So, this morning's big Halbig-related development is that Reason.com has dug up a video of a presentation by MIT economist Jonathan Gruber from January 2012. Gruber was one of the main architects of the health insurance law in Massachusetts (RomneyCare) and the national version (the ACA, aka Obamacare). In his presentation, Gruber states:

What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that's a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this. [emphasis added]

OK, yup, that is indeed what he said at the time.

Some of the various state-run exchanges continue to experience assorted technical issues, ranging from minor to serious. I may be rooting for the ACA to work, but as a website developer and a member of the Reality-Based Community, I do need to fully acknowledge that it's not all sweetness & light on the tech side these days. These issues will be resolved eventually, but you can't just ignore them either. So, without further ado...

VermontVPR (Vermont NPR), 07/23/14: Lawmakers Angered By Continuing Problems At Health Exchange

 Snowballing technological problems at Vermont’s online insurance exchange are drawing new scrutiny. And advocates warn that the situation for many customers who bought plans through Vermont Health Connect is becoming increasingly dire.

Washington State: Union Bulletin, 07/22/14: Washington state health-care exchange sounds alarm

OK, with all the fuss about the Halbig decision, people have been flooding me with a bunch of stories about both that as well as other ACA-related topics. I can't address them all fully, so here they are in bite-sized format:

Tara Culp-Ressler, Think Progress, 07/24/14: Obamacare Has Helped Americans Save Nearly $2 Billion On Their Insurance Premiums

Millions of Americans can expect to get a refund from their insurance companies this year, at an average of about $80 dollars per family, thanks to a little-known Obamacare provision that’s helping people save money on their premiums. According to a new report released by the Health and Human Services Department on Thursday, Americans across the country have received a total of $1.9 billion dollars in rebates since this provision first took effect in 2011.

Amy Fried, Bangor Daily News, 07/24/14: Supreme Court already said DC Court was wrong on Obamacare subsidies

Normally this would be a lengthy entry, but given that there have already been 4 other major national surveys saying the same thing, the latest news is just locking things down.

The New England Journal of Medicine just published a new report which concludes (shocker) that there's been a net reduction in the number of uninsured U.S. adults by around 10.3 million since the ACA exchanges went into effect:

As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

OK, I've had a chance to download the actual Excel file with the raw data and a handy graph already set up; I've cleaned up and color-coded the graph, and it's fascinating to look at, both during open enrollment as well as since it ended The things which stand out the most:

  • The obvious dead zone in October and most of November, finally coming to live around Thanksgiving time
  • The gradual rise in December, culminating in a large spike on Christmas Eve (the "official" deadline for January 1st coverage, although that varied in some states)
  • The massive spike in late March, culminating in a nearly off-the-chart peak on the "official" open enrollment deadline of March 31st, which saw over 200,000 transactions by itself

Yes, I'm quoted in this breaking story; Mr. Ornstein contacted me earlier today to ask my thoughts on his scoop, and I agreed to keep mum until it went public:

For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using Healthcare.gov by April 19, the end of the open-enrollment period.

But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.

Now, before everyone jumps on the "1 million" figure, a few important things:

When I posted my dumb-simple solution/workaround to resolve the Halbig decision back on July 2nd (assuming that it's upheld, which is by no means guaranteed), I meant it seriously, but figured that no one else would. I mean, really...the salvation of the most important healthcare law of the past 50 years and the single most important accomplishment of the Obama administration could end up being as simple as registering 3 dozen domain names and putting up a splashpage?

First, remember the news from yesterday that the ACA had lopped California's uninsured rate in half, from 22% down to 11% as of June? 22% of 38 million people = about 8.36 million; half of that is 4.18 million.

Next, remember that massive backlog of 900,000 new Medicaid (aka Medi-Cal) enrollees that California was working with as of the end of May?

Well, guess what?

For months, the state has labored under the largest such pile-up in the country, with 900,000 pending cases reported in May—the combined result of unexpectedly high application numbers and bug-ridden computer systems.

