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Interesting timing of this, coming right on top of the other ACA stabilization/improvement bill introduced by the House Democrats today:

From Sen. Baldwin's official Senate website:


“The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

WASHINGTON, D.C. – Following the Trump Administration’s recent proposed rule allowing insurance companies to once again sell ‘junk’ health care plans, U.S. Senator Tammy Baldwin today announced new legislation to block the rule and guarantee protections for people with pre-existing conditions.

UPDATE: Late last night I was able to dig up the actual legislative text of the bill introduced by the House Democrats yesterday; after reading over the details, I've decided that it's a strong enough package overall that, in software terms, it would be considered a full version upgrade (2.0) as opposed to "only" a service pack/point upgrade (1.5). I've therefore changed the headline to reflect this.

I've also updated some sections fo the analysis below to include the details from the text itself.

A little under a year ago, I posted a lengthy list of 20 recommendations for repairing, improving and strengthening the Affordable Care Act, entitled "If I Ran the Zoo". Here's a summary list of all 20:

“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

--Douglas Adams, The Hitchhiker's Guide to the Galaxy

Over a year and a half ago, I noticed that aside from the usual names being listed as insurance carriers offering individual market policies in various states (Humana, Molina, Blue Cross Blue Shield, etc), there was one other name which kept popping up over and over again: "Freedom Life":

Over the past few weeks,I've posted partial 2018 Open Enrollment Period demographic data from Connecticut, Idaho, Maryland, New York and Washington State. Still missing are final wrap-up reports from the other 7 state-based exchanges...as well as The Big One: The official report from the Assistant Secretary for Planning and Evaluation (ASPE).

The 2014 ASPE report was released on May 1st, 2014...just 17 days after the first, tumultuous 2014 Open Enrollment Period ended (only 12 days, really, since the report actually ran through April 19th, 2014 even though the "overtime" period technically ended on April 15th).

Two weeks ago the United States House of Representatives voted to pass HR 620, officially titled the "ADA Education and Reform Act", with 225 members of Congress voting Yea and 192 voting Nay.

While the vote was mostly along party lines, I was saddened to see that a dozen Democrats joined 213 Republicans to vote for it...putting it over the top.

What would H.R. 620 actually do? I don't know a whole lot about disability advocacy, I admit, but according to the American Civil Liberties Union:

The so-called “ADA Education and Reform Act”weakens the Americans with Disabilities Act and undermines one of the key goals of the law.

via Raw Story:

Sen. Orrin Hatch (R-UT) on Thursday called supporters of the Affordable Care Actsome “of the stupidest, dumbass people I’ve ever met” during a speech before the American Enterprise Institute.

We […] finally did away with the individual mandate tax that was established under that wonderful bill called ‘Obamacare,’” Hatch said, according to Fox News 13. “Now, if you didn’t catch on, I was being very sarcastic.”

“[The Affordable Care Act] was the stupidest, dumbass bill that I’ve ever seen. Now, some of you may have loved it. If you do, you are one of the stupidest, dumbass people I’ve ever met. This was one—and there are a lot of ’em up on Capitol Hill from [that] time,” Hatch added.

Matt Whitlock, a spokesman for Hatch, defended the senators comments, telling Fox News 13, “The comments were obviously made in jest, but what’s not a joke is the harm Obamacare has caused for countless Utahns.”

Today must be Healthcare Survey day. First it was the Kaiser Family Foundation's monthly tracking poll; now comes the Commonwealth Fund, which has released their own survey results regarding the Affordable Care Act and healthcare coverage in general:

To gauge the perspectives of Americans on the marketplaces, Medicaid, and other health insurance issues, the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a random, nationally representative sample of 2,410 adults ages 19 to 64 between November 2 and December 27, 2017, including 541 people who have marketplace or Medicaid coverage. The findings are compared to prior ACA tracking surveys, the most recent of which was fielded between March and June 2017. The survey research firm SSRS conducted the survey, which has an overall margin of error is +/– 2.7 percentage points at the 95 percent confidence level.

Covered California’s Executive Director Addresses Harvard Study on Impact of Eliminating Individual Mandate on Enrollment and Premium

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,”published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

Back in January, I wrote:

Millions of people who failed to make sure they were enrolled in ACA-compliant healthcare coverage are going to file their tax returns this spring thinking that they don't have to pay a penalty for not doing so only to discover that the penalty is still in effect.

