I've written a lot about the negative impact on enrollment this year due to deliberate sabotage efforts on the part of Donald Trump and the Congressional GOP, and I stand by it. I've run the numbers and honestly believe that I've proven pretty conclusively that these efforts--in particular, the last-minute yanking of millions of dollars' worth of HC.gov "Final Deadline!" advertising--had a significant negative impact, to the tune of several hundred thousand "lost" enrollments.
However, I've also repeatedly stressed that there were most definitely other factors as well which can't be pinned on Trump's efforts. Some of these are quantifiable and pretty obvious:
NOTE: I have to attend a field trip with my kid this morning so won't be able to post about the Minnesota results until around noon, but here's an overview:
There are only 2 states which still haven't announced their final 2017 Open Enrollment Period totals: Vermont and Minnesota. Vermont isn't likely to have anything too noteworthy to say (I've confirmed ~29K QHPs...they'll probably top out at ~30K), but Minnesota has a very special situation.
Minnesota confirmed ~106,000 QHP selections as of January 10th, so they probably tacked on another 5K - 10K during the last 3 weeks of open enrollment, for a total of perhaps 115,000. This would be impressive already, since they only enrolled 83.5K people last year.
However, they're also wrapping up (even as I type this) an 8-day Special Enrollment Period piggybacked onto the end of January, and those who enroll during this SEP could receive a 25% discount on their premiums depending on their income. Here's the backstory.
The table below is a slightly-modified version of the one I've been using for my "Trump Sabotage Effect" post. This version ignores all of that and simply presents all 50 states (+DC) together.
A few days ago I assumed the grand total would come in between 12.3 - 12.4 million, but I was misreading California's total based on their previous report which had made it look like they would break 1.6 million. Instead, they came in 44K below that mark, so the national total now stands at exactly 12,227,442 QHP selections, or 3.6% below 2016's final total. There's only 2 states missing data now: Minnesota and Vermont.
A record number of Idahoans signed up for health insurance coverage through the statebased health insurance exchange during the latest open enrollment period, which ended on January 31.
“Over the last three months, more than 105,000 people selected a health insurance plan through the exchange,” said Pat Kelly, executive director of Your Health Idaho. “We have never seen more interest in Your Health Idaho. We know changes are coming to the health insurance marketplace but we want our customers to know our entire team remains committed to serving them and providing them with access to affordable health insurance options.”
In total, 105,977 Idahoans signed up for coverage through Your Health Idaho during the 2017 open enrollment period.
For the past three years, Idaho has been the leader in per-capita enrollments for state-based exchanges. YHI is currently waiting on nationwide enrollment numbers to determine how it ranks for the 2017 open enrollment period.
Oof. Regular readers know that I've compiled plenty of evidence showing that while the 39 states run through the federal exchange (HC.gov) showed a ~5% enrollment drop this year, the state exchanges have been showing an overall net increase of roughly 2% over 2016. Rhode Island, however, is the odd man out on this front, as shown in this email I just received (not up on their website yet):
Despite facing a unique set of challenges this open enrollment, 29,420 individuals selected 2017 coverage through HealthSource RI during open enrollment period (November 1, 2016 – January 31, 2017). As of January 31, 27,395 of those individuals paid, and are therefore confirmed, in 2017 coverage. We do anticipate these number will change as payments are made through the February 23 payment deadline and also as HealthSource RI remedies account issues incurred during the open enrollment period. It is difficult to point to one clear cause for this year-over-year drop in enrollment, but we believe several factors might have played a role:
Over the past few weeks I've compiled increasingly solid evidence (supported by a separate analysis by David Anderson of Balloon Juice) showing that yes, a significant portion of the reduced 2017 ACA exchange enrollment was due specifically to sabotage efforts on the part of Donald Trump and the GOP.
The reason this is so significant is that the state exchanges have their own marketing budgets, ad campaigns, outreach efforts and most significantly, branding. Ads promoting "Covered California" are gonna have a far bigger impact on enrollment for the residents of CA than ads for "HealthCare.Gov". There's some residual effect, because some people visit HC.gov first and are then redirected to CoveredCA from there, but for the most part, the state exchange branding is completely separate. (As an aside, this can sometimes have negative consequences, as in the case of "kynect" in Kentucky, which did such a bang-up job of isolating their brand from "Obamacare" that most of the state hasn't the foggiest idea that the two were the exact same law, but that's a separate discussion).
Last night, CNN held a full, 90-minute debate between Bernie Sanders and Ted Cruz which was billed as "The Future of Obamacare". It was a clever idea for a couple of reasons: Not only was each of them the "runner up" for the 2016 Presidential nomination of their party, but each of them made healthcare a core part of their campaign (Bernie, of course, is a die-hard Single Payer guy, while Cruz literally shut down the federal government to stop the bulk of the ACA from being implemented).
A sizable minority of Americans don’t understand that Obamacare is just another name for the Affordable Care Act.
This finding, from a poll by Morning Consult, illustrates the extent of public confusion over a health law that President Trump and Republicans in Congress hope to repeal.
In the survey, 35 percent of respondents said either they thought Obamacare and the Affordable Care Act were different policies (17 percent) or didn’t know if they were the same or different (18 percent). This confusion was more pronounced among people 18 to 29 and those who earn less than $50,000 — two groups that could be significantly affected by repeal.
...When respondents were asked what would happen if Obamacare were repealed, even more people were stumped. Approximately 45 percent did not know that the A.C.A. would be repealed. Twelve percent of Americans said the A.C.A. would not be repealed, and 32 percent said they didn’t know.
I've been cautioned that these numbers are preliminary, but that's true of all of the "final" enrollment numbers to date; there are often minor clerical corrections and the like before the final numbers are baked in.
Anyway, here's the OE4 QHP enrollment numbers for the DC exchange, which is up about 3.1% over last year.
However, according to the official ASPE report for 2016 Open Enrollment, DC's QHP tally was slightly lower (22,693); since that's the official total used by HHS, that's what I'm going with, which means they've enrolled about 4.1% more this year.
LT. GOVERNOR WYMAN, ACCESS HEALTH CT ANNOUNCE 2017 OPEN ENROLLMENT NUMBERS
111,524 Residents Enrolled Through Access Health CT; 13,791 are New to the Exchange
(HARTFORD, Conn.) – Lieutenant Governor Nancy Wyman, Chair of the Board of Access Health CT (AHCT), and AHCT CEO Jim Wadleigh today announced that the state’s health insurance exchange enrolled 111,524 residents during the 2017 Open Enrollment Period, which ended at midnight on January 31, 2017. Of those enrollees, 13,791 consumers are brand new to the exchange. In addition, 5,000 people came through AHCT seeking dental coverage and 1,467 enrolled in health coverage through the Small Business Program.
Covered California Finishes Fourth Open Enrollment With More Than 412,000 New Consumers and Strong Participation From Young Enrollees
New plan selections met enrollment projections for the fourth open-enrollment period.
Nearly 50,000 consumers signed up for health care coverage in the final two days before the Jan. 31 deadline.
Strong finish and overall enrollment are credited to effective work by Certified Insurance Agents and enrollers and robust television, digital, print and outdoor advertising that ran throughout the open-enrollment period.
The crucial demographic of young adults ages 18–34 accounted for 37 percent of enrollment, contributing to a healthy risk mix for 2017.
SACRAMENTO, Calif. — Covered California announced Monday that it finished the open-enrollment period with 412,105 new consumers signing up for health coverage.
Today marks the end of our fourth and by far most successful Open Enrollment period. The number of plan selections ran 12% ahead of last year’s pace and the volume of last-minute customers Monday and Tuesday led us to extend sign-ups for three days for those who started the process before Tuesday’s deadline.
I share this information with extreme gratitude to our dedicated staff, our Assistance Network, our Broker partners, our health insurance company partners and the many other supportive stakeholders who helped us move forward with our shared mission no matter the headwinds we encountered along the way.
In 1897, the Indiana state House passed a bill which would have attempted to legally defined the value of π (Pi) as 3.2. Yes, I'm quite serious:
Any high school geometry student worth his or her protractor knows that pi is an irrational number, but if you’ve got to approximate the famed ratio, 3.14 will work in a pinch. That wasn’t so much the case in late-19th-century Indiana, though. That’s when the state’s legislators tried to pass a bill that legally defined the value of pi as 3.2.
The very notion of legislatively changing a mathematical constant sounds so crazy that it just has to be an urban legend, right? Nope. As unbelievable as it sounds, a bill that would have effectively redefined pi as 3.2 came up before the Indiana legislature in 1897.
As I noted last Friday, there's pretty good evidence that the Trump administration killing off most of the final HealthCare.Gov open enrollment deadline TV ads was directly responsible for a significant portion of the OE4 enrollment reduction on the federal exchange. The most obvious evidence of this is that in the final, critical 5 days of the period (when there's always been a significant spike in last-minute enrollees), the state-based exchanges (which run their own marketing campaigns) saw a 1.5% enrollment increase (at least 44,000 people) at the same time that HC.gov enrollment fell by 5% (450,000 people) short. This discrepancy between the state exchanges and the federal one will become a bit larger once the final enrollment numbers from CT, DC, ID, MA, MN, RI & VT come in.
Republicans begin to grumble: Why haven't we repealed Obamacare yet?
...The sentiment is beginning to simmer within the influential conservative wing of the Republican Party and hints at what could be the opening of an intra-party rift as the GOP's mission to overhaul the country's health care system appears to be losing steam.
...That shift in tone has irked other Republicans who are eager to take a swift vote to roll back as much of Obamacare as possible. Their fear: their conservative constituents back home won't settle for anything else.
"For goodness sake, we should be able to put something on President Trump's desk that's at least as good as what we put on President Obama's desk. Not something watered down," Rep. Jim Jordan, R-Ohio, told CNN in an interview. "Let's repeal it. Let's do what the voters sent us here to do."