Me, 3/31/20, 1:14pm:

Well, today I received a likely answer which is depressing but not surprising at all: According to my sources, there isn't any technical, logistical, personnel or support reasons why HealthCare.Gov couldn't launch a formal COVID-19 Special Enrollment Period at any time. The only logical conclusion is that the White House has decided not to allow one for political reasons.

...The more people who come to rely on the Affordable Care Act--especially the ACA exchange operated by the Trump Administration itself--the more difficult it's going to be to justify the Trump Administration continuing to support a lawsuit with the sole purpose of attempting to have the ACA struck down by the Supreme Court...which they're continuing to try and do even in the middle of a pandemic.

Susannah Luthi, Politico, 3/31/20, 5:19pm:

Trump rejects Obamacare special enrollment period amid pandemic

Three weeks ago I reported that there were growing calls from many quarters for CMS Administrator Seema Verma and HHS Secretary Alex Azar to open up a federal Special Enrollment Period at HealthCare.Gov tied specifically to the COVID-19 pandemic.

Over the next week or so, more and more of the 13 state-based ACA exchanges announced just such a COVID-19 SEP; eventually 12 out of 13 state-based exchanges did so (Idaho is the odd man out), and eventually even the health insurance industry (which is normally opposed to allowing exceptions to the official Open Enrollment Period) were onboard with a COVID SEP. Two weeks ago I was 95% certain that HC.gov would be announcing one at any moment.

And then...nothing. Nothing last week. Nothing yesterday. Nothing as of this writing.

via Sam Brodey of The Daily Beast:

The worsening coronavirus outbreak may be stretching the limits of the U.S. health care system and overwhelming state governments, but that isn’t deterring a group of 18 state attorneys general from plowing ahead with a lawsuit that could overturn the Affordable Care Act within a year—a move that could disrupt the health care system at a time of deep crisis. 

This fall, Texas Attorney General Ken Paxton is slated to argue in the U.S. Supreme Court on behalf of 17 Republican attorneys general—and against 21 Democratic attorneys general—that Obamacare is unconstitutional and must be struck down immediately.

Nearly seven years ago I made my mark in the world by becoming known as the Obamacare Enrollment Guy here at ACASignups.net.

I’m still posting updates, of course, but lately, about 95% of what I’m writing about and analyzing, like everyone else in the country, is related to the ongoing COVID-19 pandemic.

As I noted back on March 11th, this time around I’m not the one doing the hard work of actually gathering the data itself. Several other outlets/organizations have taken up the grim task of keeping a running tally of how many people have tested positive for coronavirus, how many are hospitalized, how many have died and how many have recovered.

The following memo has been floating around Twitter since last night. I was concerned that it might be a hoax, but this response Tweet from the official Henry Ford Health System account can only be interpreted as confirming that it's very real...just not public as of yet. It appears to be a legitimate internal policy memo being prepared in the event of a worst-case scenario:

With a pandemic, we must be prepared for worst case. With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.

— Henry Ford News (@HenryFordNews) March 27, 2020

@charles_gaba retweet this, your national audience needs to see this

Late last night, the U.S. Senate finally voted to approve a massive $2 TRILLION bailout/recovery bill in response to the Coronavirus pandemic. After a lot of haggling and drama, the final bill ended up passing unanimously, 96 - 0 (four Republican Senators weren't able to vote at all...due to being in self-isolation because of Coronavirus). It's expected to be quickly passed by unanimous consent in the House today and will presumably be signed by Donald Trump before nightfall.

And like that, the largest emergency economic influx bill in history is done.

There's a lot of explainers and thinkpieces being written about the bill as a whole...which elements are good, which are bad, which are flat-out offensive (especially the ~$500 billion in corporate giveaways, which still ended up in the final bill although they supposedly have some sort of oversight over which companies receive them and under what conditions), but my focus is of course on the healthcare aspects, and especially what it means for enrollment in ACA exchange plans and Medicaid via ACA expansion.

Thanks to Twitter follower V. Spell for the heads up on this chilling video from a local E.R. nurse here in Oakland County, Michigan.

I live around half an hour from both the hospitals she refers to (one is in Novi, the other in Southfield). Michigan has the fifth-highest number of confirmed cases and the eighth-highest per capita (as of this writing, we have around 2,300 confirmed cases of COVID-19), at 1 confirmed case per 4,300 residents.As of this writing, 43 Michigan coronavirus patients have died.

