Charles Gaba's blog

A new letter from the Congressional Budget Office to Sen. Orrin Hatch says:

Re: Updated Cost Estimate for S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017

Dear Mr. Chairman:

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have updated their estimate of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017, to account for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and to account for administrative action. The agencies now estimate that enacting this legislation would increase the deficit by $0.8 billion over the 2018-2027 period.

This one is quite a head-scratcher, but let me see if I can peel the onion.

(yes, I know everyone else was posting writeups about this yesterday; I was a little swamped with some personal issues)

The original announcement was made last fall:

A week or so ago, there was some confusing news about how Donald Trump may or may not be planning on signing a new healthcare-related executive order. I didn't write about it earlier because at first it sounded like he was talking about a meaningless "sell across state lines" decree...meaningless because the ACA already allows carriers to sell ACA-compliant policies across state lines, as long as the states in question sign onto an interstate compact.

More recently, however, it became clear that the executive order in question is more dangerous than I thought:

Instead of my own description, I'll let the National Association of Health Access Assisters explain:

Health Action 2018 Kicks Off the Hottest Ticket for Assisters
by Heather Bates & Liz Hagan

If you work on enrollment or support enrollment-related work, we are excited to announce new opportunities available at Health Action this year! Thanks to our host, Families USA, the National Association of Health Access Assisters (NAHAA) will launch officially at #HA2018. With four in-depth workshops and several networking opportunities, trust us that this year is not to be missed.

The Washington HealthPlan Finder issued a press release today urging people to #GetCovered before their upcoming January 15th Open Enrollment deadline. At first glance it looks like a pretty disappointing update ("over 231,00 QHPs"), since their previous update as of 12/15 was already 230,591, suggesting only a few hundred more people enrolled between December 16th - January 2nd...

Washington Healthplanfinder Reminds Residents It’s Not Too Late to Get Covered
Customers have until 11:59 p.m. on Jan. 15 to sign up for 2018 health and dental plans

The Washington Health Benefit Exchange is reminding residents there is still time to sign up for 2018 health and dental coverage through Washington Healthplanfinder. Customers have 12 more days to make their plan selections before the open enrollment period closes at 11:59 p.m. on Jan. 15.

With less than two weeks remaining until the deadline, more than 231,000 Washingtonians have already used Washington Healthplanfinder to secure their coverage for 2018. 

This just in...

NEARLY 154,000 MARYLANDERS ENROLLED IN MARKETPLACE HEALTH COVERAGE FOR 2018

BALTIMORE (JAN. 4, 2018) – A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, the state-based health insurance marketplace.

In an open enrollment period that was about half as long as a year ago, average daily enrollment in qualified health plans was up 69 percent compared to the prior open enrollment. There were an average of 2,953 enrollments each day during the recent 52-day period, compared to 1,752 average daily enrollments during a 90-day enrollment period a year ago.

“We are thrilled by the robust turnout for 2018 coverage,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which administers Maryland Health Connection. “Our hats are off to our call center, consumer assisters and brokers who helped process roughly as many enrollments as last year during a much shorter open enrollment period. We believe the result will be better access and better health outcomes for Maryland families.”

I know, I know, caveats no doubt abound here, but still:

Health spending growth has slowed, and is now more on pace with economic growth

From 1970 – 1980, the average annual growth in the U.S. economy was 9.2% per year, compared to health spending growth of 12.2%. Although health spending growth has since moderated, it generally continued to outpace growth of the economy, though by a somewhat smaller margin. The 2010 – 2013 period, however, saw an average annual growth rate in health expenditures that was similar to growth in GDP.  Health spending did pick back up in 2014 and 2015 with the coverage expansions of the Affordable Care Act.

One of the least-known but most important aspects of the Affordable Care Act is the Medical Loss Ratio:

The Affordable Care Act (ACA) includes several provisions that change the way private health insurance is regulated in an effort to provide better value to consumers and increase transparency. One such provision – the Medical Loss Ratio (or MLR) requirement – limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in 2012.

This just in from HealthSourceRI:

Between November 1 and December 31, 2017, 33,021 individuals selected a plan through HealthSource RI. Though Open Enrollment has ended, customers who began, but did not complete, the enrollment process by December 31 will be able to finalize their 2018 enrollment process between January 1 and January 23. HealthSource RI is communicating directly with customers who are eligible for this opportunity. For this reason, final 2018 Open Enrollment figures will not be available until later in the month.

At HealthCare.Gov, around 66,000 stragglers/special case enrollments were added to the total between 12/16 - 12/23, which would translate into around 250 more people in Rhode Island, give or take. Of course, HC.gov also lost 145,000 enrollees due to people dropping their renewals/etc, but RI's exchange is structured a bit differently, with auto-renewals being added on day one, so most of those folks likely already dropped out before the 12/31 tally anyway. My guess is the final total will end up around 33.2K.

A couple of weeks ago I reported that MNsure, Minnesota's ACA exchange, had achieved 108.5K QHP selections, putting them within 1,500 enrollments of breaking their all-time record set last year.

Yesterday they issued the following press release:

Minnesotans benefiting from tax credits averaging over $7,000 per year
January 2, 2018

ST. PAUL, Minn.—With just under two weeks left in the 2018 open enrollment period, MNsure is reminding Minnesota residents of important money-saving tax credits. The statewide household average for tax credits is around $7,000 per year. Approximately 62 percent of enrolled households are receiving tax credits.

“Minnesotans are saving an average of over $7,000 per year from tax credits when purchasing coverage through MNsure,” said Allison O’Toole, MNsure CEO. “This is real money for Minnesota families, and can help make the unaffordable, affordable.”

