This Just In from Covered California...

Covered California Plan Selections Remain Steady at 1.5 Million, but a Significant Drop in New Consumers Signals Need to Restore Penalty

  • Covered California finishes open enrollment with 1.5 million plan selections, which is virtually identical to 2018’s total, despite federal changes.
  • A key reason for the steady enrollment is that more people entered the renewal process for 2019 coverage after a strong enrollment period for 2018.
  • The federal removal of the individual mandate penalty appears to have had a substantial impact, leading to a decrease of 23.7 percent in new enrollment.

SACRAMENTO, Calif. — Covered California announced that more than 1.5 million consumers selected a health plan for 2019 coverage during the most recent open-enrollment period, a figure in line with last year’s total. There was a 7.5 percent increase in the number of existing consumers renewing their coverage and a 23.7 percent drop in the number of new consumers signing up for 2019.

With just two days left to go for New Yorkers to #GetCovered, Politico healthcare reporter Dan Goldberg has the latest numbers:

@charles_gaba NY latest numbers 265,209 in QHP 784,202 in EP. Enrollment deadline is tomorrow

— Dan Goldberg (@DanCGoldberg) January 30, 2019

These are solidly impressive numbers. Last year's final tally (including the last two days of Open Enrollment) was:

Last year I briefly attempted to keep track off the dozens of various state-based "ACA 2.0" protection/improvement bills flying around various state legislatures. I eventually abandoned this project since it became too difficult to keep up with, but I'm still reporting case studies as they come to my attention...and Louise Norris has just alerted me to some pretty big changes going into effect in Colorado this April.

First up: Short-term plans are being heavily neutered. In addition to being limited to 6 months per year (which is still longer than the Obama Administration's 3-month cut-off)...

Short-term plans will have to charge older adults no more than three times as much as they charge younger adults. Short-term plans are generally not available after a person is 64, but a quick check of plans currently available in Colorado show that some insurers are charging a 64-year-old up to seven times as much as a 21-year-old. That will have to stop as of April.

Last April, Maryland was one of several states which took action to counteract portions of the Trump Administration's attempts to sabotage the Affordable Care Act. In particular, Maryland (which has a Democratically-controlled state legislature but a moderate (by today's standards) Republican Governor) passed and signed into two important bills:

The combined effect of these changes was dramatic: Maryland's individual market insurance carriers, which had been planning on jacking up their average premiums by a whopping 30%, instead ended up lowering their 2019 premiums by over 13%. This is a net swing of around $3,200 per enrollee for the year (around $266 per month). In other words, instead of seeing unsubsidized 2019 premiums go up by $2,200 apiece, they dropped around $1,000.

Believe it or not, 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 over 23 million people!

In the District of Columbia (population 694,000) and New York (population 19.85 million), open enrollment runs through Jan. 31st for coverage starting March 1st.

BUT ALSO...

This is a very quick post as I’m in the middle of the Families USA healthcare conference, but it’s a significant one: The Massachusetts Health Connector, which wrapped up their 2019 ACA Open Enrollment Period last night, just reported the following:

Here is an update as of today, with Open Enrollment having ended last night.

Note: These numbers below should be considered something of a high-water mark. There will be fluctuations as plan-selecteds lose their window, members terminate, but also some applicants end up enrolling in March coverage.

Total enrollments (Including all January, February and March enrollments to date): 292,006

Plan selected/unenrolled: 8,079

2019 enrollment as defined by CMS: 300,085

Our new enrollment (people who did not have Health Connector coverage as of Nov. 1) is 60,361. This is a 23 percent increase from last year’s 49,034 at the same point in time.

Our retention rate is currently 89.7 percent, up about 2.6 percent from last year.

Holy smokes.

I know I was out of town for a couple of weeks recently, but I'll be on the job this time, really!

I'm flying out to DC Wednesday for the annual Families USA Health Action conference:

Working together, we are stronger. That’s why Families USA brings together community leaders from across the nation each year to improve the lives of America’s families. In 2019 we will meet for the 24th annual Health Action Conference on January 24-26, in Washington, D.C. at the Hyatt Regency Washington on Capitol Hill.

