th deadline, putting them just 3,300 enrollees behind last year's final total of 116,358 QHPs.

However, MN is one of the states sticking with an extended deadline this year, which means their 2019 Open Enrollment Period is still going on through January 13th...and they just reported having broken last year's total with 11 days remaining for Minnesotans to #GetCovered:

There is Still Time to Get Covered—MNsure's Open Enrollment Period Ends January 13
January 3, 2019

So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

  • In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

ALSO...

For four years now, I've been meticulously tracking and analyzing the annual premium rate change filings on the individual market (and usually the small group market) for pretty much every insurance carrier in every state, then consolidating all of that data into tables which break out the weighted average premium increases (or decreases, in some cases) on a state-by-state and national basis. Each year I've been proven to be pretty damned accurate:

It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the federal exchange, HealthCare.Gov, in terms of open enrollment numbers year after year.

However, this can be a bit tricky to compare because some of the states have shifted back and forth...four states which ran their own platform for the first one to three years (Hawaii, Kentucky, Nevada and Oregon) moved home to the mothership in later years, while one state (Idaho) did the reverse--they stuck with HC.gov for 2014 but then broke off onto their own platform after that.

Yeesh...when it rains, it pours! Right on top of updated and/or final 2019 Open Enrollment numbers 41 states (Idaho, Rhode Island and the 39 states hosted by HealthCare.Gov) comes yet another updated tally from Massachusetts:

As of today:

  • 274,317 enrollments for January
  • 2,997 enrollments for February or March
  • 3,763 plans selected (1st premium not paid but not due yet)
  • 281,077 total

Retention rate is 91 percent, up 2.6 percent from last year.

The total is only 252 higher than their last update as of December 17th, but that's not surprising considering that we had both Christmas and New Year's in between. Again, MA has managed to improve their enrollment number every year for 5 years straight, an impressive feat indeed!

Again, Massachusetts' total from last year was 267,260 QHP selections, which means they're now 5.2% ahead of last year's final number...with 3 weeks left to go!

 

As I warned back on December 19th when CMS released the Week 7 HealthCare.Gov Enrollment Snapshot Report, the final, official enrollment tally for the 2019 Open Enrollment Period was almost certain to end up slightly lower than the Week 7 cumulative numbers indicated. There are several reasons for this: Some people who were auto-renewed contact HC.gov to cancel their 2019 renewals, while others had their enrollments involuntarily denied or otherwise cancelled due to problems with verifying their identity, address or legal residency status.

Last year around 79,000 QHP selections were dropped in the final report; I expected this to be slightly lower, at around 75,000. I'm pleased to report, however, that according to CMS, only around 43,000 people were scrubbed from the 39 states hosted by HealthCare.Gov this year:

Final Weekly Enrollment Snapshot for the 2019 Enrollment Period

Rhode Island may be a tiny state, but they just became the 11th state to officially surpass their 2018 Open Enrollment Period total, and the 4th state-based exchange to officially do so...when they still had one day left to go:

EAST PROVIDENCE, R.I. (WPRI) — Rhode Islanders have just a few hours left to obtain health insurance through the state.

The deadline to sign up for and renew coverage for 2019 is Monday, Dec. 31.

The state's health insurance marketplace, HealthSource RI, plans to keep its call and walk-in center open until 7 p.m. Monday.

The center is located at 401 Wampanoag Trail in East Providence and the hotline is 1-855-840-4774.

Rhode Islanders have until midnight Monday to sign up for coverage online through HealthSource RI's website.

"Enrollment is up from last year, which we're very excited about, so that to us is a sign that the ACA is working in Rhode Island, and everybody is understanding the value of having health coverage," HealthSource RI COO Meg Ivatts said.

Now that I've brought everyone up to speed about my disappearing act, it's time to delve back into the ACA & healthcare developments of the past few weeks. There've been quite a few to talk about, but for now I'll just focus on updating the OE6 enrollment books a bit...starting with one of the two states which, until now, hasn't provided any 2019 enrollment data: Idaho.

According to this press release from December 28th, Your Health Idaho, their ACA exchange, not only surpassed last year's enrollment total of 94,507 QHP selections by over 9%, they managed to break their all-time enrollment record of 101,073 set back in 2016:

More than 103,000 Idahoans Enroll in Health Insurance for the 2019 Plan Year

Happy 2019, everyone!

As I noted a few weeks ago, this is the first time I've gone without posting any updates to the site for more than a few days since I launched this project over five years ago. Obviously a tremendous amount has happened since I went off the grid--some good, some bad--and there's no way I can catch up with all of it, but I'll try and recap a few of the developments most relevant to the ACASignups.net readership in my next post.

Before that, though, I'm sure all of you (well, some of you...ok, perhaps one or two of you?) are wondering where I was, so lemme start with that.

Unlike Islam and Mecca, there's no specific commandment under Jewish law which states that every Jew must visit Israel at least once in their lifetimes. Most Jews, however, do want to visit Israel at least once, and it's something which has been on my Bucket List since I was a kid. The day my wife and I found out she was pregnant, we decided right then and there that we were going to take our son on a family trip to Israel for his Bar Mitzvah.

This Just In...

Governor Northam Announces Over 182,000 Virginians Enrolled in New Health Coverage

  • SNAP recipients and parents of children with Medicaid coverage can use three-question application until January 4

The new coverage is available to men and women ages 19 through 64 who are not eligible for Medicare and who meet income requirements, which vary by family size. For example, a single adult with an annual income at or below $16,754 may be eligible for coverage. An adult in a three-person family with a total household annual income at or below $28,677 may be eligible.

SNAP recipients and parents whose children are currently receiving Medicaid coverage have the opportunity to use a short-form application to sign up if they do so by January 4, 2019. These individuals were notified by letter earlier this fall, and a follow-up postcard was recently mailed to potentially eligible adults in these categories.

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