ACA

The 12 Year War

Annnnnnd there it is: Moments ago, the U.S. Supreme Court finally issued their decision in the long-awaited "CA vs. TX" lawsuit...previously known as "Texas vs. Azar," "Texas vs. U.S." or, as I always preferred to call it, "Texas Fold'em," a term first invoked by University of Michigan law professor Nicholas Bagley just over three years ago.

Bottom Line: The case was basically thrown out for lack of standing, in a 7-2 decision, with Justice Breyer delivering the opinion of the court, joined by Justices Sotomayor and Kagan (of course), but also Justices Roberts, Kavanaugh, Barrett and Thomas!

Justice Alito and Gorsuch dissented.

From the opinion itself:

Held: Plaintiffs do not have standing to challenge §5000A(a)’s minimum essential coverage provision because they have not shown a past or future injury fairly traceable to defendants’ conduct enforcing the specific statutory provision they attack as unconstitutional. Pp. 4–16.

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Back on May 11th, I noted that total enrollment in healthcare policies either specifically created by (or expanded to more people by) the Affordable Care Act had likely broken 30 million Americans...an all-time high for the healthcare reform law signed by President Obama 11 years ago.

Last weekend, the Health & Human Services Dept. confirmed this, putting the actual total at around 31 million:

Today, the U.S. Department of Health and Human Services (HHS) released a new report that shows 31 million Americans have health coverage through the Affordable Care Act – a record. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect. People served by the health Marketplaces and Medicaid expansion have reached record highs.

ASPE Logo

Moments ago I posted the news that the HHS Dept. (via the Centers for Medicare & Medicaid) has confirmed what I wrote about nearly a month ago: Enrollment in ACA healthcare policies are at an all-time high, with over 31 million Americans currently covered by either ACA exchange plans, ACA Medicaid expansion or ACA Basic Health Plan coverage.

This news is based on a formal report issued by the Assistant Secretary for Planning & Evaluation (ASPE). Let's take a closer look!

Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates

Based on enrollment data from late 2020 and early 2021, approximately 31 million people were enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the highest total on record.

KEY POINTS

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A month ago I noted that by my back-of-the-envelope math, total enrollment in ACA healthcare coverage had likely reached 30 million people, concluding that:

#ACA Enrollment Is At An All-Time High Right Now Almost Any Way You Slice It.

I based this on a rough comparison of ACA enrollment in 2016 (which saw the highest ACA Open Enrollment Period enrollment to date, with nearly 12.7 million people selecting Qualified Health Plans (QHPs) during the official OEP) versus the most recent data available as of spring 2021.

My rough math was as follows (spring 2016 / spring 2021):

Michigan

It's no secret that as a) a lifetime Michigan resident and b) an openly activist Democrat, I'm a huge fan of Michigan Governor Gretchen Whitmer (I was even on a healthcare town hall panel with her back in 2017 during the Repeal/Replace debacle). Having said that, I'm still impressed with the announcement just put out by the MI Dept. of Insurance & Financial Services:

Michigan Insurers on HealthCare.Gov Provide Consumer Flexibility

(LANSING, MICH) Through an agreement announced today between Governor Gretchen Whitmer, the Michigan Department of Insurance and Financial Services (DIFS), and all nine of Michigan’s Marketplace insurers, Michiganders enrolled in a health plan through the Health Insurance Marketplace can now take advantage of expanded tax subsidies offered by the American Rescue Plan without having to restart their deductibles when they switch to another plan offered by their current insurer, and in some cases even if they choose a plan through another insurer.

I've noted before that enrollment in Michigan's ACA Medicaid expansion program, "Healthy Michigan", has risen sharply over the past year since the COVID-19 pandemic hit; it's up by over 1/3 since last February.

However, it's also worth noting that non-ACA Medicaid enrollment has also jumped significantly since the pandemic arrived. I've dug into data from the Centers for Medicare & Medicaid, the Kaiser Family Foundation and Michigan's Health Dept. archives and put together the graph below, showing that non-ACA Medicaid enrollment has risen from around 1.66 million Michiganders in February 2020 to over 1.92 million today, a 16% increase.

Combined, total Medicaid enrollment is up by around 21% to over 2.82 million as of April 2021.

I should also note that in addition to this, 267,000 Michiganders enrolled in ACA exchange coverage during the 2021 Open Enrollment Period, of which a good 90% (240,000)paid their first monthly premium based on past ACA data. At the time I noted that around 83% were subsidized, or perhaps 200,000.

I last updated my Michigan Medicaid expansion tracking back in January.At the time, I noted that enrollment in this ACA programhas increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing from 673,000 in February 2020 to 853,000 as of January 2021, or nearly 27% in less than one year.

As of April 5th, the Healthy Michigan program (that's the branding of Michigan's ACA Medicaid expansion) notes 897,261 enrollees. That's a net increase of 224,000 Michiganders enrolled in the program since last February, or over 33%.

With this as backdrop, consider the timing of the following events:

The Kaiser Family Foundation has updated their estimated breakout of the entire uninsured population of the United States as of 2019, and what sort of healthcare coverage they're eligible for thanks to the Affordable Care Act and the American Rescue Plan's expanded/enhanced subsidies.

Obviously a lot has changed since then, primarily due to the COVID-19 pandemic, but I presume this is the most recent comprehensive, reliable data they've been able to compile:

One Chance

Five weeks ago, right after Supreme Court Justice Ruth Bader Ginsburg passed away, I once again wrote about the different options available to Democrats to save the ACA from a potentially disastrous SCOTUS ruling next spring...each of which would require them holding a trifecta in the House, the Senate and of course the Presidency:

  • 1. Pass a simple bill changing the federal mandate penalty to an amount higher than $0.00.
  • 2. Pass a simple bill clarifying that the mandate is separate from the rest of the ACA.
  • 3. Pass a simple bill striking out the underlying mandate language itself.

As I understand it, two of these would also require the newly-Dem controlled Senate to also kill the filibuster (or to somehow convince enough Republicans to agree to hit the 60-vote threshold), while the third (raising the penalty back over $0.00) could be done with just 50 votes (+ VP Kamala Harris as the tiebreaker) via the reconciliation process...which itself gets messy.

10/29/20: SEE UPDATE BELOW.

A month ago, incumbent Democratic Senator Gary Peters of Michigan and his Republican challenger John James were both interviewed as part of a Detroit Regional Chamber series on several issues, including healthcare policy and the ACA.

As I noted at the time:

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