Charles Gaba's blog

As has been obvious for some time now, the early projections by the Congressional Budget Office back in the pre-exchange days of 2010 - 2013, which foresaw ACA exchange enrollment heading into the 20-million-plus range by this point, obviously not only never came to pass, but are unlikely to do so anytime in the near future under the current legal/healthcare policy structure. There are several reasons for this ranging from legitimate problems with the structure of the ACA itself to Republican obstruction, but the two most obvious errors the CBO made in their projections were:

The last time Covered California released enrollment data, they gave a hard number for new enrollees (258,158) but left the number of people renewing their policies a bit vague ("approximately 1.3 million"). I later learned that the actual number of renewals had been rounded up, so I'm assuming it's actually around 1.27 million; this gives a total of 1.53 million QHP selections as of January 3rd.

Today, CoveredCA issued another update, touting a new enrollee survey which concludes that in California, at least, people don't seem to be shying away from enrolling in spite of the ugly ACA repeal rhetoric coming out of Washington, DC:

Covered California Enrollment Continues at Strong Pace; New Research Suggests ACA News Coverage Is Not Deterring Consumers

In Arkansas70,404 people enroll in private exchange policies as of the end of January. I estimate around 50,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 331,000 enrolled in Arkansas' "Private Option" ACA Medicaid expansion program for a total of 380,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

  • Plug in the 2/01/16 QHP selections by county (hard numbers via CMS)
  • Adjust for 1/31/17 QHP selections based on hard CMS data.
  • Knock 10% off those numbers to account for those who never end up paying their premiums
  • Multiply the projected effectuated enrollees as of March by the percent expected to receive APTC subsidies
  • Then knock another 10% off of that number to account for those only receiving nominal subsidies
  • Whatever's left after that are the number of people in each county who wouldn't be able to afford their policy without tax credits.

The Medicaid expansion data comes directly from state data.

Back on December 15th, I posted an entry entitled "I cannot guarantee accurate federal data after 1/20/17", in which I warned that given Trump's never-ending stream of bullshit and the fascistic overtones of the impending Trump Administration, the odds were pretty high that once they took over, all data from the federal government would likely become highly suspect. Cooking the books, doctoring the data, flat-out purging vast quantities of information...all of this was possible.

Well, it turns out it could be even worse than that: How about no data or information whatsoever?

Federal Workers Told To Halt External Communication In First Week Under Trump
Staff have been told to stop talking to Congress and the press.

WASHINGTON ― Multiple federal agencies have told their employees to cease communications with members of Congress and the press, sources have told The Huffington Post.

Hey, remember back in August 2016 when Aetna, just three months after saying how great things were going for them on the ACA exchanges (to the point that they might even expand into several additional states), did a complete 180º by announcing that they were instead going to leave 11 of the 15 states they had been participating in?

At the time, it seemed awfully suspicious; as I noted on 8/15/16:

Oh. Well, I'm sure that was just a sheer coincidence, right? No doubt Aetna will clear this up with an unequivocal statement to put any speculation to...

From Peter Sullivan of The Hill:

Asked if the DOJ’s actions on the merger had any relation to Monday’s announcement, Aetna spokesman TJ Crawford did not directly say yes or no.

OK, this came out of nowhere: Michael Goodwin is a talented comic book artist who runs a site called Economix Comics:

Economix is a graphic novel by Michael Goodwin, illustrated by Dan E. Burr, that explains the economy. More than a cartoon version of a textbook, Economix gives the whole story of the economy, from the rise of capitalism to Occupy Wall Street. Economix is published by Abrams Comic Arts.

Today he contacted me to inform me that he's using some of my data as part of his latest project: A bona fide 20-page comic book which explains, in laymans terms, the basics of the ACA,  how Paul Ryan/Tom Price's replacement plan would work and why their replacement pretty much sucks eggs.

Here's a low-resolution version of the first page (which also just happens to be where he included my data) to give you a taste of what it's like. I'm absolutely floored and honored to play a small role in disseminating this information in such a user-friendly way:

I've recently updated the enrollment numbers out of Idaho, Connecticut and New York. None of them have moved the needle much, but the latest New York number did finally goad me into making a decision: Going forward, I'm going to start including Basic Health Plan enrollments in my Open Enrollment Period totals.

I'll still be separating them out, since the "official" number which is generally counted by everyone (including myself) only includes exchange-based Qualified Health Plans (QHPs)...but unlike standalone dental plans, BHPs are full medical insurance policies, enrolled in via the ACA exchanges, and while they may resemble Medicaid in some aspects, they aren't in either category or funding source. Furthermore, BHPs are also "cannibalizing" quite a few enrollees who would otherwise be enrolling in QHPs anyway, so it's important to recognize their impact on the numbers.

