Time: D H M S

I want to be clear about something: Much of my data analysis has a bit of snark to it, adding an acrid tinge of dark humor to healthcare, a topic which is often fraught with pain, suffering, grief and sadness. Once in awhile I take pause before twisting the sarcasm knife too much.

This is one of those moments. I'm therefore limiting the snark to the headline only.

From today's Detroit Free Press:

Three Januarys ago, Gov. Rick Snyder described a River of Opportunity all Michiganders could enter as long as the state improved third-grade reading proficiency.

“One of the important metrics in someone’s life on the River of Opportunity is the ability to be proficient-reading by third grade,” he said in January 2015. “How have we done? We were at 63% in 2010, and we are at 70% today. … But 70% doesn’t cut it.”

Over the past month or so, former CMS Administrator and healthcare hero Andy Slavitt has been urging people to fill out a sparsely worded, cryptic online form if they're interested in "making our nation's health care system work better for all Americans."

There are too many agendas that aren’t about making health care work for all Americans. We need to put health care over politics again.

Within a month, a major initiative will be announced that I and many Americans will come together for. If interested... https://t.co/7BBDUS2J8u

— Andy Slavitt (@ASlavitt) January 13, 2018

I filled it out, of course, as did what I presume are thousands of others, but few had any idea what Slavitt specifically had in mind at the time. Today he's gone public with the details:

Note: Ironically, I had to make a slight correction myself below--for some reason I originally had "Alleigh" down as "Allison".

Flashback to May 24, 2017:

From Alleigh Marre, HHS Dept. National Spokesperson, less than an hour ago (h/t Kimberly Leonard for the heads up):

"Even Charles Gaba, the author of ACAsignups.net admits in his analysis, “The simple truth is: Yes, full-price, unsubsidized premiums for individual market healthcare policies probably have doubled since 2013…” His analysis of the report drives home that Obamacare’s one-size-fits all mandates and regulations have driven up prices for all."

Here's the actual quote she's referring to:

Look what I dug up on the Washington Health Benefit Exchange website!

That's right...it's time for another state-level Datapalooza!® The first two slides come from the Feb. 2nd board meeting Open Enrollment Report; the rest come from the "Open Enrollment For 2018 Plan Year Performance Dashboard" report, which is a bit different; it actually runs through January 26th instead of January 14th for whatever reason. so some of the numbers are slightly different.


NOTE: The last few paragraphs of this post have been reformatted for clarity only.

All of Twitter is abuzz with this tweet (since deleted) by Republican Speaker of the House Paul Ryan:

A secretary at a public high school in Lancaster, PA, said she was pleasantly surprised her pay went up $1.50 a week ... she said [that] will more than cover her Costco membership for the year. https://t.co/yLX1Bod1j0

--Paul Ryan (@PRyan) February 3, 2018

While Ryan deleted the tweet above (fear not...a whole mess of people took screen shots before he did so), he has yet to remove another tweet quoting another passage from the same AP article (I took a screen shot of this one in case he deletes it as well):

“I have heard time and again that the middle class is getting crumbs, but I’ll take it!” https://t.co/yLX1Bod1j0

Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:

d) Enrollment Update

Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.

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: