Charles Gaba's blog

As I noted last Friday, there's pretty good evidence that the Trump administration killing off most of the final HealthCare.Gov open enrollment deadline TV ads was directly responsible for a significant portion of the OE4 enrollment reduction on the federal exchange. The most obvious evidence of this is that in the final, critical 5 days of the period (when there's always been a significant spike in last-minute enrollees), the state-based exchanges (which run their own marketing campaigns) saw a 1.5% enrollment increase (at least 44,000 people) at the same time that HC.gov enrollment fell by 5% (450,000 people) short. This discrepancy between the state exchanges and the federal one will become a bit larger once the final enrollment numbers from CT, DC, ID, MA, MN, RI & VT come in.

Over at CNN, MJ Lee reports that the Republican natives are getting restless:

Republicans begin to grumble: Why haven't we repealed Obamacare yet?

...The sentiment is beginning to simmer within the influential conservative wing of the Republican Party and hints at what could be the opening of an intra-party rift as the GOP's mission to overhaul the country's health care system appears to be losing steam.

...That shift in tone has irked other Republicans who are eager to take a swift vote to roll back as much of Obamacare as possible. Their fear: their conservative constituents back home won't settle for anything else.

"For goodness sake, we should be able to put something on President Trump's desk that's at least as good as what we put on President Obama's desk. Not something watered down," Rep. Jim Jordan, R-Ohio, told CNN in an interview. "Let's repeal it. Let's do what the voters sent us here to do."

MAJOR UPDATE 3/22/17: As I've noted repeatedly, my estimates of how many people are at risk of losing their coverage has always been based on the assumption of full repeal with immediate effect and, most importantly, no replacement healthcare policy whatsoever. I had to do it this way at first because there was no Republican replacement plan available until a couple of weeks ago. Then, when the AHCA plan was released, I didn't have the time or expertise to properly overhaul my projections accordingly.

Fortunately, the Center for American Progress does have the time, manpower and expertise to do exactly this. They crunched the numbers and, based in part on the recent Congressional Budget Office scoring of the AHCA, put together their own fully-detailed analysis of what impact partially repealing the ACA by passing the AHCA would have on coverage losses.

In light of this, at this point you can pretty much ignore everything below, as it no longer applies; the question is no longer "what happens if the ACA is repealed without anything replacing it?" but rather "what happens if the ACA is partially gutted and replaced with the AHCA?"

The amazing thing is that the grand total number losing their coverage would be virtually identical in either scenario! The numbers vary widely from state to state and district to district, but when you add it all up, it still comes in at around 24 million people either way!

Anyway, I've put together SIDE BY SIDE COMPARISON TABLES for each state here.

Unfortunately, due to the sheer amount of time it would take to do so, and the fact that the House is voting on the AHCA tomorrow (Thursday, 3/23), I don't have time to completely update/overhaul the Google Docs version of this data.

UPDATE 2/07/17: Over at Balloon Juice, David Anderson (aka 'Richard Mayhew') tackled the "last-minute sabotage" issue from a completely different angle, using actual statistical analysis methodology (remember, I'm not a statistician regardless of what everyone thinks)...and came to the exact same conclusion I did:

2017 using my known flawed data was running .96% behind 2016 on the January 14th inclusive update.  2017 ended up running 5.25% behind 2016 on Healthcare.gov states.  The increment (using favorable to the null hypothesis data) slowdown in pace that can be attributed to Trump Administration actions is 5.25-.96 or 4.29% of enrollment was lost due to the executive order and other Trump administration actions such as shutting down some outreach and advertising in the last eleven days of enrollment.

Before the election, I was assuming the 2017 Open Enrollment Period would rack up between 13.5 - 14.0 million QHP selections...between 6% - 10% more than last year. The HHS Dept. agreed with me, projecting around 13.8 million (an 8.6% increase).

Last year the federal exchange included around 76% of the total enrollments (around 9.6 million). This year, HC.gov added Kentucky, which should have bumped the ratio up to around 77% this year. Assuming 13.8 million total, that would mean roughly 10.6 million enrolling via the federal exchange.

After Trump won and the GOP immediately started the actual legislative process to repeal the Affordable Care Act with preliminary votes in both the House and Senate, I downgraded my projections to around 13.3 million nationally (10.2 million via HC.gov).

