I just received the following 2020 Open Enrollment report from the Massachusetts Health Connector (via email, no link):

It looks like we’ve pretty much wrapped up auto-renewal, how about an update on 2020 enrollment:

As of Nov. 29, we had a total of 286,640 people enrolled in Jan. 1 coverage, 6 with February or March enrollments, and 10,852 who had selected plans and had not yet paid to enroll. So, by the CMS definition, we are at 297,498. That includes about 17,000 new enrollments from people who did not have coverage as of Nov. 4 with the Health Connector.

I wish every ACA exchange would break out their numbers this way. Simple and to the point, but also with relevant details...not only "renewals vs. new" but also how many are enrolled for Januar vs. Feb. or March coverage and even how many have/haven't paid yet! The last is a bit unfair since Massachusetts is one of only two states, I believe, which actually handle premium payments (Rhode Island does as well...Washington State used to but doesn't anymore).

 

I'm just putting this out there today because I know there's gonna be a bunch of eye-rolling stories completely misunderstanding the data later on this week.

Last Wednesday, the Week 4 HealthCare.Gov Snapshot Enrollment Report came out and showed a "mysterious" 41% increase in ACA exchange enrollments for the week vs. last year...jumping from 500,437 QHP selections to 703,556 QHP selections for the corresponding week this year.

This Wednesday, the Week 5 snapshot report will come out and will almost certainly show a "mysterious" large drop in ACA exchange enrollments vs. last year...from 772,250 down to perhaps 500,000 or so.

Around 7,000 or so of this drop will likely be due to Nevada splitting off onto their own ACA exchange. A small number will be due to Idaho expanding Medicaid. But the vast bulk of this seemingly disastrous ~35% drop will be for a far simpler reason...the same one which caused the seeming 41% spike last week: Thanksgiving.

via Ariel Hart of the Atlanta Journal-Constitution:

The pace of Obamacare enrollment this year is up 9% so far in Georgia, a turnaround from declines since the beginning of the Trump administration. Nationwide, the pace of enrollment is up 2%.

Wait, what? Where on earth is she getting either of these numbers?

In Georgia specifically, ACA exchange enrollments are only up 4.5% vs. last year...and as I note at the link, even that's misleading because Thanksgiving was included in Week 4 last year but won't be counted until Week 5 this year.

 

I haven't been very kind to Trump's CMS Administrator Seema Verma over the past three years, with very good reason. She's spent her entire time as head of the Centers for Medicare & Medicaid pushing for states to impose draconian work requirements for Medicaid, trying to weaken or even eliminate ACA protections, promoting substandard #ShortAssPlans and mocking the very programs she's supposed to be in charge of. She's overseen troubling "memory holing" of critical information on both HealthCare.Gov as well as the Medicare & Medicaid websites,

The Week 4 HealthCare.Gov Snapshot Report from CMS should be released at any time, covering enrollment in 38 states from Nov. 10th - Nov. 23th.

As a reminder, here's what the Week 3 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around ~120,000 of the difference. Secondly, Nevada split off from HC.gov this year, which accounts for around ~19,000 of the gap the first 3 weeks. In addition, a small portion of the difference is likely due to Idaho and Maine expanding Medicaid; exchange enrollees earning between 100-138% FPL should be tranferred over to Medicaid instead.

IMPORTANT: As I've noted before, Covered California has arranged to expand and enhance their ACA premium subsidies beyond the official ACA formula starting with the 2020 Open Enrollment Period. Back in October, I posted a detailed analysis, complete with tables and graphs to explain just how much hundreds of thousands of Californians could save under the new, beefed-up subsidy structure.

However, Anthony Wright of Health Access California just called my attention to the fact that I made a major mistake in my analysis which impacted every one of the examples: I was basing them on the draft enhanced subsidy formula from back in May instead of the final version, which is considerably more generous at the upper end of the sliding scale than the draft version was!

In short:

  • The ACA formula caps premiums (for the benchmark Silver plan) at between 2 - 9.8% of household income but only if you earn between 100 - 400% of the Federal Poverty Level.
  • The draft California formula is a bit more generous from 100 - 400% FPL and also caps premiums between 9.9 - 25% of income between 400 - 600% FPL.
  • The final California formula is more generous yet: It's pretty much the same up to 400% FPL, but caps premiums between 9.8 - 18% of income between 400 - 600% FPL.

I've therefore gone back and re-calculated and re-written the entire blog post below with the updated, corrected subsidy formula. My apologies for the error!

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There's two important points for CA residents to keep in mind starting this Open Enrollment Period:

  • First: The individual mandate penalty has been reinstated for CA residents. If you don't have qualifying coverage or receive an exemption, you'll have to pay a financial penalty when you file your taxes in 2021, and...
  • Second: California has expanded and enhanced financial subsidies for ACA exchange enrollees:

Until now, only CoveredCA enrollees earning 138-400% of the Federal Poverty Line were eligible for ACA financial assistance. Starting in 2020, however, enrollees earning 400-600% FPL may be eligible as well (around $50K - $75K/year if you're single, or $100K - $150K for a family of four). In addition, those earning 200-400% FPL will see their ACA subsidies enhanced a bit.