 

UPDATE 3/14/17: Dammit, I was afraid of this...

via Lindsey Port (who ran for MN State House last fall):

It's Back!  Okay, folks, it's time to call your legislators, because the Drazkowski bill is back, and the GOP is giving it a full hearing TODAY!

This is the bill that would allow insurance companies to sell policies that do not cover chemotherapy, diabetes treatments, mental health services, maternity care, and many more benefits that are currently required to be covered by MN law.

The photo included is the Minnesota Statute 62Q, which is the statute that is being amended with this bill. These are the services that would be allowed to no longer be covered.

In their first enrollment update report two weeks ago, the NY State of Health exchange reported these numbers as of Christmas Eve:

The breakdown of enrollment as of December 24, 2016, is as follows:

  • Total cumulative enrollment: 3,472,214
  • Total Medicaid enrollment: 2,332,683
  • Total Non-Medicaid enrollment: 1,139,531
  • Essential Plan: 635,909
  • Qualified Health Plan: 217,995
  • Child Health Plus: 285,627

On Saturday they updated their numbers through January 19th:

Another 1,578 people have selected exchange QHPs via Access Health CT since the last update on January 12th:

ACCESS HEALTH CT ENROLLS 106,891 CONSUMERS IN HEALTH INSURANCE
1,192 enrolled in dental care, 1,519 enrolled through the Small Business Program

HARTFORD, Conn. (January 20, 2017) – Today, Access Health CT (AHCT) CEO Jim Wadleigh announced that 106,891 individuals have enrolled in health insurance in 2017. In addition, 1,192 individuals enrolled in dental coverage and 1,519 enrolled via the Small Business Program.

“As we head towards the final days of Open Enrollment, which ends on January 31st, we want to remind Connecticut residents that Access Health CT offers many ways to get free help choosing a plan,” said AHCT CEO Jim Wadleigh. “We are also very happy to see people taking advantage of the dental coverage we offer.”

"The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. The Republicans are the party that says government doesn't work and then they get elected and prove it." --P.J. O'Rourke, Parliment of Whores

As I noted on Friday, Donald Trump's executive order essentially orders the incoming HHS Secretary (presumably Tom Price), along with other relevant agency heads, to do everything in their power to sabotage the ACA regardless of any repeal legislation (whether partial or total) on the part of Congress. Since the ACA grants the HHS Secretary pretty wide authority about how (and whether) to enforce various components of the law, this gives ample room for the Trump administration to make the individual mandate (among other ACA provisions) effectively meaningless.

(note: too many updates in too short a period for me to even keep track of...)

At first, most healthcare reporters thought this was a fairly meaningless "mission statement" without much impact...

Trump also issued a memo to all agencies requesting that they begin to "ease the burden of Obamacare as we transition from repeal to replace," Spicer said. He declined to provide specifics on what various agencies might do in response to the president's directive.

HOWEVER, David Anderson (formerly Richard Mayhew) notes that Section 2, which instructs the HHS Secretary to "waive, defer, grant exemptions from or delay" any "fiscal burdens" o sounds an awful lot like telling them to be absurdly lenient regarding granting "hardship exemptions" from the individual mandate:

@annaedney @ZTracer yes individual mandate exemptions will be passed out like pacifiers at a rave

— David Anderson (@bjdickmayhew) January 21, 2017

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

Earlier today I noted that a bunch of Republican--yes, Republican--governors have chimed in in defense of the Affordable Care Act (or, at least the Medicaid expansion provision). They had a big powwow with GOP Congressional big shots to air their case.

Well, Republican U.S. Senator John Cornyn, the Majority Senate Whip (and therefore one of the biggest shots in the Senate) shot off quite a promise about the concerns regarding up to 32 million people potentially losing their healthcare coverage in the event the ACA is repealed:

One of the top concerns is what will happen to individuals who became eligible for Medicaid with its expansion under Obamacare. The Senate's No. 2 Republican, however, promised that no one who got coverage under Medicaid expansion will lose it.

When Conrnyn was asked if he was concerned about people who've benefited from Medicaid expansion losing coverage, he said it was a shared concern.

I've decided that for all future ACA enrollment data reports, I'm going to tack on "...on brink of possible ACA repeal" to the headline. Seems appropriate.

It's been quite awhile since I've written much of anything about the ACA's SHOP programs, which are the small business counterpart to the individual/family exchanges. The reason is pretty simple: SHOP enrollment is mostly a rounding error compared to either the ACA's Individual exchange enrollments or Medicaid expansion numbers.

SHOP enrollment (a mere 120K - 170K nationally, as far as I can tell) is even dwarfed by BHP program enrollment (around 700,000)...and that's only available in 2 states (Minnesota and New York). Heck, I don't even bother tracking them on my spreadsheets or graphs (I tried in 2014 but gave up on it the following year).

Still, once in awhile there's a bit of SHOP news to report, and this press release out of Minnesota is such an occasion:

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