Ohio

I originally intended this to be an update to yesterday's post about the woman at the Ohio Democratic Town Hall in which a woman asked Hillary Clinton why her family's insurance rates have gone up from $490/month to $1,081/month since the Affordable Care Act was passed. However, that post had already gotten absurdly long and unwieldy, so I've split it off into a new entry.

In the comments yesterday, a man named Danny Robins posted the following. I've broken it up a bit for readability, and have included my responses; both his points and my responses lend some additional insight into both Ms. O'Donnell's dilemma as well as my own point about Clinton's response:

My Columbus Ohio based health insurance practice for the past 7 years has been focused on helping small employers offer more affordable health benefits outside of the employer sponsored health insurance market. It has been widely reported that up to 70% of small employers no longer sponsor a health plan because they can not afford it. As such, I have assisted with over 2,000 people obtain individual or family health coverage.

Some of the ACA provisions have been a huge success, such as the Medicaid expansion program, which has added over 14 million people to the program over the past 3 years. Others can be viewed as being successful or so-so depending on your POV, like the 12.7 million people who have enrolled in private policies via the ACA exchanges.

And then there are the portions of the law which have gone, well, not so great, to put it mildly...in particular the non-profit, public/private hybrid Co-Ops, which are the only remaining remnant of the originally much-hoped-for "Public Option". For a variety of reasons, not the least of which was an utterly unnecessary and ultimately pointless stunt pulled by Marco Rubio and other Congressional Republicans (aka the Risk Corridor Massacre), over half of the two dozen Co-Ops nationwide melted down in spectacular fashion last fall, leaving only 11 of them surviving into 2016 after the dust settled.

In light of this, I figured it would be worth posting some positive Co-Op news for a change. First up, Ohio.

I admit that given the carnage of the past couple of weeks, I'm almost afraid to post this entry...but I had to write something positive about the CO-OP situation.

With the ACA-created CO-OPs seemingly dropping like flies due to the #RiskCorridorMassacre, I thought this would be a good time to flip things around and look at which CO-OPs are doing well (or at least not badly).

This isn't much, but it'll do for now:

Wisconsin's insurance department says it has no intention of shutting down its #ACA co-op, which appears it will remain solvent next year.

— Bob Herman (@MHbherman) October 22, 2015

@charles_gaba and at this point, other than Maine, it's difficult to expect many others will last beyond risk corridors.

— Bob Herman (@MHbherman) October 22, 2015

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and mid-range requested average rate increase for the Ohio individual market:

Again, the full explanation is included here, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 15.5% increase, but only make up about 28% of the total ACA-compliant individual market, with several other companies with requested increases of less than 10% (decreases in some cases) making up the other 72%.

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

David Ramsey has the full skinny on the unpleasant situation in Arkansas, where their "private option" Medicaid expansion program, which was always weird with a beard to begin with, is very much at risk of collapsing altogether:

Well, here we go again. The legislature is once again ready to debate the private option – the state’s unique version of Medicaid expansion, which uses funds available via the Affordable Care Act to purchase private health insurance for low-income Arkansans. Gov. Asa Hutchinson will take a long-awaited position on the policy in a speech at UAMS tomorrow morning. Then it will be up to the legislature. Health insurance for more than 200,000 Arkansans is at stake. Here are some keys to remember as the debate unfolds tomorrow and in the coming weeks. 

The short version: The AR program has to be re-approved by the legislature every year, and requires a 75% majority to do so, so it's a wonder that it's survived this long, frankly.

Thanks to commentor farmbellpsu for bringing my attention to this article from the Cincinnati Enquirer, which demonstrates everything I was concerned about with yesterday's monthly HHS report...although many of the problems are with whoever wrote/edited the story not understanding the basics either:

Fewer Ohioans choose a health plan in 2015 enrollment

Nearly 89,000 Ohioans chose a health insurance through the Affordable Health Care marketplace during the second open enrollment in November and December, the federal government reported Tuesday.

Ohio Republican Governor John Kasich, folks:

Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context.

...Mr. Kasich, referring to repealing the Affordable Care Act, was quoted as saying “that’s not gonna happen.”

...“I’ve always thought if we got a majority we would repeal Obamacare,’’ he said. “My only point was they’d probably make an accommodation for Medicaid expansion.’’

...It is an open question how expanding Medicaid benefits as generously as the Affordable Care Act allows, to adults earning up to 138 percent of the poverty level, could be paid for without increased taxes and Medicare cost reductions also created by the health care law.

...“I’m in favor of repealing Obamacare,” he repeated. “That’s all I can tell you.’’

Well, let's see here.

