Purging the In Box: Various & Sundry

Here's a bunch of ACA stories from this week...

• Both uninsured, covered urged to check options

Given those significant changes, officials are urging uninsured and insured residents to explore their options. Those who purchased plans through the healthcare.gov marketplace will automatically be re-enrolled, but health care advocates say renewal may not be the best option because the tax credits that subsidize coverage could have changed. And some who signed up last year instead may be eligible for the state's newly expanded Medicaid program.

• Obamacare Take 2: What Works and What Needs Fixing

Officials seemed to have learned from their mistakes—at the very least, the site went through more testing—but there are still questions about what the administration has done to improve the user experience, whether premiums have gone up, whether people will enroll and whether the less-talked-about state-run exchanges are fixed, too.

• ACLI considering options after judge dismisses its case against D.C. Health Link tax

Earlier this year, the ACLI sued the District over its planned funding source for the state-run health insurance exchange, a 1-percent tax on all health-related insurers. That tax applied to supplemental insurance products, such as long-term care and disability. The ACLI contended the tax shouldn't be allowed on those products because companies who weren't able to directly benefit by selling products on the exchange were being forced to pay for it.

On Thursday, U.S. District Judge Beryl Howell dismissed the case brought against the District, allowing D.C.'s health insurance exchange to continue to be funded by 1-percent tax from health-related insurers. The exchange has a $29 million budget.

• Obamacare's 95% solution: Auto-enrollment, with subsidies

The vast majority of people who enrolled in Obamacare on the federal health exchange will be both automatically re-enrolled in the health plans they selected in 2014 and automatically receive the subsidies to help pay for that insurance that they got this year, officials revealed Thursday.

A senior federal official told CNBC that an estimated 95 percent of HealthCare.gov enrollees—some 5.1 million people—will be signed up for the 2015 plan year and receive the same tax credits without having to do anything.

• Obamacare's VERY small business exchange enrollment

Remember those "other" new Obamacare exchanges—the ones that small businesses were supposed to use to sign up workers for health insurance?

Yeah, well, apparently a whole bunch of small businesses forgot about them, too.

A new Government Accountability Office report finds that a stunningly low number of workers have enrolled in insurance plans sold on small-business health exchanges run by federal and state governments.

• Analysis: O-Care Premiums Steady In 2015

Taken in the aggregate, Obamacare premiums for the 34 states using Healthcre.gov are almost completely level in 2015 compared to 2014, according to a new analysis from Avalere Health.

That comes with a lot of caveats. Premium changes vary widely from state to state, and individual consumers who are re-enrolling might need to shop around to avoid substantial spikes in what they pay next year.

On average, premiums for the cheapest bronze-level plan, which covers 70 percent of medical costs, available to a 50-year-old non-smoker increased by 3 percent, according to Avalere. For the cheapest silver-level plan, which covers 70 percent of costs, premiums increased by 4 percent.

Depending on the state, though, the change in premiums ranges from a 28-percent increase in Alaska to a 19-percent decrease in Mississippi.

For context, as CNBC reported in July, the average premium increase in the individual market from 2008 to 2010, prior to the law, was more than 10 percent.

...and a bunch more from the past few weeks...

• Small businesses can enroll in Obamacare statewide

Small businesses throughout Washington — those with 50 or fewer employees — can now shop for and enroll in health insurance plans through the state’s insurance exchange.

The exchange got off to a slow start for businesses this year when only one insurance provider, Kaiser Health Plan of the Northwest, agreed to sell plans in the marketplace and only in Clark and Cowlitz counties. For coverage beginning January 2015, small employers statewide can shop the exchange for coverage from Moda Health, and Kaiser will continue selling in the two southern counties. A total of 23 different plans are available from the two insurance companies.

...Twelve employers in Clark or Cowlitz counties currently are enrolled in coverage through Healthplanfinder Business, a marketplace created under the Affordable Care Act.

...For employers shopping the state’s exchange, the ACA includes a tax benefit covering up to half the cost of the insurance premiums. It applies to employers that paid at least half the cost of their workers’ premiums, and employed fewer than 25 people making on average $50,000 a year. Because Washington’s exchange only included two counties, the tax benefits for 2014 were extended to small businesses outside of the exchange as well.

• Who Would Have Health Insurance if Medicaid Expansion Weren't Optional

In 2012, the Supreme Court ruled that a cornerstone of the Affordable Care Act — its expansion of Medicaid to low-income people around the country — must be optional for states. But what if it had ruled differently?

More than three million people, many of them across the South, would now have health insurance through Medicaid, according to an Upshot analysis of data from Enroll America and Civis Analytics. The uninsured rate would be two percentage points lower.

• What Happened to Exchange Rate Shock? Average Premiums Move Little for 2015

In March, it seemed improbable if not impossible that carriers could avoid double-digit rate hikes for 2015 policies sold on public insurance exchanges. With the health insurer tax, reinsurance fees, a marketplace user fee and scant information about their new enrollees, several actuaries told HEX that big rate hikes were almost certain (HEX 3/20/14, p. 1). But proposed and approved premium increases being touted by state regulators, so far, have been in the low single-digits. Why?