2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

That's right. Thanks to high winds and a mid-April snowfall, I have no electricity today. Expect updates to be few and far between.

--posted from my iPhone

I've been debating whether to post about this since frankly, I'm not entirely sure that I have all the details straight about how this works. If anyone more familiar with this process wants to correct or clarify my description in the comments, please feel free to do so.

OK, so there's all sorts of hand wringing over how much premium rates will increase for 2015 based on the 2014 risk pool. The CBO issued a report yesterday which projects that in spite of all the fretting, the overall average increase will only be a few percent, which is good news if true (although this will no doubt vary from state to state).

However, I recently learned a couple of very interesting things about how the ACA works when it comes to pricing oversight and the "risk corridor" program.

Think Progress has a nice explanation of "risk corridors" (which the GOP hypocritically and wrongly refers to as an "insurance company bailout"):

There are many ways of getting a society to “do the right thing”. Many years ago, as I was driving into San Francisco across the Bay Bridge, traffic was at a crawl – except for two lanes labeled Car Pool. Those cars whizzed by and their drivers didn’t even have to stop to pay the road toll. Life can be so unfair to a lonely guy in a BMW or Porsche.

Above the highway was a billboard advertising, in large letters, the Car Pool Switchboard; its sole function was to hook up people regularly commuting from one place to another at roughly the same time. Saving a few dimes by sharing gas expenses, or even being forgiven a couple of bucks in road toll, may not have seemed like much of an incentive – but getting to work (and home) 20–30 minutes faster each day, most certainly was!

City of Angels

Yesterday I issued a reminder/warning that the March HHS report might stop at 3/29, leaving the last 2 (and by far the busiest) days of the official enrollment period, the 30th-31st to be moved over to the April report.

If HHS did this, the March report would appear to only include about 6.5M exchange QHPs, since another 600K would be moved to April, along with the additional 700K (give or take) enrollments from 4/01 - 4/15 (and even beyond).

Fortunately, if this bulletin from Inside Health Policy is true, wiser heads at HHS have prevailed...and then some!

HHS Eyes April 17 Release Of Latest Enrollment Numbers

On top of today's CBO report projecting a $104 Billion savings on the cost of the ACA over the next decade and their projection of 2015 premiums only going up slightly, this is a bit of unexpected news....

As hundreds of thousands of diabetics get health coverage under the federal law, insurance companies are aggressively targeting this glut of new patients, who are expensive to treat and often lax in taking medications and following their diet.

Insurers are calling diabetics when they don't pick up prescriptions or miss appointments. They are arranging transportation to get them to the doctor's office and some are even sending nurses on house calls in an effort to avoid costly complications that will have big impact on their bottom lines.

Well I'll be damned. Private, for-profit insurance companies actively assisting their customers in trying to stay healthy.

Exactly the way that the law was intended to work, I'd say.

Hoo, boy...this is gonna cause some heads to explode over at FOX News...

The most expensive provisions of Obamacare will cost taxpayers about $100 billion less than expected, the Congressional Budget Office said Monday.

CBO also said it doesn't expect big premium increases next year for insurance plans sold through the health care law's exchanges.

In its latest analysis, CBO said the law's coverage provisions—a narrow part of the law that includes only certain policies—will cost the government $36 billion this year, which is $5 billion less than CBO's previous estimate. Over the next decade, the provisions will cost about $1.4 trillion—roughly $104 billion less than CBO last estimated.

But wait, there's more...

Monday's report also sheds some light on one of the big challenges still to come for Obamacare: next year's premiums. Some critics have warned that premiums could skyrocket next year, based in part on the demographics of the people who signed up for coverage this year.

It took me a few minutes to figure out why, at this point, Colorado would issue a formal press release with a "final" number when there's still a day and a half to go. However, I realized that it probably simply means that practically everyone who qualified for the 4/15 extension has already done so by now; presumably they're already over 124K and there's only a few hundred partial applications left anyway, so their final tally will come in somewhere between 124K - 125K, thus allowing them to confidently release the news.

On the down side, if this "winding down" effect is true in most other states, it also suggests that instead of one final mini-spike, the 4/15 deadline will actually result in a severe drop-off, making the final total more like 7.7M instead of 7.8M, but that's fine as well.

In any event, CO is up another 3,000 exchange QHPs since last week to over 124K total.

UPDATE 4/14: From a Denver Post article on the same topic:

About 500 small employers participated in the Small Business Marketplace, or SHOP, which saw 220 enroll, covering 1,860 employees and family members.

That's a whopping increase of...90 people. Still, every one counts...