OK, this is a pretty minor update, but according to the last HHS report, as of 4/19, Ohio's official QHP tally stood at 154,668. However, according to this article, it was a few thousand higher than that:

About 157,000 Ohioans signed up for health plans through the federal exchange during the first open enrollment period, which ran from Oct. 1, 2013 into March, 2014. In January, Ohio expanded Medicaid under Obamacare to cover more low-income adults. More than 360,000 people have already enrolled around the state through that new eligibility. And most of the doom and gloom predictions about the Affordable Care Act haven’t come true. Premiums aren’t through the roof, and the website, pretty much works as the federal government prepares for a new round of open enrollment starting Nov.15.

Again, pretty minor stuff, but as we enter the 2nd year of the ACA exchanges being open (slightly different from the 2nd open enrollment period, of course, which doesn't start for another 6 weeks), I figure it's a good idea to get some little details up to date.

It's been over 3 months since I've been able to check in on the status of Ohio's implementation of ACA Medicaid expansion. As of mid-June, OH had racked up 243,230 people newly eligible thanks to the Affordable Care Act out of around 563,000 state residents who were eligible.

As of the end of August, that number has grown to 367,395 people, or over 65% of the total eligible:

Ohio Medicaid enrollment under Gov. John Kasich’s Obamacare expansion hit 367,395 in August, passing the Republican governor’s projection for July 2015.

Kasich told taxpayers and the Ohio General Assembly that an estimated 366,000 Ohioans would be enrolled in Medicaid under Obamacare at the start of the state’s 2016 fiscal year. This projection is reflected in a Governor’s Office of Health Transformation chart released in February 2013.

Last October, at the height of the botched HC.gov rollout, I repeatedly commented over at Daily Kos:

 I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

  • Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
  • California, Colorado, Connecticut and Delaware* are all state-run exchanges.
  • That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

The great irony here is that this accurate and helpful data point is provided by a very anti-ACA story, but whatever:

A total of 243,230 Ohioans have already been added to the state’s Medicaid rolls under the Obamacare expansion implemented by Republican Governor John Kasich this January.

Based on the Ohio Department of Medicaid’s May caseload report released last week, enrollment under the expansion was 232,711 in April — not the 184,671 reported last month.

The March enrollment figure was also revised dramatically upward last week, to 208,213 from the 171,910 reported last month. In April, the Ohio Department of Medicaid estimated that March enrollment for those eligible under Obamacare was 106,238.

Some more fantastic numbers out of Ohio after the earlier ones from Michigan: 185K strict expansion, 124K woodworkers and another 146K in the works:

Through April though, 184,671 newly eligible applicants were approved for coverage, the state said Monday.

About 563,000 Ohioans became eligible for Medicaid when the state agreed to accept federal support provided under the Patient Protection and Affordable Care Act to pay for broadening the health insurance program. The change raised the household income eligibility limit to include families earning up to 138 percent of the federal poverty rate -- about $32,500 for a family of four. They became eligible for coverage in January.

Another 124,195 people, meanwhile, were also added to Medicaid when it was determined they qualified for the program under the old guidelines. State officials had said they expected the public attention on expanding Medicaid would also draw in people who were already eligible but who had not signed up.

...But about 146,000 applications from that time period are still being processed and could add to the totals.

Wow. I'm not certain what the "strict expansion" vs. "woodworker" breakout is here, but am assuming it's roughly a 3:1 ratio:

An even greater number in Ohio, 156,899, were deemed eligible for Medicaid or the Children's Health Insurance Plan, or CHIP, government plans for low-income families that have been expanded under the act. That, however, is only a partial number, based on information that individuals provided when they contacted the federal health care marketplace to see about insurance. According to state figures released by the U.S. Department of Health and Human Services, Ohio has seen a combined Medicaid-CHIP surge of 208,280 since the Affordable Care Act, or ACA.

This is great news, but I have to reduce Ohio's Medicaid total by about 54,000 due to a bit of sloppy double-counting on my part. However, there's another (potential) 120K in the batter's box:

More than 106,000 Ohioans have signed up for Medicaid under an expansion of the taxpayer funded health program, while thousands of others are waiting to hear whether they are deemed eligible.

...Ohio's monthly report on Medicaid caseloads shows that 106,238 residents had enrolled under the extension as of March 31. That's about 29 percent of the roughly 366,000 newly eligible people estimated to sign up by the end of June 2015.

More than 345,000 people have sought Medicaid coverage through the state's benefit site since Oct. 1. About 65 percent of the applications have been resolved, while roughly 120,000 are still pending. Many of those cases await eligibility determinations by the state's largest counties.

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