Time: D H M S

The Children's Health Insurance Program (CHIP) has been around for 21 years. It was co-created in a bipartisan way in 1997 by Sen. Ted Kennedy and Sen. Orrin Hatch, with support from Hillary Clinton while she was First Lady of the United States.

CHIP was originally funded as a 10-year program. When the original funding ran out in 2007, it was extended for two years (to 2009) under George W. Bush with little incident (he had previously vetoed an expanded version but later signed the extension of the existing version).

Under President Obama, CHIP was extended (and expanded) again through 2013. The Affordable Care Act added another 2 years to CHIP, extending funding through 2015. In 2015, CHIP funding was extended again, through September 30, 2017.

The completely GOP-controlled Congress allowed CHIP funding to expire. Most state still had a few months worth of money held in reserve for the program, but some started sending out termination notices to the parents of enrollees, letting them know that they'd be kicked off the program within the next month or two.

via Covered California, yesterday:

  • An analysis of potential premium changes in states across the nation shows increases of 16 to 30 percent likely in 2019 if federal steps are not taken.
  • While the Patient Protection and Affordable Care Act’s subsidies would largely insulate subsidized consumers from these costs, millions of unsubsidized consumers would pay the full price of these increases. Many would likely be priced out of coverage.
  • Continued policy and premium uncertainty risks further carrier withdrawals, leaving more consumers with only one health plan and even the prospect of “bare counties.”
  • The analysis reviews three federal policy options that could stabilize markets and mitigate the impact of premium increases in many states.
  • Covered California’s open-enrollment period is still underway and consumers have through Jan. 31 to sign up for coverage.

Flashback to September 24, 2013:

The United States federal government shut down for the first 17 days of October 2013 because Ted Cruz and other Congressional Republicans, furious about the Affordable Care Act surviving everything they had thrown at it over the preceeding 3-4 years, thought that pulling the plug would torpedo the launch of the ACA's first Open Enrollment Period.

Unfortunately for them, that simply wasn't in the cards:

Rather, any defunding would be temporary, because of a government shutdown. On the day the exchanges were due to open, much of the federal government would go offline, including a big portion of the Health and Human Services Department that is running the coverage expansion. But legislative inaction cannot gut Obamacare in the way that legislative action could. During a shutdown, implementation would “substantially” continue.

That’s according to a Congressional Research Service report prepared for Senator Tom Coburn, an Oklahoma Republican. In no small part, the reason is that much of the Affordable Care Act’s financing comes from mandatory spending, rather than discretionary spending, and a continuing resolution concerns only the latter. Moreover, some of the law’s money comes from multiyear or “no-year” discretionary funds that do not get wrapped up in the continuing-resolution process either. The Health and Human Services Department says its reform implementation fund would not get touched by a lapse in appropriations.

A few days ago I reported that the Washington Health Benefit Exchange had enrolled 234,000 people in private policies for 2018 when they had just a couple of days left to go.

Today Hannah Recht provided a link to this WA state navigator meeting in which rough final numbers were included as part of the slideshow presentation, along with a bunch of other data points which should be of interest to other healthcare/navigator wonks. 242,800 is a rough number but assuming it doesn't get changed by much, it means the Apple State enrolled 7.6% more people in QHPs this year than last, with nearly 1/3 of them being new to the WA exchange.

Washington State was already beating their 2017 numbers anyway, so this update just pads their lead.

UPDATE: Arrrrgh!!! Literally moments after I went live with this, Hannah Recht pointed out to me that the Washington Health Benefit Exchange has (unofficially) posted their (rough) final 2018 enrollment numbers via an internal slideshow presentation. The table and all numbers below have been updated to reflect the additional 8,800 enrollees added in WA over the final few days of its enrollment period.

UPDATE 1/22/18: Covered California has just issued a major update to their enrollment data, adding another 122,000 QHP selections to the national tally. Everything below has been updated to include this.

UPDATE 1/28/18: The deadline for Massachusetts has passed and they've posted their final numbers. Everything below has been updated to reflect this update.

No official link or press release yet, but This Just In from Politico NY's Dan Goldberg...

.@charles_gaba new numbers from NY

243,600 -- qhp surpassing last year's
726,300 in the Essential Plan

— Dan Goldberg (@DanCGoldberg) January 18, 2018

Last year, New York State of Health enrolled a total of 242,880 people in ACA exchange policies; this means they're slightly ahead of that number with two weeks left to go before the January 31st Open Enrollment deadline. This makes NY the fifteenth state to surpass last year's total...as well as the 7th State-based Marketplace (or the 10th if you include SBMs which are piggybacking on the federal exchange platform). I'll be writing something up about that later today.

Access Health CT already reported their top-line 2018 Open Enrollment Period number and a few other data points via Twitter a couple weeks ago, but they just issued a more detailed press release:


(HARTFORD, Conn.) – Lt. Governor Nancy Wyman and Access Health CT (AHCT) CEO Jim Wadleigh today provided the results of the Connecticut healthcare exchange’s fifth open enrollment period, which ran from November 1 to December 22, 2017. During this open enrollment cycle, 114,134 residents signed up for private health insurance coverage, reflecting a 2.3 percent increase compared to enrollment figures last year.

