Time: D H M S

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

UPDATE 01/15/18: Since I originally posted this, the deadlines for 2 more states have passed (CO & MN), and I have minor, non-final enrollment updates for MA, MN, DC & WA. Everything in this post has been updated accordingly, including the table below.

UPDATE 01/16/18: Updated table and writeup to include final Colorado numbers, which just came out today.

UPDATE 01/17/18: Updated table & writeup to include final Maryland numbers, which just came out today.

As I keep stressing, the 2018 Open Enrollment Period is still going on across 6 states 4 states 3 states (+DC). Colorado's deadline is Friday night. Minnesota's is Sunday, followed immediately by Washington State on Monday. Eight days later, Massachusetts closes the books on the 23rd. Finally, eight days after that, OE5 officially ends for the last three state-based exchanges in California, DC and New York State.

I'm a little late with this one (spent pretty much the entire day dealing with cleaning up the aftermath of my Terrible, Horrible, No Good Very Bad Day), but Connect for Health Colorado, the CO ACA exchange, issued their first update since December 17th with 3 days left to go before Open Enrollment ends for 2018:

Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Deadline is Friday
Posted on Tuesday, January 9, 2018

DENVER — More than 158,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through January 8, 2018, a rate 2 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, days ahead of the enrollment deadline.

Note: Obviously none of this remotely compares to, say, being without electricity for over three months or being deported to El Salvador after living here legally for over a decade for no reason, but I think I'm entitled to vent a bit once in awhile...

Yesterday morning I was using the snowblower when I hit a rolled-up newspaper buried under the snow (in a plastic sleeve) which promptly got jammed in the impeller and likely burned out the auger belt.

Then, I noticed my front driver's side tire was really low, but I had to pick up my kid from school so didn't have time to fill it with our air pump before doing so. I figured I could get there and back, but also turned out to be really low on gas, so on the way back, we stopped at a nearby gas station where I figured I'd use their air pump as well. Got gas but the air pump was broken.

No official press release yet but AccessHealthCT just released a series of tweets with their official final numbers...

114,134 CT residents have enrolled in a health plan for 2018 - 2.3% more than last year! #AHCT

— Access Health CT (@AccessHealthCT) January 8, 2018

Happen to be in the Birmingham/Bloomfield area of Michigan on Monday, Jan. 8th? Swing by the Bloomfield Township Public Library at 1099 Lone Pine Road, Bloomfield Hills, MI 48302 from 7pm - 9pm, where I'll be giving the Birmingham/Bloomfield Democratic Club an overview of the ACA/healthcare landscape situation now that the dust has mostly settled on the 2018 Open Enrollment Period.

A new letter from the Congressional Budget Office to Sen. Orrin Hatch says:

Re: Updated Cost Estimate for S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017

Dear Mr. Chairman:

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have updated their estimate of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017, to account for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and to account for administrative action. The agencies now estimate that enacting this legislation would increase the deficit by $0.8 billion over the 2018-2027 period.

This one is quite a head-scratcher, but let me see if I can peel the onion.

(yes, I know everyone else was posting writeups about this yesterday; I was a little swamped with some personal issues)

The original announcement was made last fall:

A week or so ago, there was some confusing news about how Donald Trump may or may not be planning on signing a new healthcare-related executive order. I didn't write about it earlier because at first it sounded like he was talking about a meaningless "sell across state lines" decree...meaningless because the ACA already allows carriers to sell ACA-compliant policies across state lines, as long as the states in question sign onto an interstate compact.

More recently, however, it became clear that the executive order in question is more dangerous than I thought:

Instead of my own description, I'll let the National Association of Health Access Assisters explain:

Health Action 2018 Kicks Off the Hottest Ticket for Assisters
by Heather Bates & Liz Hagan

If you work on enrollment or support enrollment-related work, we are excited to announce new opportunities available at Health Action this year! Thanks to our host, Families USA, the National Association of Health Access Assisters (NAHAA) will launch officially at #HA2018. With four in-depth workshops and several networking opportunities, trust us that this year is not to be missed.