No other national grassroots health care conference brings together the swath of consumer activists and policymakers to inform, engage and inspire America’s health care agenda. We will be rolling up our sleeves to greet a new Congress and state legislatures in 2019.

via DC Health Link (the District of Columbia ACA exchange):

DC Health Link Pulling Out All the Stops for African-American “Week of Action”
Friday, January 18, 2019

Marching in MLK, Jr. Day Parade, barber shop outreach, and visiting churches highlight opportunities to boost African-American health insurance enrollment

WHAT/WHO:

With less than two weeks left to the January 31 deadline to sign up for 2019 coverage, DC Health Link is ramping up outreach efforts to the African-American community, where the uninsured rate remains high. DC Health Link, in partnership with various community organizations, is encouraging uninsured African-Americans to enroll in quality, affordable health insurance during DC Health Link’s “African-American Week of Action.”

New York State of Health continues to roll on with the 2019 ACA Open Enrollment Period. With nine days left for people to enroll, they're now nearly 3% ahead of last year's final QHP selection total:

Press Release: NY State of Health Hosts Online Informational Webinars in Spanish and Mandarin Tomorrow

  • Enrollment Remains Strong During Final Weeks of Open Enrollment
  • Enroll Today! 2019 Open Enrollment Ends January 31, 2019
  • Customer Service Center Hours Extended before Deadline

ALBANY, N.Y. (January 22, 2019) - NY State of Health, the state’s official health plan Marketplace, today reminded New Yorkers that now is the time to enroll in a Qualified Health Plan (QHP) for 2019 coverage. NY State of Health will hold webinars in Spanish and Mandarin tomorrow night, January 23, 2019. Open Enrollment for 2019 ends January 31. Consumers across the state have a choice of many quality health plans, and financial assistance is available to most individuals who buy coverage through NY State of Health.

A couple of weeks ago, I noted that Speaker of the House Nancy Pelosi, in an interview airing on MSNBC, stated that two of the major pieces of healthcare legislation she intends on pushing through this session are raising the ACA's tax credit eligibility threshold and "replacing" the now-repealed ACA individual mandate (i was never sure whether "replacing" meant reinstating it or actually replacing it with some other enrollment incentive).

I realize that the odds of any useful healthcare legislation managing to pass the Senate and become law under the Trump Administration is pretty slim, but hey, it's still good news, right!

Well, that news just got a whole lot better! via Richard Alonso-Zaldivar of the AP:

UPDATE 4/16/19: Please note that this overview refers to the version of Medicare for America introduced in December 2018. There's a revised version of the bill being re-introduced in the near future which is expected to include several important changes. The only two which have been made public so far are: 1) Deductibles are expected to be eliminated altogether; and 2) the upper-end percent-of-income maximum premium is supposed to drop from 9.69% to an even 9.0%.

There's a half-dozen or more different healthcare policy overhaul bills which are being batted around by Congressional Democrats these days, ranging from the fairly modest ("lower the Medicare buy-in to age 50!") up through the full-blown, "pure" Single Payer bill being pushed by Bernie Sanders & other "Medicare for All" activists.

I've noted several times before that the Massachusetts Health Connector (MA's ACA exchange) is one of only a handful of states which has managed to break their Open Enrollment record for five straight years:

  • 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...

What's most remarkable about the current total is that the 2019 Open Enrollment Period hasn't ended yet in Massachusetts. Residents still have until midnight Wednesday, January 23rd to enroll.

Oh, yeah...and don't forget: Unlike most states, Massachusetts still has a healthcare coverage mandate law which imposes a financial penalty on MA residents who don't have adequate healthcare coverage (unless they qualify for a hardship or other special exemption):

As part of her proposed 2020 annual budget, Rhode Island Governor Gina Raimondo has included an item of particular interest to those following the ACA:

Health Care Access and Affordability

State government plays a critical role in today’s health care system. Every policy decision we make has an impact on the individuals, children and families who need care. The Governor’s FY20 budget proposal builds on this momentum, preserving vital ACA protections that promote market stability and help to keep uninsured rates low. There are no eligibility cuts or broad-based benefit impacts proposed.

...Market Stability and Reinsurance Initiative

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:

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