Then, next spring (assuming the IRS sticks to its guns on the issue and there's no further legislative changes made), anyone who didn't #GetCovered for 2018 are also going to have to pay the penalty (which, again, is either $695 per adult/$348 per child or 2.5% of their household Modified Adjusted Gross Income).

The damage caused by the mandate being repealed to the individual market risk pool (and rate premiums) will be felt this November, when people start shopping around for 2019 coverage...but the actual "benefit" (i.e., those who don't get covered not having to pay the mandate penalty) won't show up until spring 2020.

The Kaiser Family Foundation runs a highly respected monthly national tracking poll on healthcare issues. Their latest was just released, and while there's a bunch of interesting stuff included, there are two main takeaways. Here's the first:

The February Kaiser Health Tracking Poll finds a slight increase in the share of the public who say they have a favorable view of the Affordable Care Act (ACA), from 50 percent in January 2018 to 54 percent this month. This is the highest level of favorability of the ACA measured in more than 80 Kaiser Health Tracking Polls since 2010. This change is largely driven by independents, with more than half (55 percent) now saying they have a favorable opinion of the law compared to 48 percent last month. Large majorities (83 percent) of Democrats continue to view the law favorably (including six in ten who now say they hold a “very favorable” view, up from 48 percent last month) while nearly eight in ten Republicans (78 percent) view the law unfavorably (unchanged from last month).

I noted a few weeks ago that as many as 9 states are ramping up plans to reinstate one version or another of the ACA's just-repealed Individual Mandate. I concluded:

My only advice is that if they do take the political risk of imposing a mandate penalty, at least make sure it's more stringent than the one which was just repealed--I'd probably recommend making it something like the same cost as the least-expensive Bronze plan available on the exchange after whatever tax credits they'd otherwise have applied.

Well, I don't know about the details, but it looks like the District of Columbia, at least, is full-steam ahead:

DC Health Benefit Exchange Authority Executive Board Recommends Policies to Protect Health Insurance for District Residents
Friday, February 23, 2018

This just in...I used to track the monthly Medicaid/CHIP reports pretty religiously, but the total numbers have actually stayed fairly stable month to month for the past year or so (mainly because the states which expanded Medicaid under the ACA have mostly "maxed out" by now). This should start changing in Maine later this year as they voted to expand the program via ballot initiative last November, and Virginia may end up expanding Medicaid to up to 400,000 people there as well later this year.

In the meantime, here's where things stood as of the end of 2017, according to CMS:

Highlights from the December 2017 Report

Medicaid and CHIP Total Enrollment

From the About page of the Art as Social Inquiry website:

Art As Social Inquiry combines art and advocacy as a way to engage audiences. Theresa Pussi Artist BrownGold is the painter/writer/performance artist behind Art As Social Inquiry.

"I have often wondered why so many good people have such different and divisive opinions. Art As Social Inquiry asks the questions: Are we our opinions? Or are we something more? Then what? What is beyond the emotional charge of our opinions? And how do we get there?"

Art As Social Inquiry — an artist-at-work painting portraits of real people whose lives embody the social issues of the day, issues like access to healthcare, immigration, how we die. The artist also uses songwriting and performance art, two more art-making tools, to help us see ourselves in the bigger world, and the opinions we cling to.

Our opinions affect our actions. Art As Social Inquiry unearths those opinions.

Not sure when this was posted, but the trendline is interesting...according to the first chart, Colorado ended 2017 down only 16.3% from their total OE4 enrollment number (161,568 QHP selections).

The cumulative enrollment numbers are also important: During the entire off-season (from 2/01/17 - 12/31/17), 41,387 people selected QHPs via Special Enrollment Periods (SEPs), or roughly 124 per day. Of course, technically speaking the last day of SEP enrollment for 2017 should have been 11/15/17 (for coverage starting December 1st), but it looks like a few hundred people slipped in after that.

Colorado's SHOP enrollment, meanwhile, hovered right around the 3,000 person mark all year.

Press Release: NY State of Health Releases County-Level Enrollment Data

Feb 27, 2018

ALBANY, N.Y. (February 27, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released county-level enrollment data as of January 31, 2018, showing that overall enrollment increased in each of New York’s 62 counties. Total enrollment in the Marketplace is now over 4.3 million people, reflecting an increase of 700,000 people (19 percent) from 2017.  Many upstate counties saw significant enrollment gains in the last year.

“Consumers from Chautauqua to Suffolk and every county in between are shopping for health plans through the Marketplace,” said NY State of Health Executive Director, Donna Frescatore. “With affordable premiums and a robust choice of plans, NY State of Health is where New Yorkers go to get covered.”