I haven't posted an update on Pennsylvania's implementation of the ACA's Medicaid Expansion provision since last May, when it stood at around 625,000 enrollees.

Just moments ago, PA Governor Tom Wolf announced that enrollment has now broken the 700,000 milestone:

Over 700,000 Additional Pennsylvanians Enrolled in Governor Wolf’s Medicaid Expansion Plan
February 02, 2017

Harrisburg, PA – In February of 2015, Governor Wolf expanded Medicaid to ensure that Pennsylvanians can receive affordable, straightforward, accessible healthcare without unnecessary delays and confusion. Today, Governor Wolf announced that over 700,000 Pennsylvanians have enrolled in HealthChoices, Pennsylvania’s mandatory managed care Medicaid program, since expansion occurred two years ago. U.S. Census data shows that the commonwealth’s uninsured rate has dropped from 10.2 percent in 2010 to 6.4 percent in 2015.

After New York and Washington State, Maryland is the 3rd state to release their final official OE4 enrollment numbers:

NEARLY 158,000 MARYLANDERS ENROLLED IN HEALTH COVERAGE FOR 2017 THROUGH THE STATE MARKETPLACE

INCLUDING MEDICAID, 501,000 HAVE ENROLLED SINCE NOV. 1

BALTIMORE (Feb. 1, 2017) – A total of 157,637 Marylanders enrolled in private health coverage plans for 2017 by yesterday’s deadline for open enrollment, capped by the largest single-day call volume ever for Maryland Health Connection, the state’s health insurance marketplace.

Including Medicaid enrollments, more than a half-million Marylanders have newly enrolled or renewed in health coverage for 2017 through the state marketplace since Nov. 1 when open enrollment began. Maryland Health Connection now covers 1.1 million in all — one of every six people in Maryland.

Hmmm...I'm honestly not sure what this last number (1.1 million covered by the exchange) refers to...they just said it was 158K QHPs + 343K in Medicaid = 501K total.

Yesterday New York was the first state exchange to report their final OE4 enrollment tally; it was a bit mixed, with QHP selections 29,000 (10.7%) lower than last year...but BHPs increasing by a whopping 286,000 (75.3%) year over year, for a net combined gain of over 256,000 people.

Today, the Washington State exchange chimes in, and their numbers are impressive: Over 225,000 QHP selections.

More than 225,000 people used Washington Healthplanfinder to select Qualified Health Plans – a 13% increase over last year’s total.

The ASPE report for OE3 showed WA's official 2016 tally at 200,691, so 225K would actually only be 12.1% higher, but the press release says it's 13%, so either they're basing it on a slightly lower unofficial 2016 tally, or "over 225K" actually means closer to 226,000.

Oh for the love of God...

GOP Rebrands Obamacare Strategy From 'Repeal' to 'Repair'

Some Republicans in Congress are starting to talk more about trying to “repair” Obamacare, rather than simply calling for "repeal and replace.”

There's good reason for that.

The repair language was discussed by Republicans during their closed-door policy retreat in Philadelphia last week as a better way to brand their strategy. Some of that discussion flowed from views that Republicans may not be headed toward a total replacement, said one conservative House lawmaker who didn't want to be identified.

Using the word repair “captures exactly what the large majority of the American people want,” said Frank Luntz, a prominent Republican consultant and pollster who addressed GOP lawmakers at their retreat.

I'm actually a bit surprised that NY State of Health is the first state exchange out of the gate with final enrollment numbers, but good for them:

Press Release: NY State of Health Announces Enrollment Surges: More Than 3.6 Million New Yorkers Secure Health Coverage

Feb 1, 2017

  • Nearly 50,000 sign up during final two days of Open Enrollment
  • An additional 800,000 New Yorkers enroll through the Marketplace since January 2016

ALBANY, N.Y. (February 1, 2017) -- NY State of Health, the state’s official health plan Marketplace, today announced that more than 3.6 million New Yorkers enrolled in comprehensive health coverage through NY State of Health, a 28 percent increase from 2016.