Smart idea via the NY State of Health ACA exchange:

Increased Visits to Food Pantries During Holiday Season Provide Opportunity to Reach Uninsured New Yorkers

ALBANY, N.Y. (November 25, 2019) – NY State of Health, the state's official health plan Marketplace, today announced its partnership with food pantries for the third holiday season to educate consumers about enrolling in high quality, affordable health insurance. Food pantries across New York will have certified enrollment assistors on-site throughout November and December to answer questions about health coverage options and how to enroll in a health plan. This year, the Marketplace is also offering eligible New Yorkers the option to receive information on the Supplemental Nutrition Assistance Program (SNAP) during the enrollment process.

From The Hitchhiker's Guide to the Galaxy:

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.”

From a June story about Arkansas' "Designed to Fail" Medicaid work requirement disaster:

Under the Arkansas law, targeted enrollees were notified by the state via mail and informational flyers that they were required to work 80 hours a month, participate in another qualifying activity such as job training or community service, or meet criteria for an exemption such as pregnancy, a disability or parenting a child.

UPDATE: Well what do you know? Less than a day after Kliff wrote her story on the BYU-Idaho situation, they've already reversed their stance! Bravo for her!

BYU-Idaho, the school @sarahkliff reported would not allow its students to enroll in Medicaid, sent this email to students reversing its decision, per my DMs pic.twitter.com/jEuIu9K1KT

— Dylan Scott (@dylanlscott) November 26, 2019

Original story below...

I heard about this story a couple of weeks ago but didn't get around to writing about it until today. Via Twitter:

Students of the BYUs: might want to start making some noise: the Church Board of Ed just decided that they won’t accept Medicaid as a provider for their student health insurance requirement. The week IDaho expanded Medicaid too. Catch 22? DMBA doesn’t count for ACA requirement.

As my friend, U of M Law Professor and former Deputy Assistant Attorney General Sam Bagenstos just noted, this was pretty much inevitable:

BREAKING -- Poverty rights group files suit in federal court against work requirements MI has enacted for those on expanded Medicaid program Healthy Michigan.

— Gongwer News Service (@GongwerMichigan) November 22, 2019

A lawsuit has been filed challenging Michigan's new Medicaid work requirements that take effect Jan. 1. Plaintiffs are 4 people enrolled in the Medicaid expansion program known as Healthy Michigan #MiLeg

— David Eggert (@DavidEggert00) November 22, 2019

Fellow U of M law professor Nicholas Bagley already has the legal complaint itself:

Back in late October, a few days before the launch of the 2020 Open Enrollment Period, I issued a warning to ACA exchange enrollees who may have been benefiting from the "Silver Loading" premium pricing strategy for in 2018 and/or 2019 that the enhanced subsidies they've been taking advantage of for two years are likely going to be reversed for 2020:

What happens next year if the benchmark Silver plan drops by 4%...but the Bronze, Gold, and the OTHER Silver plans stay flat?

via Amy Goldstein of the Washington Post:

Earlier this year, a top Republican communications operative delivered a plan to boost the profile of Seema Verma, President Trump’s appointee overseeing health insurance for the elderly and poor. The “Executive Visibility Proposal” was a month-by-month blueprint to have her grant interviews to Women’s Day and other magazines, speak at prominent conferences and appear at Washington’s most prestigious social events.

Marked “privileged, pre-decisional, deliberative,” the eight-page proposal, emailed to Verma’s deputy chief of staff, was part of an unusual campaign carried out by high-paid contractors Verma brought on at a cost to taxpayers of more than $3 million.

Over at the Washington Post, reporter Yasmeen Abutaleb has a disturbing-sounding story which immediately caught my eye and raised major internal alarms within the healthcare wonk/advocate community:

Critics say ‘junk plans’ are being pushed on ACA exchanges

The Trump administration has encouraged consumers to use private brokers, who often make more money if they sell the less robust plans.

The Trump administration is encouraging consumers on the Obamacare individual market to seek help from private brokers, who are permitted to sell short-term health plans that critics deride as “junk” because they don’t protect people with preexisting conditions, or cover costly services such as hospital care, in many cases.

So far, this is nothing new; I've been warning people about this since day one...it's the 2nd item on my "Seven Important Things to Remember" blog post from November 1st:

The Week 3 HealthCare.Gov Snapshot Report from CMS should be released later on this afternoon, covering enrollment in 38 states from Nov. 10th - Nov. 16th.

As a reminder, here's what the Week 2 report looked like:

There are two major things to account for when comparing the two years: First, there's a day missing due to Nov. 1st falling on a Friday instead of a Thursday this year. This likely accounts for around half of the 244,000 difference. The other significant difference is that Nevada split off from HC.gov this year, which accounted for around 12,000 of the gap the first 2 weeks.

If you assume around 130,000 of the difference is due to the missing day, that still leaves 2020 Open Enrollment around 100,000 short of the same time period last year on HealthCare.Gov.

Connect for Health Colorado® Reports Coloradans are Shopping Around for 2020 Coverage

DENVER – Nearly 24,000 Coloradans have signed up for a health insurance plan through Connect for Health Colorado’s Marketplace between Nov. 1 and Nov. 15. for coverage starting Jan. 1, 2020.

More Coloradans buying their own health insurance are seeing lower premiums, largely due to the reinsurance program that passed this year. Reinsurance helps insurers with their most costly claims. However, given the complexities of how financial help available through the Marketplace is calculated, current customers should shop around to reduce monthly costs.

Heh. This is a pretty good layman-speak for #ReverseSilverLoading.

On average, those who qualify to automatically renew their plan would lower their premiums by 15 percent (compared to 2019) if they switch to the lowest-cost plan in their current level of coverage.

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