Time: D H M S

I don't have much to add here. This is sad and depressing to watch unfold.

Indiana Adds Work Requirement To Medicaid, Will Block Coverage If Paperwork Is Late

Indiana on Friday became the second state to win federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act. A less debated provision in the state's new plan could lead to tens of thousands of people losing coverage if they fail to complete paperwork documenting their eligibility for the program.

The federal approval was announced by Health and Human Services Secretary Alex Azar in Indianapolis.

Medicaid participants who fail to promptly submit paperwork showing they still qualify for the program will be locked out of enrollment for three months, according to updated rules.

At this point, the only significant top-line 2018 Open Enrollment numbers missing are the final 10 days out of California (which could add perhaps 40,000 to the total) and a solid month of enrollment from the District of Columbia (23 days, actually, but they extended their deadline by 5 extra days, which may or may not be included in the final, official report from CMS). DC's tally through 1/08 was 21,352 QHP selections. Their all-time high was around 22,700 set in 2016, so I can't imagine that they added more than perhaps 2,000 more since 1/08. In other words, about 99.5% of the 2018 OEP QHP selections have likely been accounted for.

That means it's time to move on to...breaking down the demographic data! Woo-hoo! Parrrr-tyyyy!!

The big, official CMS report from the Assistant Secretary for Planning and Evaluation (ASPE) presumably won't be released for a couple of weeks, but some of the state-based exchanges are faster about posting their demographics. First up: Connecticut!

OK, this may seem kind of silly; data that I've compiled has been cited/quoted by any number of publications, news stories, healthcare wonks and so forth over the past 4+ years, so I suppose this really shouldn't be that big of a deal to me.

Even so, the Kaiser Family Foundation is among the Gold Standards when it comes to making reliable, accurate healthcare data available to the public, so I'm deeply flattered to be cited on their website (for the first time to my knowledge) as an official data source:

This Just In, courtesy of Dan Goldberg of Politico New York...

.@charles_gaba NY releases final numbers --253,102 in QHP with 41% receiving NO financial assistance. (That's amazing!) 738,851 in Essential Plan 374,577 in Child Health Plus

— Dan Goldberg (@DanCGoldberg) February 1, 2018

New York had already broken their 2017 numbers (just barely) a couple weeks ago, so this is effectively icing on the cake: Total QHP selections are up 4.2% year over year vs. the 242,880 they signed up last year.


Last year, after 7 years of doing everything in their power to undermine, sabotage and weaken the ACA, Congressional Republicans tried every which way they could to repeal the law. They tried passing AHCA , B-CRAP, ORRA, Graham-Cassidy and a few other variants along the way to no avail.

Finally, in late December, desperate for a win on "repealing Obamacare"--any type of win--they said "screw it" and just repealed the ACA's individual mandate all by itself. They didn't replace it with a reasonable inducement for people to get covered, mind you, against the advice of actuarial expert advice, mind you; they just...got rid of it.

The vote to repeal the mandate penalty was incredibly short-sighted and will almost certainly lead to negative consequences when it actually goes into effect (which won't be until next year, causing much confusion until then, but that's a different discussion)...but at least it's legal.

The same can't be said for Idaho's decision last week to simply ignore federal law altogether in the future:

Nothing new or noteworthy here, but I've posted the "last call" press releases for California and DC, so I figured with just 8 hours left to go I should do so for New York as well:

ALBANY, N.Y. (January 24, 2018) – NY State of Health, the state’s official health plan Marketplace today announced that New Yorkers who have not yet signed up for coverage in a Qualified Health Plan (QHP) should enroll now so they are covered for 2018. Open Enrollment ends January 31st. Consumers across the state have a choice of multiple health plan options and for many, coverage is more affordable than last year.

Enrollment through NY State of Health continues to climb to record levels with more than 4.2 million enrolled across all programs. As of January 16, 2018, 243,600 consumers have enrolled in a Qualified Health Plan (QHP) and 726,300 have signed up for the Essential Plan, exceeding numbers at the end of open enrollment in 2017.

This announcement is far less surprising than the one from the DC exchange I posted a few minutes ago...

Final Day of Open Enrollment! Covered California Will Help Consumers Who Get Caught Up in Surge of Last-Minute Shoppers

  • Covered California’s open-enrollment period ends at midnight tonight.
  • Due to an expected increase in demand today, consumers who start an application before midnight will be able to work with a certified enroller to complete the process on Thursday or Friday.
  • Covered California Service Center representatives are available to help through midnight on the 31st and through 8 p.m. on Feb. 1 and 2. 

SACRAMENTO, Calif. — On the final day of open enrollment, with tens of thousands of people expected to sign up for health coverage, Covered California announced it would help consumers “cross the finish line” if they get caught up in the surge of last-minute shoppers.

Huh. Deadline extensions were fairly common in the first couple of years of Open Enrollment, but have mostly been phased out more recently. This is a bit unexpected from the DC Health Link:

.@MayorBowser has extended the deadline for individuals & families to enroll in quality affordable health insurance to Monday, February 5th at 11:59 pm. Take advantage of today's extended hours at enrollment centers across the city. Don't delay #GetCoveredDC pic.twitter.com/8R7zq0EzA1

— DC Health Link (@DCHealthLink) January 31, 2018



Earlier this evening, Donald Trump gave his 90-minute State of the Union speech. He mentioned "Obamacare" exactly one time:

We eliminated an especially cruel tax that fell mostly on Americans making less than $50,000 a year — forcing them to pay tremendous penalties simply because they could not afford government-ordered health plans. We repealed the core of disastrous Obamacare — the individual mandate is now gone.

I'm not going to go try and explain yet again why the ACA's Individual Mandate was included in the law in the first place or why repealing it is such a bad idea; I've embedded my video explainer above to do that.

Instead, I want to make something very clear:


If you've been following this site for awhile, you know that for the 2018 Open Enrollment Period, I sort of partnered up with two grassroots healthcare advocacy groups: ACA Consumer Advocacy and the Indivisible ACA Signup Project. We created and disseminated a whole mess of blue-themed Open Enrollment infographics, in both English and Spanish, for all 50 states and the District of Columbia via our websites, social media and even in print via downloadable PDF versions distributed across various public locations.

Anyway, with Open Enrollment officially wrapping up in the final 3 states (well, 2 states + DC) on Wednesday, Jan. 31st, they shared a few metrics, which I'm proud to repost here as well:

Thread: So, about those blue images. We partnered with @2018ACASignup to try to help offset #ACASabotage around enrollment. Kinda impressed with how the whole thing worked. Here are some numbers:


Amazon, Berkshire, JPMorgan Move to Target Health-Care Costs

Three corporate giants are teaming up to combat what billionaire Warren Buffett calls a “hungry tapeworm” feasting on the U.S. economy: health care.

OK, I'm interested...

Amazon.com Inc., Buffett’s Berkshire Hathaway Inc. and JPMorgan Chase & Co. said they plan to collaborate on a way to offer health-care services to their U.S. employees more transparently and at a lower cost. The three companies plan to set up a new independent company “that is free from profit-making incentives and constraints,” according to a short statement on Tuesday.


If you look at The Graph for the 2018 Open Enrollment Period, you'll notice that in addition to the large green section (Qualified Health Plan (QHP) selections across the 39 Healthcare.Gov states) and the smaller blue section (QHP selections across the 12 State-based exchanges), there's a much smaller burgundy slice at the top labelled "BHPs (MN/NY only). This represents around 820,000 people in Minnesota and New York only who are enrolled in Basic Health Plans, or BHPs.

Last August, I woke up at 3am with excruciating pain in my abdomen on my right side. I tried to "walk it off" (bad cramp?), go to the bathroom (bad gas?), force myself to throw up (low-level food poisoning?) and drank a big glass of water (dehydration?) all to no avail. In utter agony, I finally had my wife wake up our son so she could drive me to the emergency room. I was especially worried because of the location of the pain; I feared I might be suffering from appendicitis, which is, of course, potentially deadly if not treated immediately. Even if it wasn't, it hurt like hell.

About five hours, an IV pain medication drip and a CT scan later, I was sent on my way back home with a less serious diagnosis: A kidney stone. Nasty and painful, but not generally fatal (although they can be if left untreated too long, causing sepsis).

A few weeks later I got the bill: $600. Not a lot of fun to pay of course, but it was much better than the official cost of the ER visit: $6,000. BCBSMI paid the other 90% of the cost.

A huge shout-out to Ken Kelly for calling my attention to this press release which was apparently sent out way back on December 19th???

Vermont wraps up 2018 open enrollment for Vermont Health Connect

News Release — Department of Vermont Health Access
Dec. 19, 2017

Vermonters who Didn’t Complete Plan Selection Urged to Call this Week

WATERBURY, VT – State officials reported that nearly 23,000 Vermonters had confirmed a 2018 health plan and qualified for financial help to make the plan more affordable. Total enrollment in qualified health plans, which typically includes 46,000 small business employees and 11,000 individuals who don’t qualify for financial help, is expected to surpass 80,000. While enrollment will be similar to past years, this year’s earlier deadline means fewer members will experience gaps in coverage. In past years, nearly 2,000 members missed out on January coverage.

As I announced a couple weeks back, I spent most of the past week attending the annual Families USA healthcare conference in Washington, D.C. The conference has been going on for many years, but this is the first time I attended, so it was a big deal for me.

Here's a little background on the organization:

Families USA is a nonprofit, nonpartisan consumer health advocacy organization. It was co-founded in 1981 by attorney Ronald Pollack, its current executive director, and Philippe Villers, the organization’s current president. Families USA is an influential advocate in Washington, D.C., and has played a leading role on virtually every major piece of health care legislation, especially the Affordable Care Act (ACA), the Children’s Health Insurance Program (CHIP), numerous Medicaid measures, and the Medicare Part D plan.

(Update: Ron Pollack stepped down last year; Frederick Isasi is the new Executive Director)