Well THIS falls under the Good News department:

CMS Announces Additional Special Enrollment Periods to help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands
Agency provides extended special enrollment periods for 2018 Medicare and Exchange coverage

En español

This just in via email...

MNsure ends open enrollment with record number of signups

116,358 Minnesotans enrolled in private health plans through MNsure for 2018 health coverage

ST. PAUL, Minn.—Today MNsure announced that a record number of Minnesotans in the individual market signed up for health coverage through MNsure during open enrollment, breaking the previous year’s record of 114,810. Despite an open enrollment period three weeks shorter than 2017 and significant challenges stemming from the federal level, MNsure enrolled more Minnesotans than ever. Thirty percent of MNsure enrollees were new this year.

*According to these numbers, MNsure beat out last year's enrollment total by about 1.3%...impressive in its own right. But it's actually better than that, because the official 2017 Open Enrollment number according to CMS was only 109,974 people...which means that officially, MNsure has actually outperformed last year by 5.8%!


I've been operating ACASignups.net for nearly 4 1/2 years. It started out as a nerdy hobby thing in my spare time, but quickly overtook my life. I always planned to shut it down after the first Open Enrollment Period ended back in April 2014...and then in March 2015...and again in 2016. Year after year, people clamored for me to keep it going one more year.

via Email just moments ago...

Connect for Health Colorado® Reports Plan Selection Totals for 2018 in Line with Target and Nearly Matching Longer 2017 Enrollment Period

DENVER —  More than 165,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace by the close of Open Enrollment, according to new data released today by Connect for Health Colorado®. 

“These are positive results that show us holding steady and in line with our targets for the year,” said Connect for Health Colorado CEO Kevin Patterson.  “Despite the uncertainty that created some confusion in the market, we have seen volumes that nearly match last year’s longer Open Enrollment Period. I am happy to see so many families and individuals put this protection for their health and financial well-being in place for the year. We will be reporting our results in coming weeks in our annual End of Open Enrollment Report.” 

Except he's not threatening to shoot a dog; he's threatening the lives of nearly half a million of his constituents.

Bevin issues ultimatum: If courts block Medicaid plan, half million Kentuckians will lose care

Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.

No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.

But several advocacy groups have said some of the changes — such as requiring some "able-bodied" adults to work or volunteer at least 20 hours a week — likely will be challenged in court because they violate federal law that establishes Medicaid purely as a health program and does not authorize work requirements.

Every quarter, Gallup posts the results of an exhaustive healthcare coverage survey (with over 25,000 U.S. adults). They just posted the latest update, which covers the fourth quarter of 2017, and the results are...striking.

Gallup has a rather annoying habit of not including the full Y-axis in their charts, so I've reformatted their quarterly survey results into a fuller version, noting a couple of key dates. The most obvious takeaway:

  • The U.S. uninsured rate among adults, which had reached 18% just before the major Affordable Care Act provisions (individual market exchanges and Medicaid expansion) kicked into effect, reached an all-time low of 10.9% last winter...
  • ...only to reverse the trend since then, climbing back up again over the first year of the Trump Administration to end 2017 at 12.2%.

One important thing to keep in mind is that Gallup's surveys only include adults over 18, which means they only include about 77% of the population. Since children tend to have a much lower uninsured rate than adults (thanks in large part to programs like Medicaid and CHIP), this skews the results for the total population by several percentage points.


Over 2,500 people have watched my 17-minute 3-Legged Stool explainer video to date, and many have given it high praise (especially considering the utter lack of production value). However, there've been a few complaints about a couple of patches which are a bit slow or where the slides accompanying the audio are a bit confusing, so I've added some additional slides and reworked a few others to make it more clear. I've also noted the most significant update: That in the end, yes, the GOP did indeed repeal the Individual Mandate.

Later this week I hope to whip up a follow-up video which explains other recent developments, including how Silver Loading and the Silver Switcharoo worked to help salvage the 5th Open Enrollment Period; why the Alexander-Murray bill is no longer neccesary; what the doomed Collins-Nelson reinsurance bill was all about, and so forth.

(Note: In my original tweet on this, I misstated the number of Dreamers as 800K; turns out it's a bit under 700K, apologies for my mistake)

In this corner: Over 690,000 young people who were brought the the United States as children who are now facing deportation if the Deferred Action for Childhood Arrivals (DACA) program isn't codified into law by Congress no later than March 5th (although it's actually not that simple--850 are losing their DACA protection every week already).

In the other corner: Around 9 million children enrolled for part or all of the year in the Children's Health Insurance Program (CHIP) who are on the verge of being kicked off the program if it isn't funded by Congress in the immediate future. It's officially funded through the end of March, but again, it's more complicated than that--21 states will still run out of CHIP funding as soon as the end of February, and some could lose funding as early as January 19th, the same date as the federal budget appropriation deadline.

Both of these should be no-brainers. CHIP has long had strong bipartisan support, and the CBO has concluded that funding it for five years would only cost a pittance (by federal budget standards), while funding it for ten years would actually save the federal government $6 billion.