In which Congressional Dems formally propose 3 of my 20 recommendations

Over at Vox, Sarah Kliff has a nice exclusive:

A small group of Democratic legislators will do something unusual Wednesday morning: hold a press conference to talk about the parts of Obamacare that are broken.

Ten House Democrats will unveil a new plan to fix Obamacare, highlighting the parts of the law that have struggled to work and offering modest steps to improve them. The proposal includes more funding to help insurance plans cover the sickest patients, along with possibly changing the timing of the open enrollment season in hopes of attracting more Americans to sign up for insurance.

These Democrats are agitating for a new strategy, one where they speak openly about the health law’s weak spots — particularly the individual market — and how to shore them up. The party has so far been reticent to highlight Obamacare’s problems at a moment when Democrats are fighting against Republican efforts to repeal parts of the law.

Kliff has more details, but according to her piece, it boils down to five points:

  • Formally appropriate Cost Sharing Reduction (CSR) reimbursement funding
  • Create a permanent Reinsurance Fund of $15 billion per year
  • Allow Medicare buy-in for older Americans (no specific age range given)
  • Ensure that the individual mandate is enforced and the enrollment period is promoted/advertised
  • Move the Open Enrollment Period to the spring to align with tax filing season

The first three of these are no-brainers, and in fact I already have them listed as numbers 1, 13 and 20 on my "If I Ran the Zoo" list of fixes/improvements for the ACA. I'm not sure why they aren't including a specific starting age for the Medicare buy-in option; either 55 or 50 would seem to be obvious and have been mentioned repeatedly by others.

As Kliff notes, I'm not really sure that "tell Trump/Price to enforce the mandate/advertise open enrollment" really counts as an ACA improvement, since these are things that are supposed to be being done under the ACA already. The same could be argued regarding CSR reimbursements as well, of course, but in that case there is a case to be made (literally...that's what the currently pending federal lawsuit is about) that this does require official Congressional action to resolve.

As for the fifth one, shifting the Open Enrollment Period from the fall to the spring, I'm not quite sure what this is even doing on the list. Don't get me wrong, I've discussed/debated the "what's the best time for open enrollment" issue with other healthcare wonks quite a bit in the past, and several folks have indeed suggested moving it to the spring...but I thought that debate had already been decided two years ago:

Yesterday I estimated that total #ACATaxTime-specific enrollments were likely around 200,000. Today, thanks in part to CNBC's Dan Mangan, I can pin this down even further...

OK, so that's whatever New York's number is. There's really no way of knowing this without the official report from the NY exchange, but assuming it's proportionate to most other states based on their Open Enrollment Period population, it should be somewhere between 6,000 - 8,000 people, meaning a grand total of roughly 214,000 nationally.

This is in reference to the one-time, 6-week "Tax Filing Special Enrollment Period" created in spring 2015 as a second chance for people who didn't sign up for coverage during open enrollment, weren't eligible for an exemption and claimed that they "didn't know" about the individual mandate penalty to do so. In the end, only 214,000 people nationally took advantage of the Tax Season enrollment option.

Here's what I had to say about the results of this at the time:

In the end, it appears that the type of person who still didn't know that there was a tax penalty even after 5 years of people screaming about it on every news media outlet every day tends to also be the type of person who still won't sign up even when you give them an extra 6 weeks to do so.

There's been a lot of discussion about whether it's better to keep open enrollment in the fall/winter season or to move it to the spring. The thinking is that as it stands now, people are distracted by the holiday season (Thanksgiving, Christmas, New Year's, Hanukkah, Kwanzaa), scrambling to deal with end of year finances and so forth. In the springtime, the thinking goes, matching the enrollment period up with the tax filing season would let people enroll at the same time they file their taxes, while discussing the penalty for not doing so with their tax preparer, etc.

However, while [214,000] is a decent number of people, in my view it's not nearly enough to justify shifting things to the spring in the future, for a few reasons:

  • First, it's much easier to market and remember to align things with the calendar year. "Sign up now for January 1st coverage" is easier for people to get.
  • Second, if you enroll in late March, your policy won't even kick into effect until May...and if you enroll in late April, your policy won't start until June! That means that new enrollees could go uncovered for up to 5 months of the year, which is insane.
  • Third, even worse, insurance deductibles are based on the full calendar year. If you have a $3,000 deductible, instead of having 12 months to "use" it, you'd only have 7-8 months to do so before it's used up, which means you're effectively losing money (assuming you get injured/sick a few times per year, of course)
  • Fourth, this would play havoc with the insurance actuaries when trying to set rates for the following year.

To be fair, the mandate penalty in April 2015 (covering 2014 taxes) was only $95/person or 1% of household income, so it's possible that many people shrugged it off as being too nominal to worry about. In addition, the 6-week TaxTime SEP was slapped on at the last minute by the HHS Dept., so it's likely that many people never heard about it; moving the official open enrollment period to the spring would be quite different. And finally, if this policy was formally implemented, I assume it would also mean that insurance companies would officially shift their "annual" coverage periods forward by 5 months as a "year" of coverage would actually run from May 1 - April 30 instead of January 1 - December 31.

However, doing so would also confuse the hell out of people. I know corporations (and the government) uses a "fiscal year" starting in October instead of January, but that's been a long-standing practice which is fully understood by people in business, finance and government. Trying to get the general public to understand that the "year" actually starts in May for their insurance would cause far more confusion and headaches than it's worth, I would think. So...count me down as thinking this would be a bad idea.

Still, I'm all for the other 4 on the Dems' checklist. It'd be nice if they threw in a few more of my list of 20, but this is a good start.