So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

  • In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

ALSO...

Last year there was much hand-wringing by myself and other healthcare wonks about whether or not the Trump Administration would attempt to kill off Silver Loading (and its even-wonkier cousin, Silver Switching). HHS Secretary Alex Azar and CMS Administrator Seema Verma kept sending out mixed and confusing signals about their intentions.

Eventually, Azar decided that while he doesn't like the practice, there wasn't enough time to change the rules before the 2019 Open Enrollment Period was set to begin, so he decided to take a pass for the time being.

Well, in yesterday's NBPP release, the HHS Dept. addressed the issue of CSR reimbursement funding directly...but they also made it clear that they're letting Silver Loading slide for another year:

Here's another wonky-but-important negative change which Trump's HHS Dept. is planning on making to the ACA exchanges starting in 2020:

We propose a premium adjustment percentage of 1.2969721275 for the 2020 benefit year, including a proposed change to the premium measure for calculating the premium adjustment percentage. Under §156.130(e), we propose to use average per enrollee private health insurance premiums (excluding Medigap and property and casualty insurance), instead of employer-sponsored insurance premiums, which were used in the calculation for previous benefit years, for purposes of calculating the premium adjustment percentage for the 2020 benefit year. The annual premium adjustment percentage sets the rate of increase for several parameters detailed in the PPACA, including: the annual limitation on cost sharing (defined at §156.130(a)), the required contribution percentage used to determine eligibility for certain exemptions under section 5000A of the Code (defined at §155.605(d)(2)), and the employer shared responsibility payments under sections 4980H(a) and 4980H(b) of the Code.

Here's what this seeming gobbledygook means, as explained by Matt Fiedler of the Brookings Institute:

Yesterday, the Dept. of Health & Human Services finally released the 2020 Notice of Benefit and Payment Parmeters, otherwise known as the NBPP, several months later than they were supposed to. There's a LOT of proposed changes to digest, and I'll write more about others soon, but I want to focus on one of the bigger ones here: Auto-renewals:

Currently, enrollees in plans offered through a Federally-facilitated Exchange or a State-based Exchange using the Federal platform can take action to re-enroll in their current plan, can take action to select a new plan, or can take no action and be re-enrolled in their current plan. Since the program’s inception, these Exchanges have maintained an automatic reenrollment process which generally continues enrollment for current enrollees who do not notify the Exchange of eligibility changes or take action to actively select the same or different plan.

So I was reading this thread on Twitter...

When people say “oh the shutdown only affects government workers,” remind them that IT requires maintenance. GOV websites that help businesses are going offline by the dozens per week https://t.co/1wGeTgsCyy pic.twitter.com/sYmBwTYFSq

— Ned Pyle (@NerdPyle) January 17, 2019

How many government servers were not patched in the past month? How many applications and website frameworks were not updated? How many pentests were postponed? How many logs were not examined for intruders?

— Ned Pyle (@NerdPyle) January 17, 2019

Imagine if your private company simply stopped having employees show up for a month. The government is no different and the impact is larger than all but the most massive private sector orgs

— Ned Pyle (@NerdPyle) January 17, 2019

via Amy Lotven of Inside Health Policy two days ago:

Issuers Urge CMS To Offer Guidance On 2020 Exchange Policy As Rule Stalled

Two associations representing health plans tell CMS that with the annual exchange rule stalled at the White House Office of Management and Budget (OMB) due to the government shutdown, the agency should immediately issue informal guidance that the plans need to understand regulatory and operational changes for the 2020 plan year. Issuers will likely be asked to submit applications in May, and it is critical to get guidance as soon as possible for adequate preparation, the Association for Community Affiliated Plans (ACAP) and the Alliance for Community Health Plans (ACHP) say in a Jan. 15 letter.

CMS typically released the draft Notice of Benefit and Payment Parameters (NBPP) in the early fall and it was generally finalized prior to the new year, although last year the final version was delayed until spring, which also frustrated plans. This year, the proposed rule didn’t land at the OMB for review until Nov. 28.

Livetweets from the Access Health CT monthly board meeting. It's important to note that the Connecticut ACA exchange originally was going to stick with the "official" 2019 Open Enrollment deadline of December 15th, but after the horribly-timed judicial ruling in the #TexasFoldEm federal lawsuit, decided to bump their 2019 enrollment deadline out by an extra month after all:

OVERVIEW: We ended #OpenEnrollment with 111,066 Active 2019 Enrollees. Of those, 71% qualified for premium tax credits.#AHCTBoDMeeting #CustomerFirst

— Access Health CT (@AccessHealthCT) January 17, 2019

With the final Open Enrollment deadlines now having passed for Minnesota, California, Colorado and Connecticut (but some data still missing for CA and CT), it's time to check in once again to see where things stand at the state-by-state and national levels.

