OK, the guest host is actually Cliff Schecter, but I'll be a guest on the Leslie Marshall radio talk show this afternoon from 3:00 - 3:30pm EST today, talking ACA, repeal and so forth.

Listen to the Live Stream here!

You can also listen to the podcast after the show here.

OK, given the impending End of the World As We Know it (and, on a smaller scale, the potential End of the Affordable Care Act), this is a pretty minor thing, but worth noting.

This afternoon I did a write-up about today's Week 10/11 HealthCare.Gov Snapshot Report, which showed nearly flat enrollment growth from 12/31 to 1/14...two solid weeks with barely 64,000 additional signups across 39 states. As I noted, this particular stretch of Open Enrollment was expected to be pretty quiet, but even so, the numbers were still far lower than I expected.

In the Weeks 8/9 Snapshot Report, HHS reported exactly 8,762,355 QHP selections as of New Year's Eve via HealthCare.Gov specifically (which only includes 39 states).

Then, last week, the ASPE department released their "Mid-Season Report", which included more detailed enrollment data for every state...but cut off a week earlier (only through Christmas Eve). After filling in all the blanks, I concluded:

For weeks now, I (and many others) have been crunching the numbers and making projections to see just what the fallout would be on the individual market (and the total uninsured rate) if the GOP were to follow through with their promise to repeal the Affordable Care Act.

There's a lot of variables at play, and there's also no way of knowing what (if any) replacement plan they'd come up with instead, but there are two main scenarios to consider: First, what would things look like if the ACA were to be fully repealed (without a half-decent replacement ready to swoop in); second, what would happen if the ACA were to be partially repealed via the reconciliation process (ie, killing off the subsidies, individual/employer mandates, Medicaid expansion and so forth, but keeping the guaranteed issue, community rating and other regulatory provisions in place, which is what would happen if the Republicans were to continue on their present course).

With the Republicans scrambling to come up with a plan, any plan to replace the Affordable Care Act at the same time that they repeal it (as opposed to, you know, simply not repealing it, at least until they actually have a reasonable plan, which they could certainly do if they wished to), there was a huge amount of buzz generated Sunday night over this story from Robert Costa and Amy Goldstein of the Washington Post:

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

Drug negotiations aside, the rest of the article is exactly what you'd expect:


No, I'm not accusing him of murdering anyone (well, unless his ACA replacement bill becomes law, that is), but it's starting to look like the Senate would have to be on drugs to confirm orthopedic-surgeon-turned-Congressman Tom Price as the new HHS Secretary:

Exhibit A, via Manu Raju of CNN:

Trump's Cabinet pick invested in company, then introduced a bill to help it

Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising new ethics concerns for President-elect Donald Trump's nominee for Health and Human Services secretary.

...Less than a week after the transaction, the Georgia Republican congressman introduced the HIP Act, legislation that would have delayed until 2018 a Center for Medicare and Medicaid Services regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.

OK. We're past the "mini-deadline" for February 1st coverage in 47 states (+DC). New York has extended their Feb. coverage deadline out until Wednesday (1/18), while Massachusetts, Rhode Island and Washington State are taking enrollments through next Monday (1/23).

The real "final" deadline to sign up for 2017 healthcare coverage is Tuesday, January 31st. Anyone who signs up between the dates above and the 31st will be enrolled in a policy starting coverage on March 1st.

After that, under the ACA, the only ones who are supposed to be able to sign up for 2017 coverage are people who qualify for:

Back in mid-December, just about all of the ACA exchanges bumped out their enrollment deadlines for January 1st coverage by a few days. I was mildly surprised because improvements in the bandwidth, coding, layout and support staffing have meant a smoother process towards the big last-minute surge. Still, I wasn't blown away by the development or anything, as mid-December has always seen a massive spike in enrollment.

On the other hand, this announcement by the New York State of Health exchange is very surprising:

New Yorkers Now Have Until January 18 to Enroll in or Renew Health Insurance Coverage Beginning February 1

Consumer Demand Remains High Prompting Deadline Extension

ALBANY, N.Y. (January 12, 2017) – NY State of Health, the state's official health plan Marketplace today announced that consumers now have three additional days to enroll in a health plan with coverage starting February 1. The deadline has been extended through 11:59 p.m., January 18. The previous deadline was January 15.

Last week I noted that I overestimated the number of QHP selections in Connecticut by 9,900 (oops). Today they've reported that 818 of that gap has since been made up:



Call Center will be open Sunday, January 15 instead of Monday, January 16 in honor of Martin Luther King Holiday

HARTFORD, Conn. (January 13, 2017) - Today, Access Health CT (AHCT) CEO Jim Wadleigh announced that 105,313 people are enrolled for 2017 coverage as of January 12th.  In addition, Wadleigh announced that the AHCT Call Center will be open on Sunday, January 15th from 10:00 AM to 5:00 PM and closed on Monday, January 16th for the Martin Luther King Jr. holiday.

