UPDATE: If you scroll all the way to the bottom, I've added a completely updated state/national-level table as well, reflecting both the "clean repeal" and Trumpcare scenarios.

As I noted a few days ago, the Center for American Progress has outdone me. I crunched the numbers and broke out roughly how many people would lose healthcare coverage assuming the Affordable Care Act were to be fully repealed, with immediate effect and no replacement healthcare legislation whatsoever--that is, kicking nearly 15 million Medicaid expansion enrollees, over 750,000 Basic Health Plan enrollees and roughly 8.2 million significantly-subsidized individual market exchange enrollees off of their policies all in one shot. Add it all up and it comes to roughly 24 million people nationally.

3/22/17: Now that the GOP is apparently going to try and cram through killing off Essential Health Benefits and so forth in the #Trumpcare bill after all, it seems like a good time to repost this.

George Orwell, 1984:

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

3/22/17: Now that the GOP is apparently going to try and cram through killing off Essential Health Benefits and so forth in the #Trumpcare bill after all, it seems like a good time to repost this.

For years now, the Holy Grail of healthcare policy for progressives has been Universal Coverage (UC): Every single person receiving guaranteed, comprehensive, quality, affordable healthcare coverage. For most progressives, the means for paying for universal coverage is envisioned as a Single Payer (SP) system...which simply means that people pay taxes to the federal government, which in turn pays the medical bills to doctors, hospitals and other healthcare providers (note that neither UC nor SP have anything to do with Socialized Medicine (SM), in which all of the doctors/hospitals work for & are controlled directly by the government).

 

Republican Pete Sessions just literally said "Nobody is going to lose their coverage, you'll be able to keep your same doctor," "same plan." pic.twitter.com/nn0f4dFloc

— Tommy Christopher (@tommyxtopher) March 22, 2017

(sigh)

Seven years ago, President Obama repeatedly made an infamous promise: That under the Affordable Care Act, "If You Like Your Plan, You Can Keep It...If You Like Your Doctor, You Can Keep Them."

As a big fan of Obama and a supporter of the ACA, this statement has been making me, and any intellectually honest Democrat, wince ever since.

As I've stated many, many, many times over the years:

This morning Yesterday I noted that Paul Ryan, who apparently just remembered that yes, older white people tend to a) vote in midterms and b) vote Republican, has decided to take measures to win over the missing votes he needs to drag his dumpster-fire-of-a-healthcare bill over the finish line.

The changes in question appeared to include a) hurting even more poor/disabled people more quickly than before by speeding up the Medicaid expansion cut-off and block-granting non-ACA Medicaid...but also a vague reference to beefing up the individual market tax credits for older enrollees.

Now the Medicaid cruelty aside, I've long been an advocate of beefing up the indy market subsidies myself, so this isn't necessarily a terrible idea, although the devil would be in the details. I assumed, for instance, that Ryan & Co. planned on changing the age-based structure from this:

UPDATE: After thinking about it all day, I've decided to remove the "scrotum" nickname from the headline. I reserve the right to keep it in the body of this and future posts, however.

After being lambasted by pundits, reporters and politicians across the political spectrum for pushing an ACA replacement bill which would effectively raise insurance premiums on older enrollees up to eight times higher than they would be otherwise (eating up over 50% of their annual income in some cases)...

...it looks like Paul "Scrotum" Ryan has decided to resolve this issue by...beefing up the tax credits for the higher age bracket:

House Speaker Paul Ryan said Sunday he's seeking changes to the Republican health care bill to provide more assistance to 50-and-60-year-olds.

I've spent the past two months painstakingly crunching the numbers in an attempt to project just how many people would likely lose their healthcare coverage if the ACA were to be: a) fully repealed; b) with immediate effect; and c) without any substantive replacement policy put into its place.

My conclusion, after much analysis, double-checking and updating, is that the grand total would be roughly 24 million people: Around 8.2 million current exchange enrollees, nearly 15 million via Medicaid (expansion or otherwise), and the 750,000+ people enrolled in BHP programs in Minnesota and New York.

 

I told the following story about two years ago. It bears repeating for a different reason:

When I was 18 years old, my father died of a brain tumor. 

A few weeks after the funeral, I left for college at Michigan State University. Freshmen were required to room blind, so I had no idea who my roommate would be. When I met him, a tall blonde guy named Brian, I was still wearing the Kriah ribbon--a small torn piece of black cloth.

We shook hands, introduced ourselves, and then Brian asked me what the torn ribbon was for. I explained that my father had recently passed away, and that Jewish custom was for mourners to wear torn black cloth as part of the mourning process.

