Charles Gaba's blog


Record Number of Idahoans Select Insurance through Your Health Idaho
Lawmakers Get Update on State’s Health Insurance Exchange

BOISE, Idaho – Your Health Idaho (YHI) executive director Pat Kelly went before lawmakers on Wednesday to give them an update on the third year of operations for Idaho’s state-based health insurance exchange. YHI set new records for enrollment during 2016 and led state-based exchanges across the country in per capita enrollment.

“Lawmakers’ choice to keep the federal government out of Idaho’s health insurance decisions and to do things our way has benefited Idaho immensely,” said Kelly. “Your Health Idaho gives consumers options when it comes to selecting a health insurance plan and we keep more money in Idahoans’ pockets by having lower assessment fees than the federal government.”

In federally managed states, consumer fees are set at 3.5percent. In 2016, YHI’s board of directors set the state’s assessment fee at 1.99 percent. To date, lower health insurance assessment fees have saved Idahoans more than $15 million.

I, and many others, have suggested (sometimes jokingly, sometimes not) that Donald Trump and the GOP's "terrific!" replacement for the Affordable Care Act could very well be to simply rebrand it as "TrumpCare", declare victory and call it a day.

I'm realize that Paul Ryan and Tom Price have other (terrible) ideas, but reading the latest goat entrails which make up Donald Trump's blathering suggest that he's now decided to do pretty much that (granted, that could have easily changed while I was typing that last sentence). Via Maggie Fox of NBC:

President-elect Trump just promised that private insurance companies can help lower costs and get health insurance to more Americans.


I embedded this song into a blog post back on April 30, 2014, after the dust had settled from the first Open Enrollment Period.

I posted it again on May 4, 2015, after the second enrollment period...and then a third time on June 29, 2015, right after the King v. Burwell Supreme Court decision was announced.

I was debating whether to hold off on doing so yet again until after January 31st, since that's the last day of the 2017 Open Enrollment Period...but upon further reflection, today is really more appropriate.

I've committed to keeping the site operating through at least April 30, 2017...which is also around the point that pretty much all of the final reports from HHS, CMS, ASPE and so forth documenting the OE4 numbers should have been released. I'm also assuming that we'll have some idea about just where the hell the ACA repeal/replacement direction is at that point...although who the hell knows?

Anyway, the answer to the question "Where do we go from here?" is, quite the fuck out of me.

To everyone who has donated in the past...or submitted data, or offered suggestions, or reposted/retweeted links to the site over the past 3 1/2 years...thank you.

I'm not closing up shop or anything (yet)...but if anyone's in a position to pony up a few bucks to help keep the site going for as long as possible, this is as good a time as any to do so.

Not sure if the sender wants public credit or not, but a few Republican Goverors have some things to say about repealing the Affordable Care Act...especially Medicaid expansion:

Today, Republican Governors will meet with GOP Congressional leaders in DC to discuss – you guessed it –the Affordable Care Act. Medicaid expansion is a key factor in this discussion because, as Governors will tell you, Medicaid expansion is leading to lower uninsured rates, higher rates of care, and critical treatment for people fighting opioid use disorders. And if Republicans repeal the ACA without a replacement plan in the same bill, CBO would score a subsequent bill restoring Medicaid expansion funding as an almost $1 trillion spending increase over 10 years. Interestingly, a number of GOP Senators broke with their party on expansion related vote-a-rama measures last week, and Governors from both parties have spoken out about this issue, as well as about the dangers of repeal and delay.


OK, the guest host is actually Cliff Schecter, but I'll be a guest on the Leslie Marshall radio talk show this afternoon from 3:00 - 3:30pm EST today, talking ACA, repeal and so forth.

Listen to the Live Stream here!

You can also listen to the podcast after the show here.

OK, given the impending End of the World As We Know it (and, on a smaller scale, the potential End of the Affordable Care Act), this is a pretty minor thing, but worth noting.

This afternoon I did a write-up about today's Week 10/11 HealthCare.Gov Snapshot Report, which showed nearly flat enrollment growth from 12/31 to 1/14...two solid weeks with barely 64,000 additional signups across 39 states. As I noted, this particular stretch of Open Enrollment was expected to be pretty quiet, but even so, the numbers were still far lower than I expected.

In the Weeks 8/9 Snapshot Report, HHS reported exactly 8,762,355 QHP selections as of New Year's Eve via HealthCare.Gov specifically (which only includes 39 states).