The Washington HealthPlan Finder issued a press release today urging people to #GetCovered before their upcoming January 15th Open Enrollment deadline. At first glance it looks like a pretty disappointing update ("over 231,00 QHPs"), since their previous update as of 12/15 was already 230,591, suggesting only a few hundred more people enrolled between December 16th - January 2nd...

Washington Healthplanfinder Reminds Residents It’s Not Too Late to Get Covered
Customers have until 11:59 p.m. on Jan. 15 to sign up for 2018 health and dental plans

The Washington Health Benefit Exchange is reminding residents there is still time to sign up for 2018 health and dental coverage through Washington Healthplanfinder. Customers have 12 more days to make their plan selections before the open enrollment period closes at 11:59 p.m. on Jan. 15.

With less than two weeks remaining until the deadline, more than 231,000 Washingtonians have already used Washington Healthplanfinder to secure their coverage for 2018. 

This just in...


BALTIMORE (JAN. 4, 2018) – A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, the state-based health insurance marketplace.

In an open enrollment period that was about half as long as a year ago, average daily enrollment in qualified health plans was up 69 percent compared to the prior open enrollment. There were an average of 2,953 enrollments each day during the recent 52-day period, compared to 1,752 average daily enrollments during a 90-day enrollment period a year ago.

“We are thrilled by the robust turnout for 2018 coverage,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which administers Maryland Health Connection. “Our hats are off to our call center, consumer assisters and brokers who helped process roughly as many enrollments as last year during a much shorter open enrollment period. We believe the result will be better access and better health outcomes for Maryland families.”

I know, I know, caveats no doubt abound here, but still:

Health spending growth has slowed, and is now more on pace with economic growth

From 1970 – 1980, the average annual growth in the U.S. economy was 9.2% per year, compared to health spending growth of 12.2%. Although health spending growth has since moderated, it generally continued to outpace growth of the economy, though by a somewhat smaller margin. The 2010 – 2013 period, however, saw an average annual growth rate in health expenditures that was similar to growth in GDP.  Health spending did pick back up in 2014 and 2015 with the coverage expansions of the Affordable Care Act.

One of the least-known but most important aspects of the Affordable Care Act is the Medical Loss Ratio:

The Affordable Care Act (ACA) includes several provisions that change the way private health insurance is regulated in an effort to provide better value to consumers and increase transparency. One such provision – the Medical Loss Ratio (or MLR) requirement – limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in 2012.

This just in from HealthSourceRI:

Between November 1 and December 31, 2017, 33,021 individuals selected a plan through HealthSource RI. Though Open Enrollment has ended, customers who began, but did not complete, the enrollment process by December 31 will be able to finalize their 2018 enrollment process between January 1 and January 23. HealthSource RI is communicating directly with customers who are eligible for this opportunity. For this reason, final 2018 Open Enrollment figures will not be available until later in the month.

At HealthCare.Gov, around 66,000 stragglers/special case enrollments were added to the total between 12/16 - 12/23, which would translate into around 250 more people in Rhode Island, give or take. Of course, HC.gov also lost 145,000 enrollees due to people dropping their renewals/etc, but RI's exchange is structured a bit differently, with auto-renewals being added on day one, so most of those folks likely already dropped out before the 12/31 tally anyway. My guess is the final total will end up around 33.2K.

A couple of weeks ago I reported that MNsure, Minnesota's ACA exchange, had achieved 108.5K QHP selections, putting them within 1,500 enrollments of breaking their all-time record set last year.

Yesterday they issued the following press release:

Minnesotans benefiting from tax credits averaging over $7,000 per year
January 2, 2018

ST. PAUL, Minn.—With just under two weeks left in the 2018 open enrollment period, MNsure is reminding Minnesota residents of important money-saving tax credits. The statewide household average for tax credits is around $7,000 per year. Approximately 62 percent of enrolled households are receiving tax credits.

“Minnesotans are saving an average of over $7,000 per year from tax credits when purchasing coverage through MNsure,” said Allison O’Toole, MNsure CEO. “This is real money for Minnesota families, and can help make the unaffordable, affordable.”