Thanks to Jed Graham for bringing up an interesting point about the 2015 renewal-vs-new-enrollee issue earlier today.

His original point was that it's likely going to cause no end of headaches (especially to me) to try and keep track of the enrollment figures since there's going to be around 7.5 million existing enrollees to contend with (most of whom, I would hope, will renew their policies) plus the newly-added enrollees whose policies start in January or later.

However, it occurred to me to check something out and sure enough, over at HC.gov you'll find this notice:

Any 2014 plan you enroll in with a Special Enrollment Period ends December 31, 2014. This is true no matter what month in 2014 your coverage starts.

With Open Enrollment 2.0 coming up fast, here's some quick hits from the various state-run ACA exchanges:

Massachusetts: State vows easier time on rebuilt Mass. Health Connector site

When people shop online for health insurance through the Massachusetts Health Connector next month, they will have a radically different experience than the trouble they encountered last year, state officials promised Thursday.

Last year’s website, redesigned to meet the terms of the Affordable Care Act, never worked properly, leaving people unable to buy subsidized health insurance. This year, officials say, the newly rebuilt website will enable users to cruise smoothly from log-in to plan choice.

Vermont: Thousands directed to shut-down health exchange website to pay bills

Thousands of Vermont Health Connect customers who signed up to pay health care premiums online recently received email notices directing them to pay through a website that is offline.

Me, September 6th:

In any event, you can expect a slew of new "OMG!! X MILLION POLICIES CANCELLED!!" attacks this fall as well...just before the midterms. It's not so much that this is false--some policies will be cancelled--as heavily exaggerated, along with the "impact" of those cancellations (most people will do exactly what my wife and I did...simply replace the old policy which isn't compliant...with a new one which is compliant and offers more comprehensive coverage...in many cases at a much lower rate after tax credits are applied, as long as they enroll via the ACA exchange instead of directly via the company).

Remember that when you start seeing the campaign attack ads with absurdly ominous music playing over black-and-white footage of someone reaching into the mailbox and pulling out...a notice from their insurance company (DUN-dun-dunnnnn...).

Me, October 2nd:

On Tuesday, the New York Daily News posted a story about a man in New York who is suing Empire BlueCross BlueShield because the insurance policy he purchased from them is essentially useless. As the header summarizes it:

Man sues Empire insurance company, claims search for doctor became ‘frustrating’ runaround

Jon Fougner says his simple search for a doctor through the insurance company website turned into a ‘Dickensian nightmare.’ Some doctors did not accept new patients, others never returned his calls, and some had wrong contact information listed on the Empire BlueCross BlueShield website, he claims. He accuses Empire of breach of contract, fraud and false advertising.

Now that Mitch McConnell is starting to feel the heat, he's decided to try and double down on the Evils of Obamacare by tying Alison Lundergan Grimes to the law (even though she didn't vote for it, seeing how she isn't, you know, a Senator yet).

So, he's started running a new ad in which a real-life doctor attacks Obamacare (mentioning in the "O" word 6 times in 30 seconds, if you include the on-screen text) while stating that Grimes supports it while McConnell wants to repeal it.

These jackasses just don't know when to quit, do they?

A year after shutting down the government, a group of Senate Republicans are pressuring House Speaker John Boehner (R-OH) to oppose any funding bill in the lame duck session that includes appropriations for a small program contained in the Affordable Care Act, potentially triggering another showdown.

I noted this issue about a week ago (although I actually have to give credit to anti-ACA advocate Megan McArdle, of all people, for laying it out so well):

I had to visit HC.gov for the first time in months today to check on something and was impressed by the mostly new interface and overhauled layout. Obviously a lot of the content changes are connected to prepping for the 2nd Open Enrollment Period (lots of "get ready!" and "upcoming deadlines!" and the like), but right off the bat I saw one important improvement: It's finally responsive. That is to say, HC.gov is finally optimized for smartphones & tablets.

Beyond that, some of the promised improvements are extremely welcome:

  • the health insurance website will feature a streamlined application for most of those signing up for the first time. Seventy-six screens in the online application have been reduced to 16, officials said.

In addition...

In an election where people like me are practically begging Democratic candidates in blue states to campaign on the Affordable Care Act, this is a jaw-dropping development.

South Dakota's Senate race normally would be considered a yawner. While the state does have a history of electing the moderate Democrats from time to time, it's pretty red for the most part, and no one was expecting Democrat Rick Weiland to have much of a chance against former Republican Governor Mike Rounds.

However, in an interesting development, independent candidate Larry Pressler has jumped into 2nd place in a recent poll. The thing is, Pressler isn't some no-name small timer; he's already a former U.S. Senator, serving for 3 terms before losing to Democrat Tim Johnson in 1996.

With Johnson retiring, his seat is open, and Pressler wants it back, so he's jumped back into the game. Here's the thing, though: Pressler used to be a Republican. In South Dakota.

