January 2020

California and New York have both released updated 2020 Open Enrollment numbers, so I figured I'd update my spreadsheet one more time before the final data is released. This time I've included a smaller secondary table at the bottom which adjusts the Federal and State-based exchange numbers for Nevada.

OFFICIALLY, HealthCare.Gov enrollment is down nearly 128,000 people this year, but that's not fair because Nevada broke off of HC.gov onto their own full state-based exchange platform this year. When you adjust for that, HC.gov is only down 119,000 people for the remaining 38 states. Meanwhile, the state-based exchanges are officially down 2,900 at the moment, but again, with Nevada joining them, they're actually down around 8,900.people.

That leaves the missing enrollment data from five states. Rhode Island and Vermont haven't released any data...I'm assuming they'll both be very close to last year (call it at least 33,000 and 24,000 respectively). I'm assuming New York + DC will be good for perhaps 3,000 more enrollees combined in their final days. And California will likely tack on another 30,000 or so in their final 2 days of Open Enrollment.

I'm a bit late on this one. It was reported a week or so ago but was officially introduced today:

Trump administration finalizing Medicaid block grant plan targeting Obamacare

• The plan is guaranteed to enrage critics and invite attacks from Democrats in an election year.

The Trump administration is finalizing a plan to let states convert a chunk of Medicaid funding to block grants, even as officials remain divided over how to sell the controversial change to the safety net health program.

CMS Administrator Seema Verma plans to issue a letter soon explaining how states could seek waivers to receive defined payments for adults covered by Obamacare's Medicaid expansion, according to seven people with knowledge of the closely guarded effort. An announcement is tentatively slated for the end of next week, more than one year after Verma and her team began developing the plan.

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

Hmmm...looks like there was some sort of data breach at AccessHealthCT:

A Small Number Of Access Health CT Consumers Will Receive Mail This Week About Their Personal Information And Should Review Carefully

HARTFORD, Conn. (January 28, 2020)—Approximately 1,100 Access Health CT consumers will be receiving an ORANGE ENVELOPE in the mail this week. It is important that consumers review this information carefully as they will need to take action to enroll in free services being offered to help protect their personal information that may have been compromised in a data breach.

“Access Health CT takes the privacy and security of consumers’ personal information seriously, and it is making this public notice in an abundance of caution,” said Chief Executive Officer of Access Health CT, James Michel. “We apologize for any inconvenience to consumers and we remain steadfast in our commitment to keep our consumers’ best interests as our number one priority.”

This just in from the New York State of Health ACA exchange:

Press Release: New Yorkers Have More Time to Get Covered in 2020: NY State of Health Open Enrollment Deadline Extended to February 7

• Enroll Now for Affordable, High-Quality Health Coverage in 2020
• Free, In-Person Enrollment Help is Available: Click Here to Find a NY State of Health Certified Assistor

ALBANY, N.Y. (January 28, 2020) – NY State of Health, the state’s official health plan Marketplace, announced that consumers will have an additional week to enroll in a Qualified Health Plan (QHP) for 2020. The Open Enrollment deadline has been extended until February 7 to give consumers more time to enroll. NY State of Health’s Customer Service Center representatives and in-person assistors are available to help individuals find the best plan for themselves and their families.

Huh. That's unexpected.

via KIVI Boise:

The number of Idaho residents who have signed up for Medicaid under the state’s voter-approved expanded coverage has passed 60,000.

The Idaho Department of Health and Welfare posted updated numbers Thursday. The agency estimates 91,000 residents meet requirements.

Coverage started January 1, but enrollment is year-round. Those who sign up for Medicaid will be covered for doctor visits that occurred earlier in the same month.

Voters authorized Medicaid expansion in 2018 with an initiative that passed with 61% of the vote after years of inaction by state lawmakers. In 2019, lawmakers added restrictions requiring five waivers from the U.S. Department of Health and Human Services.

Waivers are required when states want to deviate from Medicaid rules. Federal officials have yet to approve any of Idaho’s requested waivers.