Regular readers of this site know that I have a checkered history with Forbes writer Chris Conover. It's been mostly on the hostile side, but he's also occasionally brought up a valid point which I've incorporated into my estimates; in particular, the "Sub26er" estimate has been changed from a flat 3.1 million to a range between 1.6 - 3.1 million in part due to his information (as well as Glenn Kesslers'). I believe the term which applies on both of our parts is "grudging respect" though I could be wrong at his end.

Thanks to the Washington Post's Greg Sargent for the heads up on a new national CNN poll about the ACA. Here's the key findings...and kudos to CNN for clearly distinguishing between those who oppose it for being "too liberal" (which basically means they don't like Medicaid expansion and tax subsidies) and those who oppose it because they want Single Payer (which includes myself, although that doesn't mean I oppose the law, since I see it as a path towards single payer):

According to the poll, only 18% of the public say they or their families are better off now that the major provisions of the health care law have been implemented. Another 35% report that, while their lives have not improved, the Affordable Care Act has benefited other people in the U.S. Add those two numbers together, and that means 53% say that Obamacare has helped either their families or others across the country.

OK, that may seem like an awkward way of shoehorning the Halbig decision into what's otherwise a simple state-level enrollment update entry, but the two are joined at the hip, since the state in question (Arkansas) happens to be one of those being run through Healthcare.gov:

A total of 185,000 persons have enrolled in expanded Medicaid and another 40,000 have bought insurance in the Obamacare exchange—together nearly half of all the previously uninsured citizens in Arkansas. When the new governor takes office, some 215,000 will be enrolled in expanded Medicaid alone. Will Hutchinson and, indeed, most Republican legislators want to end medical coverage for so many of their neighbors and constituents?

OK, now that I've showered, dressed and eaten lunch, let's see what the latest Halbig developments are (I'll explain below just why I didn't pounce all over the story this morning):

First, the ruling itself, courtesy of the L.A. Times:

President Obama’s healthcare law was dealt a new blow Tuesday as a federal appeals court ruled that due to a wording glitch in the Affordable Care Act, some low- and middle-income residents are not entitled to receive government assistance to subsidize their insurance.

In a 2-1 vote, a panel of judges on the U.S. Circuit Court of Appeals for the District of Columbia rejected the Obama administration’s argument that the problem was triggered by imprecise language in the complex law and that Congress had always intended to offer the subsidies nationwide to low- and middle-income people who bought insurance through one of the state or federal health exchanges created under the law.

OK, I'll have much more to say about today's Halbig decision this afternoon, but for the moment, let me just repost a press release, verbatim, from the campaign of Mark Totten, presumptive* Democratic nominee for Attorney General here in Michigan:

(*ok, technically he's not the nominee until after the MDP convention next month, but I'm pretty sure he's uncontested).

Schuette Forces Massive Tax Hike on Working Michigan Families

July 22, 2014

FOR IMMEDIATE RELEASE

Mark Totten for Michigan Attorney General
July 22, 2014

Contact: info@marktotten.com / (269) 203-3520

Schuette Forces Massive Tax Hike On Working Michigan Families

Federal court backs Schuette’s crusade to raise taxes by nearly $5,000 on a half-million Michigan families, while shipping Michigan tax dollars to California and New York

...however, I just finished mowing the lawn and am grungy as hell at the moment. I'll read up on the decision and write something more substantive later on today.

In the meantime, here's the three posts I've written about it so far...

Speaking of which, my potential dumb-simple solution to the problem has been lent support by none other than Larry Levitt of the Kaiser Family Foundation:

If Halbig stands, the administration could try to make it easy for states to set up state exchanges with a http://t.co/GH5hnakhxX back-end.

With all my stories about the requested premium increases in various states not living up to the "sky is falling" hype, several people have called attention to the fact that in New York State, it's not looking good:

ALBANY—New York insurance companies are looking to raise health insurance premiums by an average of 13 percent, according to proposed rates released by the state's Department of Financial Services on Wednesday.

The requests come from the 41 insurance companies operating in New York's insurance market. Last year, 16 insurers offered plans on the state's health exchange, which was created by the Affordable Care Act.

The six most popular plans on the state’s exchange requested double-digit increases in their premium rates for next year, with an average request of a 14.6 percent rate hike.

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