UPDATE 1/13/18: Colorado's deadline passed last night, so we're now down to 5 states + DC: 79.9 million people, or roughly 24.5% of the population.

UPDATE 1/15/18: Minnesota's deadline passed last night, so we're now down to 4 states + DC: 74.3 million people, or roughly 23% of the population. (Note: I had a miscalculation in an earlier version of this post)

UPDATE 1/16/18: Washington State's deadline passed last night, so now we're down to 3 states + DC: 69 million people or roughly 20.6% of the population.

UPDATE 1/19/18: I've added Puerto Rico & the U.S. Virgin Islands to the graphic below to note the SEP added for those who've moved to the mainland.

UPDATE 1/24/18: Massachusetts' deadline passed last night, so now we're down to California, New York and DC: 60 million people or roughly 18% of the population.

Happy New Year!

2018 Open Enrollment has officially (and unofficially) ended for 44 47 states.

HOWEVER...there are 6 3 other states, as well as the one in the District of Columbia, which have deadlines later than December 31st:

  • Colorado: Jan. 12th for coverage starting Feb. 1st.
  • Minnesota: Jan. 14th for coverage starting Feb. 1st.
  • Washington State: Jan. 15th for coverage starting Feb. 1st.
  • Massachusetts: Jan. 23rd for coverage starting Feb. 1st.
  • California: Jan. 31st (enroll by Jan. 15th for Feb. 1st coverage; enroll by Jan. 31st for Mar. 1st coverage)
  • District of Columbia: Jan. 31st (enroll by Jan. 15th for Feb. 1st coverage; enroll by Jan. 31st for Mar. 1st coverage)
  • New York: Jan. 31st (enroll by Jan. 15th for Feb. 1st coverage; enroll by Jan. 31st for Mar. 1st coverage)

Collectively, these states/DC represent over 85.5 million people, or 26% of the entire U.S. population.

via U.S. News & World Report:

PROVIDENCE, R.I. (AP) — Rhode Island's health insurance exchange says time is almost up to purchase coverage for 2018.

HealthSource RI says Sunday is the last day to choose and pay for a 2018 health plan through the exchange for residents who don't receive affordable health coverage through an employer.

HealthSource RI said Friday that more than 32,000 people have signed up and many new enrollees are 18 to 34 years old.

Last year, about 30,000 people enrolled.

HealthSource RI says it wants to remind people they need to purchase insurance for 2018 to avoid a tax penalty.

Rhode Island has now officially beaten last year's total of 29,456 QHP selections, though they're still way down from the 34,670 they achieved two years ago. Of course they still have until tomorrow (New Year's Eve deadline), so they might be able to come close. At a minimum, RI is now at least 8.6% ahead of last year.

Fire up the wayback machine, Sherman, and set your course for late 2014:

Default Re-Enrollment: Under current rules, consumers who do not take action during the open enrollment window are re-enrolled in the same plan they were in the previous year, even if that plan experienced significant premium increases. We are considering alternative options for re-enrollment, under which consumers who take no action might be defaulted into a lower cost plan rather than their current plan. We are considering allowing states to pursue these sorts of re-enrollment alternatives for coverage in 2016. The FFM is exploring such an approach for coverage in 2017.

Me, yesterday:

Now here's some bad news: The effectuated enrollee drop-off could be fierce this spring, for two important reasons.

...So what's gonna be different for 2018?

Well, first of all, 41 states, the official Open Enrollment deadline was on December 15th. That means that unlike prior years, it's too late for most of these folks to change their minds. They can either stick with the policy they signed up for (or were signed up for) or they can drop it, but that's it. Of course, anyone who was enrolled into a differentpolicy than the one they already had technically still has a 60-day window from 12/31 (until March 1st) to choose a different policy via a Special Enrollment Period, but otherwise their options are limited.

In other words, assuming several hundred thousand people drop their policies after 12/15 but before 1/31, instead of already being accounted for, they won't show up in the until the First Quarter report is released, likely sometime in April. This will make it look as though the "March drop-off" is more like perhaps ~18% instead of ~14%.

The good news, as touted by myself and pretty much every other ACA supporter last week, is that in spite of every type of sabotage, undermining, obstruction and confusion thrown at Obamacare over the past year by Donald Trump along with Congressional Republicans, the 5th Open Enrollment Period for the Affordable Care Act is actually going...pretty well, all things considered.

As I noted last Wednesday, over 8.8 million people enrolled in exchange policies via the federal exchange (which covers 39 states), and I've also confirmed that another 2.8 million have enrolled in the other 11 states (+DC) which operate their own full ACA exchange engines, for a total of more than 11.6 million QHP selections so far. In addition, Open Enrollment is still ongoing across nearly half the country; not only do 10 of the 12 state-based exchanges have extended deadlines (all the way out to the traditional 1/31/18 cut-off for three of them), but thanks to a Special Enrollment Period created by CMS in response to the various hurricanes which ravaged southern states a few months back, 8 more states still have until New Year's Eve for people to #GetCovered.

I've confirmed with the Massachusetts Health Connector that their official QHP selection tally stood at exactly 262,534 as of Christmas Day (12/25).

This puts them a mere 232 higher than they were 6 days earlier (12/19), which seemed a little odd to me given that 12/23 was MA's deadline for January 1st coverage; normally I'd expect a last-minute enrollment surge in the final days ahead of a big deadline, although it's not nearly as big a deal in the states which still have later deadlines for February or March coverage. On the other hand, Christmas Eve and Day were included here, and no one enrolls in health insurance on Christmas, of course. I wouldn't expect much this week either with New Year's coming up; there's usualy a 9-day Dead Zone from 12/24 - 1/01 anyway.

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