(sigh) OK, until this morning I was under the impression that the exchange QHP enrollment rules were:

  • 46 states +DC (36 on the Federally-run exchange, plus another 11 of the state-run exchanges): April 15 as long as you started the process by 3/31
  • Oregon: April 30, no "started by 3/31" requirement
  • Nevada: May 30 with the "started by 3/31" requirement
  • Connecticut & Washington State: No extensions

I did know that Florida was allowing paper applications received by April 7 to have their enrollments completed by April 30, but I thought that was it.

Well, if this Motley Fool article is correct, the final numbers could be even a little higher yet:

The new federal deadline -- a special enrollment period – already allowed registrations delayed by exchange-related problems to be finished as late as April 30 for those who submitted a paper application by April 7. That extension applied to individuals living in states where insurance enrollment under the Affordable Care Act is conducted through the federal exchange.

A few days ago I gave a final 4/15 exchange QHP estimate range from between 7.7 - 7.9M, with an outside shot of 8M.

Today I'm narrowing my projection within that range; unless there's a really big absolute-last-minute spike today and tomorrow (which is conceivable), it's looking like the final tally will end up somewhere between 7.8 - 7.9M. 7.75 - 7.85M I suspect the 8M mark will remain tantilizingly out of reach.

On the other hand, if I've seriously lowballed here and it does end up around, say, 7.95M, it's just barely possible that a handful of stragglers from Nevada and Oregon (along with paper applications in Florida?) could just barely drag the 4/30 total over the 8M line (Nevada has actually extended their "started by 3/31" policy all the way out until May 30, while Oregon has extended their full enrollment period out to 4/30).

Feeling a bit loopy on a rainy Sunday afternoon, so I present the mystery of one of the most significant songs ever released: Young MC's "Bust a Move":

Your best friend Harry has a brother Larry
In five days from now he's gonna marry
He's hoping you can make it there if you can
'Cause in the ceremony you'll be the best man

Question: If Larry is the one getting married, why are YOU the best man instead of his own brother? You're HARRY's best friend, not LARRY's.

For that matter, who waits until 5 days before the ceremony to ask someone to be in their wedding party, especially the best man? That's awfully short notice, barely enough time to get sized for the tux.

Posit: The brothers had some sort of falling out, perhaps over the bride. If so, that still doesn't explain why he'd ask his brother's best friend to be the best man, unless Larry just wants to rub Harry's nose in it.

As it happens, a friend of mine figured out the answer. If no one guesses it today, I'll post the answer tomorrow.

Earlier today I received the following question via Twitter:

@charles_gaba off-topic? NJ had coverage 4 adult until age of 30-31? Do they go down to 26 under ACA and if so, did you account for that?

— Mary Ann James (@ernestine1006) April 13, 2014

I honestly wasn't sure how to answer this. I had heard that some states already required insurers to allow kids up to 26 to be covered, but wasn't previously aware that NJ (or any other state) went beyond 26...

@ernestine1006 I have no idea. Didn't know any state required policies to offer higher than 26. Would imagine it works like min. wage...

— Charles Gaba (@charles_gaba) April 13, 2014

...and thanks to the power of Twitter, this was quickly confirmed to be the case:

I talked about this a couple of weeks ago, but given that the March HHS report should be released sometime this week (unless it's delayed due to the craziness of the late-March surge), I thought it was important to post again:

The March HHS Enrollment Report may leave off March 30th and 31st, and therefore leave 600,000 exchange QHP enrollments to be tacked onto the April report instead.

Every one of the prior 5 HHS reports on ACA enrollments has been tied to the calendar week instead of the calendar month, cutting the tally off on whatever Saturday happens to fall closest to the end of that month:

Earlier today a friend of mine (Eclectablog...who, by the way, is also the head of the best blogging team in America, and who could use your help with his quarterly fundraiser at the moment) noted that there was an anti-ACA banner ad from the Koch Bros running at the bottom of this site earlier today.

His Tweet was intended as snark, of course, but at least a couple of people didn't appear to get the joke, and actually think this means I'm either hypocritical or some sort of 11th Dimensional Chess-playing Double Agent Mole working for the Koch Bros. Not sure how that would work, exactly, but whatever.

OK, I actually do have one update today (it's 8:30 at night and my kid is getting ready for bed).

When I first learned that Washington State's off-exchange total was a whopping 2.2x that of their exchange-based enrollments back on February 20th, I casually noted that if that held true nationally, it would make the off-exchange QHP tally easily 7.7M or higher ...and this was back when the exchange QHPs were only around 3.5M.

However, I also tried to be cautious in my "official" estimate, keeping it to around 4M or so since I didn't know how many there really were beyond the 300K (later 560K) or so I had documented at the time. After all, other states would likely have a much lower ratio of Off- to On-exchange QHPs; In Wisconsin, for instance, Off-Exchange QHPs were only about 23% as high as exchange-based.

Because sometimes you just want to take your kid to the zoo for the day.

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