“New York continues its commitment to bring affordable, comprehensive health coverage to New Yorkers” said NY State of Health Executive Director, Donna Frescatore. “New Yorkers now have access to affordable health insurance coverage, giving hundreds of thousands of previously uninsured individuals economic and healthcare security.”

 

(this is mostly a repost from last week, but there've been some additional developments since then):

Friday, January 20th:

Politically, the big unknown is whether or not Paul Ryan and Mitch McConnell will get away with trying to pin the blame for this on the Democrats/the law itself. That's why they've been pushing the "Obamacare is already in a death spiral!" claim hard for the past few weeks, even though it quite simply isn't.

...So, if this does end up in a worst-case scenario, Trump's "stop enforcing the mandate altogether!" order here could end up causing that death spiral even if the GOP doesn't technically end up repealing anything legislatively. The carriers would start announcing that they're bailing next year as soon as this spring (remember, the first paperwork for 2018 exchange participation has to be filed in April or May), and McConnell/Ryan would simply say, "See?? We told you it was collapsing all by itself! We didn't touch nuthin'!!"

I've stated many times over the past few weeks that between the GOP actively starting the legislative repeal process with preliminary votes, Trump actually taking office, his executive order within hours of doing so instructing the HHS Dept. to actively sabotage implementation of the ACA, and the last-minute yanking of TV advertising for the final few days of Open Enrollment that there's simply no way of making a solid prediction about what the final enrollment tally will end up being.

However, based on previous yearly patterns and spot-checks of HealthCare.Gov and the buzz from some of the state exchanges earlier today, I'm still gonna take a shot: I expect the final QHP selection tally to come in...pretty damned close to last year's 12.7 million, actually.

Officially, I'm giving it a range of anywhere between 12.4 - 13.0 million, with around 9.5 - 10.0 million of that coming via the federal exchange (which covers 39 states this year, including Kentucky) and the remaining 3 million or so being courtesy of the 12 remaining state-based exchanges.

Now that Minnesota, California and especially HealthCare.Gov (with Trump's blessing???) have issued overtime/extension periods of one type or another, this isn't particularly surprising to read, but Connect for Health Colorado is joining the Overtime Bandwagon as well:

Connect for Health Colorado® Extends Enrollment Deadline in Response to Surge in Sign-ups
Posted on Tuesday, January 31, 2017

DENVER — Connect for Health Colorado® today announced it is giving consumers who attempt to enroll by the Jan. 31 deadline three more days to complete their enrollment.

Individuals who began the enrollment process by midnight Tuesday will have until 6 p.m. Friday, Feb. 3, to choose a health insurance plan that will be in effect March 1, 2017. Friday will be the last day to purchase coverage this year, except for customers who experience a qualifying life change event, such as marriage, divorce, having a child, losing your employer-sponsored insurance, or moving to Colorado.

IMPORTANT UPDATE:

I've received confirmation from CMS that this "in line by midnight" grace period ONLY applies to those who CALL THE FEDERAL EXCHANGE at 1-800-318-2596​ and LEAVE THEIR CONTACT INFORMATION.

In other words, it does NOT appear to apply to those who are using the website application/enrollment process only; you have to CALL HC.gov and leave your number to qualify.

Every Open Enrollment Period to date, most of the ACA exchanges have ended up offering some sort of deadline extension and/or "in line by midnight" overtime grace period to allow people who started the enrollment process by the deadline additional time to wrap up their paperwork and complete the process.

Each year, this overtime period has shrunk:

First Minnesota's ACA exchange, MNsure, announced an 8-Day "don't call it an extension!" Special Enrollment Period mainly targeted at providing a 25% premium discount for those who don't qualify for the normal federal APTC/CSR financial assistance.

Now, Covered California has announced their own 4-day "Overtime" period, although this is more of the standard "waiting in line" variety:

Covered California Gives Consumers More Time to ‘Cross the Finish Line’ as It Prepares for Surge of Enrollment

  • Consumers must begin the application process by the end of Jan. 31 and complete their enrollment by the end of Feb. 4.
  • Thousands of Certified Insurance Agents and Community Enrollment Partners are ready to provide free and confidential in-person assistance.

SACRAMENTO, Calif. — Covered California announced it is giving consumers who attempt to enroll by the Jan. 31 deadline four more days to complete their enrollment.

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