Gallup has just released their latest nationwide, fully-detailed quarterly insurance survey, and the results are...pretty much exactly what everyone in the real world (as opposed to FOX News, etc.) has been reporting for months now.

The uninsured rate for adults (Gallup doesn't survey kids under 18, of course), which hit a high of 18% last fall (just prior to the ACA exchanges launching) is holding steady at 13.4%, the same number it was at in the 2nd quarter of 2014:

The total U.S. population currently sits at roughly 316 million. Of that, around 76.7% are over 18, or about 242 million people.

18% of that is 43.6 million. 13.4% is 32.4 million...a net reduction of around 11.2 million uninsured, or about a 26% drop in the uninsured rate nationally.

There's nothing wrong with this AP article noting that getting an exemption from the $95 (or 1% of your taxable income) fine for not having ACA-compliant healthcare coverage could prove to be pretty complicated. Overall it's a fair assessment of some of the potential headaches involved in the hoops you have to jump through to get a waiver...

WASHINGTON (AP) — Millions of Americans may qualify for waivers from the most unpopular part of President Barack Obama's health care overhaul. But getting that exemption could be an ordeal.

Community groups are concerned about a convoluted process for waivers from the law's tax penalty on people who remain uninsured. Not everyone is complaining, however: Tax preparation companies are flagging it as a business opportunity.

The law's requirement that Americans carry health insurance remains contentious. Waivers were designed to ease the impact.

However, one line in the aticle made me chuckle:

But while some exemptions seem simple, others will require math calculations.

Oh noes!! Not MATH CALCULATIONS!! Aieeeeeeee!!!

(sigh) When I posted about Wal-Mart (yes, that Wal-Mart) embracing the ACA exchange system by opening up enrollment kiosks staffed by licensed brokers in 2,700 of its stores, some people were understandably suspicious of their motives.

While I still think that overall this is a good thing, less than 24 hours later, one of those motives just became pretty clear:

Wal-Mart told The Associated Press that starting Jan. 1, it will no longer offer health insurance to employees who work less than an average of 30 hours a week. The move affects 30,000 employees, or about 5 percent of Wal-Mart's total part-time workforce, but comes after the company already had scaled back the number of part-time workers who were eligible for health insurance coverage since 2011.

By an amazing coincidence, January 1st just happens to be the same day that new ACA-compliant policies purchased during the 2nd open enrollment period kick into effect.

After all the fuss and bother about "Rate Shock!!" in 2015 (aka "Step #8 on the It'll-Destroy-America-To-Might-Suck-Someday chart"), PricewaterhouseCoopers, which has been tracking not just the average 2015 rate requests or approved rates but is also accounting for factors such as...

...metal level/plan design, age, and geography, on health insurance plan premiums. At present, certain states are only reporting partial information about next year’s rates, and others are only reporting percentages that rates will change without sharing actual premium data. Unless otherwise noted, only individual health insurance filings containing rate information have been included in this analysis.

The most-recent CMS report, which only runs through June 30th, gave the net gain in Medicaid/CHIP enrollment as around 7.2 million, plus an additional 950,000 people who were added to Medicaid due to ACA provisions prior to October 2013. That's 8.15 million total over pre-ACA numbers.

There's two important points to keep in mind, however: First, again, that only ran through 6/30/14; there's been 3 solid months of additional Medicaid/CHIP enrollments since that time; and second, as of September there was a backlog of over a million people still waiting to be processed and added to the Medicaid/CHIP roles (1/3 of this in California alone).

I have no idea how much of this backlog has since been cleared up, but if CA's improvement rate is anything to go by, my guess is that most of it should be out of the way by the time the 2nd open enrollment period kicks in on November 15th.

Minnesota continues to quietly crank along as we enter the 2nd year of MNsure:

latest enrollment numbers 

October 5, 2014

Health Coverage Type Cumulative Enrollments
Medical Assistance 217,535
MinnesotaCare 75,870
Qualified Health Plan (QHP) 55,243
TOTAL 348,648

Note that I'm not really even bothering to keep the Off-Season Projection Chart updated anymore; we're close enough to the 2nd Open Enrollment period that it seems a bit silly to bother (heck, I've already projected the graphs out through 11/15 anyway).

A couple of weeks ago there was a rather absurd-sounding report from a right-wing outlet called "The Pioneer Institute" which claimed that the Massachusetts Health Connector (their ACA exchange site) was going to cost over $1.1 billion over a 2-year period. I didn't really address it at the time, mainly because regardless of the disastrous experience of the MA exchange, that number just didn't seem grounded in reality. Sure enough, it turns out that estimate was about four times too high:

BOSTON - With the next open enrollment period set for Nov. 15, Gov. Deval Patrick on Monday said the state's troubled health care exchange website is fixed, at a cost of an additional $26 million to the state, bringing the federal and state total to $254 million in information technology costs.

...Consumers who log onto the Health Care Connector website will have a "full end-to-end shopping experience" for health plans on Nov. 15, Patrick said.

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