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.

From Covered California:

Covered California’s Iconic Bus Tour Rolls into San Francisco to Promote Health Insurance Enrollment Ahead of Final Deadline

  •  Covered California’s bus tour promotes enrollment and encourages consumers to see if they are eligible for financial help in obtaining quality health insurance.
  •  The San Francisco visit coincides with the release of Governor Gavin Newsom’s budget which focuses on making health care more affordable through increased financial help and a state individual shared responsibility provision.
  •  Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
  •  An estimated 1.1 million uninsured Californians are eligible to enroll in Covered California and research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.

This just in from the MA Health Connector:

Update from us, as of last Friday:

  • 277,029 paid enrollments
  • 7,615 plans selected/unpaid
  • 284,969 total, per CMS enrollment definition
  • We have 47,573 new enrollees.

Once again: Massachusetts has managed to outperform their ACA enrollment numbers every year for five years running:

  • 2014: 31,695 (major technical problems)
  • 2015: 140,540 (complete platform overhaul)
  • 2016: 213,883
  • 2017: 266,664
  • 2018: 267,260
  • 2019: 284,969 and counting...

Just as impressive, if not more so: 97.2% of Massachusetts ACA enrollees have already paid their first monthly premium, which is well above the ~90% national average.

BLOCK GRANTS FOR MEDICAID — A Trump plan is in the works. Scoop today, behind the firewall right now. https://t.co/2PdVQKPoLH

The Trump administration is plotting a path for Medicaid block grants for states, a longstanding GOP goal to rein in spending on the entitlement program. News from me and @ddiamond https://t.co/EPkeqlPiSV

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

— Dan Diamond (@ddiamond) January 11, 2019

Per admin sources, CMS has guidance to states in the works on the topic. Officials also very aware of the political sensitivities surrounding such a plan.

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

Yesterday I wrote about the current status of several federal lawsuits against the Trump Administration over the decision to stiff contractors (i.e., health insurance carriers) out of nearly $2 billion in Cost Sharing Reduction reimbursement payments.

This morning I wrote about the current status of the infamous #TexasFoldEm lawsuit brought by 20 Republican Attorneys General and Governors against the ACA, and the impending appeal of Judge O'Connor's ruling in their favor.

But there's more Big Deal ACA litigation in the works as well...and while the Trump Shutdown has brought some of them to a standstill, Harris Meyer of Modern Healthcare reports that others are still churning along:

I haven't written anything about the developments in the #TexasFoldEm anti-ACA lawsuit in awhile, partly because I was out of the country for a couple of weeks and got backlogged. Then again, things are kind of at a standstill at the moment anyway, so perhaps that omission on my part isn't quite as big of a deal as I had feared.

Anyway, here's some of what's happened since Judge O'Connor's lousy ruling on December 14th:

A federal judge in Texas who recently declared the Affordable Care Act unconstitutional has stayed his ruling to allow for appeals.

That means “Obamacare” remains in effect while litigation continues.

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