His response?

"Oh, I'm sorry to hear that he's burning in hell right now."

I should note that this was less than 5 minutes after we had met. I was assigned to live in the same room as this guy for the next 9 months.

For 2017, the weighted, average, unsubsidized (that's critical!) premium rate increase for ACA-compliant individual market healthcare policies was roughly 25% nationally.

There were plenty of reasons for this, including normal inflation/healthcare costs; the discontinuation of two of the three stabilization programs (Reinsurance and Risk Corridors, although the RC program had already been sabotaged a year earlier anyway); correction for under pricing by many carriers in the first couple of years of the ACA exchanges; and, of course, the fact that the ACA exchange risk pool continues to be worse than hoped for in numerous states/counties.

Of course, for the roughly 10 million exchange enrollees who are receiving tax credits, this didn't really impact them much at all:

On average, ACA marketplace consumers receiving tax credits are literally paying exactly the same this year as last year -- $106 per month. pic.twitter.com/WzqA6DsWRN

You may have noticed that I haven't been posting as many blog entries the past week or two. This has been partly due to our 5-day power outage, of course, as well as various other personal odds & ends. The main reason, however, is that I've been driving around the metro Detroit area giving a PowerPoint presentation about the ACA and Trumpcare to various groups. Last night was my 4th or 5th presentation, and while it was kind of sloppy and scattershot the first few times, I'm streamlining and modifying for each new event.

Even so, I'm cramming a lot of information into an hour or so, and several people at each event have asked if I could upload the slideshow to the website for easy download.

Therefore, I present: The Affordable Care Act and Repeal/Replace: Where Things Stand (pdf).

Me, February 3:

Of course, it's impossible to prove that the Trump executive-order/ad-kill combo was the cause of the numbers petering out at the end of the enrollment period...but I have some pretty strong evidence that it did.

How? Well, remember, the 12 state-based exchanges, which cover around 1/4 of all Qualified Health Plan (QHP) selections nationally, were not hurt by the ads being killed. The executive order might have had some impact, but the actual HC.gov ads being yanked shouldn't have hurt them much since these exchanges have their own, separate branding, marketing budgets and outreach programs.

I therefore decided to compare how the 39 HC.gov states performed relative to the 12 state exchanges...the results are pretty telling.

...UPDATE 3/16/17: I've updated the tables and chart below with the final, official 2017 Open Enrollment Period numbers from CMS.

As I noted earlier today, CMS has released the official 2017 Open Enrollment Period report, along with a whole mess of State, County and Zip Code-level breakouts and related demographic information, including APTC/CSR recipients, Metal Levels, Income Levels and so on.

This means I now have to dive back into my "How Many Could Lose Coverage?" project and update/revise the numbers for every state, county and Congressional district. Fun times!

On the one hand, this will take some time, so please bear with me. It took nearly 2 months to compile this data for all 50 states; it might take another week or so to update them with the latest numbers. Also note that it may only be the 39 states on the federal exchange which get updated, unless some of the state-based exchanges release their own updated reports.

On the other hand, it's important to note that for most counties/congressional districts, the numbers are likely to be fairly close to where they already are. For example, I've already completed Michigan; here's a before/after comparison:

Moments ago, CMS released the official 2017 Open Enrollment Period final enrollment report. They also released a nice set of bonus data sets at the state, county and even zip code levels, which was unexpected (usually they don't release these until later in the year).

Back in mid-November, I made a Big Deal® about being extremely mistrustful of any official data being released by the federal government after the Trump adminstration took over. I concluded, however, with the following:

In addition, unless I'm mistaken, most of the actual staff...the career employees at CMS/HHS, many of who've been there through more than one administration, will likely remain, and will do their jobs to the best of their ability, including trying to compile and publish data as accurately as possible.

Yesterday the CBO pretty much torpedoed the Trumpcare bill. Everyone from across the political spectrum now seems to agree that it's a complete disaster, with the exception of Paul Ryan and Tom Price (hell, even an internal Trump White House analysis apparently concluded that even more people would lose coverage than the CBO did...26 million vs. the CBO's 24 million).

However, there's one part of the AHCA which should be kept: The $100 billion that they currently have allocated to throw at the states to stabilize the individual market. As the CBO noted:

After five days, my power still hasn't been restored, and it's no fun typing with freezing fingers on a cold keyboard, but I had to make an exception for this: The CBO has officially scored the Trumpcare bill.

I'll be writing much more about it over the next few weeks, of course, but for the moment, my initial overview can be found in my latest article for healthinsurance.org. Take a look!

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