ACA

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):

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:

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.

RE-UPPED 1/31/22: It was announced this morning that John James, who lost not one but two statewide U.S. Senate races back to back in 2018 & 2020, is taking a third swing at elected office in 2022. This time he's setting his sights lower, going for Michigan's new open 10th Congressional district, which is still competitive but which definitely has more of a GOP-tilt to it. In light of that, I decided to dust off this post again.

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:

"If you have a pre-existing condition...heart disease; diabetes; breast cancer...they're coming for you. If you love someone who has a pre-existing condition...they're coming for you. If you're under the age of 26 on your parents' coverage...they're coming for you."

Wednesday night's Vice-Presidential debate between Kamala Harris and Mike Pence wasn't as bad as last week's dumpster fire of a Presidential "debate" between Donald Trump and Joe Biden. The questions were mostly better, and neither Pence nor Harris screamed at each other. On the other hand, the moderator did a terrible job of cutting Pence off when he ran over his time limit or interrupted Harris, and just as importantly, Pence flat-out refused to answer most of the questions at all, often instantly changing the subject to whatever he happened to feel like talking about with zero pushback from moderator Susan Page.

Pennsylvania launches new state-based health insurance marketplace, Pennie

• Pennie replaces Healthcare.Gov and will improve access to coverage and increase affordability

Harrisburg, PA – September 22, 2020 – Today, Pennsylvania announced, Pennie, the new state-based health insurance marketplace for 2021 coverage. Pennie is available to all Pennsylvanians and aims to improve the accessibility and affordability of individual market health coverage. It is also the only place that connects Pennsylvanians to financial assistance to reduce the cost of coverage and care.

Pennie was created by Act 42 of 2019, passed unanimously by both chambers of the General Assembly and signed into law by Governor Tom Wolf on July 2, 2019.

There's a lot to unpack in this press release from Covered California:

Covered California Hits Record Enrollment, Providing Important Lessons for the Nation on Meeting Americans’ Health Care Needs During the Pandemic and Major Economic Downturn

• Covered California’s investments in marketing and outreach, along with consumer-first polices, helped it reach a record enrollment of 1.53 million people.

• The record enrollment was bolstered by 289,000 people who signed up for coverage during the COVID-19 special-enrollment period, including 21 percent who were previously uninsured and likely ineligible to enroll under federal rules.

That's roughly 61,000 Californians who were able to enroll in ACA exchange policies specifically due to CA having an open SEP (that is, no requirement of coverage loss/etc. to do so).