END OF 2018 OPEN ENROLLMENT (MASSACHUSETTS)

Time: D H M S

Kentucky

No sooner had I posted my big "wrap-up" reports when Rachel Karas of Inside Health Policy gives me the following heads up:

.@kynectky 2016 enrollment numbers as of today: QHP: 93,687; total Medicaid: ~1.3M; Total in expanded Medicaid: 437,091 cc: @acasignups

— Rachel S. Karas (@rachelkaras) February 5, 2016

Hmmm...OK, I guess "as of today" means I need to make the "thru date" 2/04/16 instead of 1/31 or 2/01, but whatever; the point is that this is Kentucky's final official total.

Kynect's total was 81,121 as of 12/26, so they only added about 12,500 more since Christmas. 93,687 is only around 75% of the 125K I was expecting, and is over 12,600 fewer private enrollees than they had last year, making them one of only 8 states to drop their open enrollment total.

In fact, each of the other 7 are special cases:

OK, there's a lot of confusion (including some by myself) about the whole "saving money" issue with regard to Matt Bevin shutting down Kentucky's kynect exchange. I've discussed it with Louise Norris, and I think the situation is as follows:

  • Currently, kynect's $28 million annual budget is covered by a 1% fee charged to all premiums for everyone on individual policies (on or off exchange), small group policies and large group policies.
  • In other words, right now, as far as I can tell, around 1.8 million Kentuckians are paying roughly $16 per year to pay for Kynect.

Not that it'll save the state any money or anything (and in fact could end up costing them more, both in terms of the cost of winding down the organization/transitioning to the federal exchange as well as the higher fees which will apparently be required), but doing something sensible doesn't seem to be part of Matt Bevin's DNA:

FRANKFORT, Ky. - Following through on a campaign pledge, Gov. Matt Bevin has notified federal authorities he plans to dismantle kynect, Kentucky's health insurance exchange created as part of the Affordable Care Act.

In a Dec. 30 letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, Bevin said he plans to wind down the state health exchange and transition Kentuckians to the federal site, healthcare.gov, to shop for insurance under the law also known as Obamacare.

If you look at the State-By-State OE3 enrollment breakdown, you'll notice that there are still 4 blank fields all the way down at the bottom, plus a special note regarding California:

When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

"Sometimes I park in handicapped spaces
While handicapped people make handicapped faces."

--Denis Leary, "Asshole"

A couple of weeks ago I noted that newly inaugurated Republican Governor of Kentucky Matt Bevin was, true to his word during the campaign, making the destruction of kynect, the Bluegrass State's ACA healthcare exchange, one of his first and highest priorities.

Never mind that the exchange has (unlike most of the other ACA exchange sites) operated pretty much flawlessly since day one.

Never mind that thanks to the ACA and kynect, the uninsured rate in Kentucky has been slashed by more than half over the past two years, from over 20% down to 9%.

Never mind that the "kynect" branding has been an unprecedented and award-winning success.

As I noted last week, as of Monday, December 7th, here's the sort of information which could be found on outgoing Democratic Governor Steve Beshear's "Healthier Kentucky" webpage:

Open Enrollment stats as of Thursday 2/19/2015:

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

Here's what Democratic Kentucky Governor Steve Beshear's official "Healthier Kentucky" webpage looked like yesterday. Outdated, of course (no updates since the end of the 2015 Open Enrollment Period), but lots of data touting the thousands and thousands of people the Affordable Care Act (aka OBAMACARE, guys) has helped receive healthcare coverage via either private policies or Medicaid expansion:

In 1994, there was an episode of the acclaimed sci-fi TV series "Babylon 5" titled "Believers". Here's the basic plot synopsis:

Dr. Franklin faces an ethical dilemma when the parents of a dying child refuse to let him operate for religious reasons. Their son is suffering from a chronic respiratory ailment and will die soon. It can be cured with surgery; however their religion prohibits surgery (believing that cutting into a body will release the spirit, reducing the body to something worse than death—it is something only to be done to food animals). Franklin's associate Dr. Hernandez attacks their beliefs, but Franklin reprimands her, telling her that they have to work with the parents, not against them.

Over at the Washington Post, Amy Goldstein has a pretty good story about the Real People who are benefitting from the ACA in Kentucky...and those among them who voted for Republican Matt Bevin anyway:

Dennis Blackburn has this splintered self-interest. The 56-year-old mechanic hasn’t worked since he lost his job 18 months ago at a tire company that supplies a diminishing number of local coal mines. “The old guy had to go home,” Blackburn says of his layoff.

He has a hereditary liver disorder, numbness in his hands and legs, back pain from folding his 6-foot-1-inch frame into 29-inch mine shafts as a young man, plus an extra heartbeat — the likely vestige of having been struck by lightning 15 years ago in his tin-roofed farmhouse.

Unlike the federal exchange (HealthCare.gov) and many of the state-based exchanges which have experienced massive technical problems to some degree or another over the past two years (Oregon, Nevada and Hawaii have gone kaput; Massachusetts & Maryland had to be completely rebuilt; Vermonts is still iffy),  the Kentucky ACA exchange website, aka "kynect" (lower-case intentional), has been chugging along smoothly since Day One on October 1, 2013. It's fully self-sufficient, well known and trusted by Kentuckians, and has been an amazingly successful venture in general.

So naturally...

Speaking in his first public comments since he was elected governor of Kentucky on Tuesday, Matt Bevin repeated his pledge to dismantle kynect, the state’s health insurance exchange that has been hailed as a national model.

“My intent is to have it wound down by the end of next year,” Bevin said of the online service people use to shop for health coverage or determine whether they are eligible for Medicaid under the Affordable Care Act.

One of the arguments Kentucky Governor-elect Matt Bevin has made in favor of killing off the wildly successful, smoothly-operating kynect state-based ACA exchange has been that doing so would "save Kentucky money". The idea is that by shifting everything over to the federal exchange at HealthCare.Gov, the state of Kentucky would save the cost of operating their own exchange.

In one sense, this is true; kynect is currently supported by a flat 1% charge for all premiums on all individual policies sold in Kentucky, both "inside and outside of the marketplace." In other words. whether you enroll in a individual policy either via Kynect or directly through the insurance carrier, they're tacking on a 1% surcharge to your premiums to pay for the exchang to operate. So, yes, dropping kynect would also stop that 1% fee from being charged.

The population of Kentucky is just over 4.4 million people.

The number of Kentuckians enrolled in Medicaid specifically due to the Affordable Care Act's expansion provision is just over 400,000 people (418K to be precise, according to Emma Sandoe, who used to work for CMS).

By my math, that's a bit over 9% of the entire state's population which--assuming Republican Governor-elect Matt Bevin keeps his vow from the campaign--is about to be kicked off of Medicaid.

Wil Wheaton said it best: 

Oh, Kentucky. You really fucked up today.

— Wil Wheaton (@wilw) November 4, 2015

Ultimately, the blame lies with the voters for failing to care about their own interests, but I do want to say one thing about Democratic candidate Jack Conway's campaign.

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