At least 13 states have now exceeded their 2018 Open Enrollment performance, 7 of which use state-based exchanges: Idaho, Oklahoma, Massachusetts, Minnesota, Mississippi, Colorado, Rhode Island, Florida, Maryland, Hawaii, Wyoming, New York and Utah.

Also worth noting: Four states (Colorado, Hawaii, Massachusetts and Minnesota) are part of the "Five Year Club"...all four have managed to break their previous enrollment records for five years in a row. Mazel Tov!

This just in from Connect for Health Colorado...

Connect for Health Colorado® Sees Increase in Number of Coloradans Receiving Financial Help in Sixth Open Enrollment Period

DENVER – More than 169,000 Coloradans selected health coverage for 2019 through the state health insurance Marketplace by the close of Open Enrollment Tuesday, an increase of 2 percent over the previous Open Enrollment period, according to new data released today by Connect for Health Colorado®, and the number getting financial help buying insurance grew sharply.

About three of every four people—77 percent – who chose health insurance through Connect for Health Colorado qualified to receive financial help to reduce their monthly premium. That is up from 69 percent in 2018 and 61 percent in 2017.

Back in April 2017, I compiled a 20-itme "ACA 2.0 wish list" which I titled "If I Ran the Zoo", which gained some amount of attention from the healthcare policy wonk community. To be clear, I wasn't the first one to come up with most of these ideas; it was mainly just pulling together a bunch of proposals to protect, repair and strengthen the ACA from various sources into a single, comprehensive collection.

Since then, several bills have been introduced by Democrats in either the House or the Senate which addressed one or more of these recommendations, and last spring there were two bills (one in the House, one in the Senate) which tackled over a half-dozen of them in a package deal. None of these bills have gone anywhere since then, of course; with the Dems having retaken the House, it's a lot more viable that one or more will do so this year, although getting any of them through the Senate is obviously a much tougher climb.

However, some of the items on the list haven't even made it that far, including #5 on my list:

Immediately after the Colorado ACA exchange released their final 2019 enrollment numbers comes Minnesota's...via MNsure...

MNsure reaches record-setting sign-up numbers in sixth open enrollment period

  • 123,731 Minnesotans sign up for private health coverage

ST. PAUL, Minn.—MNsure reported strong numbers during its sixth open enrollment period, which ended Sunday. Nearly 400 more Minnesotans signed up for coverage than during the previous open enrollment period, which ended with 123,334 sign-ups.

Hmmm...just as with Colorado, MNsure's official numbers don't quite jibe with CMS's official report from last year, which put MN's tally at 116,358 QHP selections...nearly 7,000 fewer than MNsure's number.

A pop-up message appeared on the home page of Connect for Health Colorado on Tuesday the 15th:

If you encounter long hold times today and are unable to get through to our Customer Service Center on Jan. 15 to complete your enrollment, please contact our customer service center no later than 6:00 p.m. on Friday, Jan. 18 to complete your enrollment. At that time, you must let the representative know that you were unable to get through on Jan. 15.

Oddly, the message didn't include C4HCO's actual phone number: 855 752-6749

Colorado was already within 0.5% of surpassing last year's enrollment total as of January 3rd (just 712 enrollees shy); I'm certain they've beaten that number already.

Gov. Newsom Urges Uninsured to Get Covered Before Midnight Deadline Tomorrow as Covered California Continues Promoting Enrollment

  • Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
  • Gov. Gavin Newsom promotes enrollment for the estimated 1.1 million uninsured Californians eligible to enroll in Covered California or Medi-Cal.
  • Covered California research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.

LOS ANGELES, Calif. — California Gov. Gavin Newsom on Monday urged Californians who need health insurance to enroll as Covered California continued promoting coverage statewide before the deadline to enroll on Jan. 15.

“Covered California is in the final two days of open enrollment. That means if you are without health insurance, you need to sign up by Tuesday, Jan. 15, to secure health coverage,” Newsom said.

I just updated AccessHealthCT's numbers a week ago; it looks like they only added 428 more people over the next seven days:

With the clock ticking, Access Health CT’s latest statistics show they are closing in on last year’s numbers.

As of Friday afternoon there are now 109,126 Connecticut residents enrolled in insurance plans through the exchange. The deadline for enrolling was extended to Jan. 15. 

Last year 114,000 Connecticut residents enrolled in plans sold on the exchange.

CT is just over 5,000 signups shy of last year's 114,134 QHP selection total. They probably added a couple hundred more over the weekend (weekends are always slower anyway), but the odds of matching last year's total by tomorrow (Tuesday) night are extremely slim. My guess is they'll end up between 110K - 111K.

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