The video is about 7 minutes long, but I implore you to watch the entire thing. For those who can't view or hear it, i've transcribed it verbatim below.

For several years now, I've been urging Congress to upgrade the Affordable Care Act via a series of major improvements. Most notable among these is the need to #KillTheCliff...that is, to eliminate the so-called "Subsidy Cliff" which kicks in for ACA individual market enrollees who earn more than 400% of the Federal Poverty Line (roughly $50,000 for a single adult or $103,000 for a family of four).

As I've explained many tmes, the ACA's subsidy structure works pretty well for those earning between 100 - 200% FPL, and is at least acceptable for those earning 200 - 400% FPL (in fact, thanks to #SilverLoading, it works quite well for most of that population as well). The real problem kicks in above 400% FPL (and to a lesser extent below 138% FPL for those living in the 14 states which still haven't expanded Medicaid). In addition, the subsidy formula still doesn't make policies truly affordable for many of those receiving them.

In short, both the upper- & lower-bound Subsidy Cliffs need to be eliminated, and the underlying formula needs to be strengthened as well.

Besides effectively baking in a more-generous version of H.R. 1868 (Rep. Lauren Underwood's #KilltheCliff bill which I've been pushing for so hard for over a year now), the House Democrats' "Take Responsibility for Workers and Families Act" coronavirus stimulus/relief bill also includes some other important ACA-related provisions. Some of these are temporary, others would be permanent.

For a couple of weeks now, I've been posting constant updates as one state-based ACA exchange after another has announced a COVID-19-specific Special Enrollment Period in light of the ongoing pandemic crisis. Until now, though, there's been two ACA exchanges which haven't made such an announcement. One is the Big One, HealthCare.Gov, which hosts a whopping 38 states and which is facing increasing pressure to do so.

The other...is Idaho. Specifically, Your Health Idaho, the state's ACA exchange.

Dave Anderson brought this to my attention in the big "Take Responsibility for Workers and Families Act" coronavirus stimulus/relief bill being rolled out today as an alternative to the Senate Republican's "$500 billion corporate slush fund" bill being pushed by Mitch McConnell.

If you scroll allllllllll the way down to Pages 1,088 - 1,090, there are two provisions which relate directly to the Affordable Care Act's Advance Premium Tax Credits for exchange enrollees:

SEC. 103. RESTORATION OF LIMITATIONS ON RECONCILIATION OF TAX CREDITS FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN WITH ADVANCE PAYMENTS OF SUCH CREDIT.

(a) IN GENERAL.—Section 36B(f)(2)(B)(i) of the Internal Revenue Code of 1986 is amended to read as follows:

photo courtesy of Michelle Mills

Today is the 10th Anniversary of the signing of the Patient Protection & Affordable Care Act. On March 23rd, 2010, President Barack Obama signed the bill into law, although it would be another 3 years and 9 months before most of the major provisions would go into effect: ACA exchange policies, Advance Premium Tax Credits and Cost Sharing Reduction subsidies, Medicaid expansion in most states (although a few got an early start via special waivers and conversion of existing programs), and so forth.

You may notice that I referred to it as the Patient Protection & Affordable Care Act. I, like most people, tend to shorthand the name as simply "the Affordable Care Act" or "the ACA", but the truth is that it's the patient protection part which received the most attention during the Great ACA Repeal Debacle of 2017...and which has once again come front & center in the spring of 2020.

I realize this may seem more than a little trite given the ongoing and everpresent COVID-19 pandemic...and it might be particularly so given that a dozen state-based ACA exchanges have just launched Special Enrollment Periods to help address the crisis (with HealthCare.Gov likely to follow them any day now).

Even so, the 10th Anniversary of the signing of the Patient Protection & Affordable Care Act is coming up this Monday, so I figured I should take a moment to note the continuing trendline between the Federally Facilitated Marketplace (FFM) (HealthCare.Gov) and the State-based Marketplaces (SBMs). There have been as many as 15 or as few as 12 depending on the year.

The first table below lists the official number of Qualified Health Plans which were selected by Americans during the official Open Enrollment Periods for the first seven years they've occured. The blue cells represent states which operated their own full SBMs that year. This has changed over the years as follows:

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