Over at Business Insider, Bob Bryan has posted a writeup explaining where exactly things stand regarding the Republican Party's ongoing ACA repeal process. He's even included the handy checklist to the right.

The US House of Representatives on Friday struck the second blow in the repeal of the Affordable Care Act (ACA), better known as Obamacare.

The House passed a resolution Friday that will direct committees in the Senate to draft legislation that would repeal the ACA.

The resolution's passage followed a morning of spirited debate, including a colorful goat analogy from one Republican lawmaker. But both parties largely stuck to their talking points: Republicans highlighted increasing premiums and costs, while Democrats focused on expanded coverage to more than 20 million Americans.


(Update: Thanks to Griffin Cupstid, MD for the link to the CNN transcript, which allowed me to make some minor wording edits below).

I wrote up a long-ass Twitter thread last night. I've reformatted it for a blog entry this morning:

So, I watched the ACA-related segments of Republican House Speaker Paul Ryan's CNN Town Hall thing last night. He took several questions about the ACA (Obamacare, remember) and Medicare, but I'm just gonna focus on the first one here. The questioner was a self-described lifelong Republican who used to hate the idea of the ACA...right up until he was diagnosed with cancer and given just months weeks to live. Pre-ACA he would have been denied coverage for the pre-existing condition and would have died. He profusely praised the ACA and flat-out thanked President Obama for saving his life. The actual question was "why would Ryan repeal the ACA without a replacement in place."

QUESTION: I was a republican and I worked for the Reagan and Bush campaigns. Just like you, I was opposed to the Affordable Care Act. When it was passed, I told my wife we would close our business before I complied with this law. Then, at 49, I was given six weeks to live with a very curable type of cancer. We offered three times the cost of my treatments, which was rejected. They required an insurance card. Thanks to the Affordable Care Act, I'm standing here today alive.

Being both a small business person and someone with pre-existing conditions, I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?

RYAN: Oh, we -- we wouldn't do that. We want to replace with something better. First of all, I'm glad you're standing here. I mean, really -- seriously.

QUESTION: Can I say one thing? I hate to interrupt you...I want to thank President Obama from the bottom of my heart, because I would be dead if it weren't for him.

Given the massive backlash/debate going on over the impending (supposed) repeal of the Affordable Care Act, there seems to be one particular fact which a huge number of Obamacare opponents (and even many supporters of the law) don't seem to be aware of.

One of the big talking points among ACA opponents is "Why should my hard-earned tax dollars go to subsidize someone else's lazy ass?"

Now, aside from the fact that a) "being self-employed" or b) "happening to have a job which doesn't offer health benefits" or c) "being married to/a child of either a) or b)" hardly makes one "lazy", there's something which these folks should know:

nearly everyone's healthcare coverage is heavily taxpayer subsidized.

Remember this pie chart?

Most people know that the Orange (Medicare), Burgundy (Medicaid) and, over the past few years, Blue (ACA exchange/Medicaid expansion) enrollees are taxpayer subsidized.

A few days ago I noted that MNsure, Minnesota's ACA exchange, has skyrocketed from last place to first in terms of achieving my personal OE4 enrollment targets, having enrolled 103,578 people in Qualified Health Plans (QHPs), plus another 19,960 in MinnesotaCare (MN's BHP program) and 65,164 in Medicaid.

Yestrerday they updated their numbers once again:

That's a further increase of 3,009 Minnesotans in QHPs in the past week or so. MN has already blown past my original projection (86K) and has reached 92% of my revised target (116K).

A few days ago I had the honor of joining healthcare reporter Jonathan Cohn and healthcare patient advocate Amy Lynn Smith as a guest on The Sit & Spin Room, a podcast presented by Michigan's best political website, Eclectablog, featuring hosts Chris Savage and the mysterious @LOLGOP.

Cohn is the guest for the first half-hour, while Smith and I join in for the remaining hour of the show.

Check it out!

This isn't a particularly dramatic update given that CMS released their "mid-season" report yesterday, which already updated Washington's tally from 180K thru 12/20 to 194K as of 12/24...but an update's an update:

The Washington Health Benefit Exchange today announced that more than 200,000 customers have selected 2017 health and dental coverage through Washington Healthplanfinder since the open enrollment period began on Nov. 1 – an increase of almost 14 percent over the same point last year.

Hmmmm...the numbers look good, but that "...and dental" caveat is a bit troubling. I've asked for clarification; it's possible that the "dental" reference simply refers to the fact that some Qualified Health Plans also include dental coverage, as opposed to referring to standalone dental plans, which shouldn't be counted as QHPs.