Then, last week, the ASPE department released their "Mid-Season Report", which included more detailed enrollment data for every state...but cut off a week earlier (only through Christmas Eve). After filling in all the blanks, I concluded:

For weeks now, I (and many others) have been crunching the numbers and making projections to see just what the fallout would be on the individual market (and the total uninsured rate) if the GOP were to follow through with their promise to repeal the Affordable Care Act.

There's a lot of variables at play, and there's also no way of knowing what (if any) replacement plan they'd come up with instead, but there are two main scenarios to consider: First, what would things look like if the ACA were to be fully repealed (without a half-decent replacement ready to swoop in); second, what would happen if the ACA were to be partially repealed via the reconciliation process (ie, killing off the subsidies, individual/employer mandates, Medicaid expansion and so forth, but keeping the guaranteed issue, community rating and other regulatory provisions in place, which is what would happen if the Republicans were to continue on their present course).

With the Republicans scrambling to come up with a plan, any plan to replace the Affordable Care Act at the same time that they repeal it (as opposed to, you know, simply not repealing it, at least until they actually have a reasonable plan, which they could certainly do if they wished to), there was a huge amount of buzz generated Sunday night over this story from Robert Costa and Amy Goldstein of the Washington Post:

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

Drug negotiations aside, the rest of the article is exactly what you'd expect:


No, I'm not accusing him of murdering anyone (well, unless his ACA replacement bill becomes law, that is), but it's starting to look like the Senate would have to be on drugs to confirm orthopedic-surgeon-turned-Congressman Tom Price as the new HHS Secretary:

Exhibit A, via Manu Raju of CNN:

Trump's Cabinet pick invested in company, then introduced a bill to help it

Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising new ethics concerns for President-elect Donald Trump's nominee for Health and Human Services secretary.

...Less than a week after the transaction, the Georgia Republican congressman introduced the HIP Act, legislation that would have delayed until 2018 a Center for Medicare and Medicaid Services regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.

OK. We're past the "mini-deadline" for February 1st coverage in 47 states (+DC). New York has extended their Feb. coverage deadline out until Wednesday (1/18), while Massachusetts, Rhode Island and Washington State are taking enrollments through next Monday (1/23).

The real "final" deadline to sign up for 2017 healthcare coverage is Tuesday, January 31st. Anyone who signs up between the dates above and the 31st will be enrolled in a policy starting coverage on March 1st.

After that, under the ACA, the only ones who are supposed to be able to sign up for 2017 coverage are people who qualify for:

In Minnesota, assuming 116,000 people enroll in private exchange policies by the end of January, I estimate around 58,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 234,000 enrolled in the ACA Medicaid expansion program and around 62,000 covered by their Basic Health Plan (BHP) program (aka MinnesotaCare) for a total of 354,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

A few days after the election, I posted:

Last spring, during the primaries, there was a month or so where there was still a small but not unreasonable possibility that Ted Cruz could have ended up pullling the nomination out of the grasp of Trump's hands. During that time, there was a lot of discussion among progressives (and some intellectually honest #NeverTrump conservatives) as to which one would be worse from a progressive/Democratic/liberal point of view.

After all, the reasoning went, Trump supposedly held strongly liberal positions on many key issues up until like 5 minutes ago (he was pro-choice, etc). He's promised a gargantuan infrastructure spending program (roads, bridges, etc)! Hell, during the very first GOP primary, he came right out and said that he thinks Single Payer healthcare is awesome in other countries! He later stated that whatever he came up with would "cover everyone" with "the government paying for it all". How awesome is that for a progressive!!

However, there are some major problems with this...

In Kentucky, assuming 80,000 people enroll in private exchange policies by the end of January, I estimate around 43,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 443,000 enrolled in the ACA Medicaid expansion program, for a total of 487,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

Back in mid-December, just about all of the ACA exchanges bumped out their enrollment deadlines for January 1st coverage by a few days. I was mildly surprised because improvements in the bandwidth, coding, layout and support staffing have meant a smoother process towards the big last-minute surge. Still, I wasn't blown away by the development or anything, as mid-December has always seen a massive spike in enrollment.

On the other hand, this announcement by the New York State of Health exchange is very surprising:

New Yorkers Now Have Until January 18 to Enroll in or Renew Health Insurance Coverage Beginning February 1

Consumer Demand Remains High Prompting Deadline Extension

ALBANY, N.Y. (January 12, 2017) – NY State of Health, the state's official health plan Marketplace today announced that consumers now have three additional days to enroll in a health plan with coverage starting February 1. The deadline has been extended through 11:59 p.m., January 18. The previous deadline was January 15.