If the anticipated 91,000 people do eventually sign up, it would cost Idaho about $400 million, with the federal government paying 90%.

(I have no idea who created this image...I'll give credit if someone can point me towards the artist)

I'm a bit embarrassed to admit that I don't seem to have written much about the Trump Administration's repulsive proposed "public charge" policy over the past year or so. Here's a general overview from last fall via Nicole Narea of Vox:

The US has been able to reject prospective immigrants who are likely to become a “public charge” — dependent on the government for support — since 1882, but since World War II, few immigrants were turned away using that criteria. In 1999, the Clinton administration issued guidance that said only cash benefits, which very few immigrants use, would be considered in making the determination.

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

I spent most of last week in Washington, D.C. for the 25th Annual Families USA Health Action Conference:

Families USA, a leading national, non-partisan voice for health care consumers, is dedicated to achieving high-quality, affordable health care and improved health for all. Our work is driven by and centered around four pillars: value, equity, coverage, and consumer experience. We view these focus areas — and the various issues unique to each area — as the cornerstones of America’s health care system.

Public policy analysis that is rooted in Hill and administration experience, movement-building advocacy, and collaboration with partners are deep-rooted hallmarks of our work. In turn, our work promotes a health system that protects consumers’ financial security as much as it does their health care security.

As we advance our mission by combining policy expertise and partnerships with community, state, and national leaders, we forge transformational solutions that improve the health and health care of our nation’s families and speak to the values we all have in common.

Head's up, readers...next week, for the third year in a row I'll be attending the Families USA Health Action conference in Washington, D.C...and for the first time, I'll actually be on one of the panels:

Friday, January 24th, 2:00pm-3:15pm • Workshops / Session 4

WHAT'S NEXT? COVERAGE AND AFFORDABILITY OPPORTUNITIES IN RED, BLUE, AND PURPLE STATES

Description: A surprisingly broad range of resources and options are available to streamline enrollment and to lower consumers’ health care and coverage costs in the individual market. Learn about promising, innovative strategies tailored to fit very different political conditions.

Speakers:

• John-Pierre Cardenas, MSPH, Independent Health Policy Adviser, formerly Maryland Health Benefits Exchange
• Charles Gaba, ACASignups.net
• Heather Howard, J.D., Center for Health & Wellbeing, Woodrow School of Public and International Affairs, Princeton University
• Holly Hernandez, Harris Health

Moderator: Stan Dorn, J.D., Families USA

8/26/20: See 2021 pricing update below.

I've written several times before about how health insurance risk pools work. I even whipped up a crude video explainer about them a couple of years back. The healthiness or lack thereof of a given risk pool is the biggest factor involved in determining how expensive or inexpensive insurance policy premiums will be.

This year, my own family became a perfect example of this. Unlike most health insurance horror stories you often hear about, the final results in our case are positive...although we did go through a brief panic attack period before getting there.

My wife and I are both self-employed, and have a few recurring medical issues. We have one child, a teenager with Asperger's syndrome and a (fortunately fairly mild) case of cerebral palsy, which means long-term physical therapy and some other recurring medical expenses. Since we'd max out the deductible on a Silver plan each year, we've been enrolled in an ACA exchange Gold HMO plan since 2015. It's expensive even with partial subsidies, but we don't want to risk a major hole in coverage if at all possible.

Note: Photo of John Conyers used at the request of the thread author. Thread reposted with permission.

About a week and a half ago, a die-hard Bernie Sanders supportern named David Klion posted something I found pretty offensive. I already wrote about that.

However, in the wake of that back & forth, a Twitter follower of mine, a woman of color who goes by the handle @Kamalaallday, posted an angry rant which I felt lent a lot of insight as to why many in the black community aren't nearly as keen on "Medicare for All" as envisioned by Sanders and other M4All activists as you might expect.

I already knew about some of her complaints and concerns below, but not all of it. Instead of putting words in her mouth, I'm just gonna let her speak for herself.

I've embedded the first tweet directly, but have converted the rest of the thread into bullets and reworked the structure (putting half-sentences together and adding paragraph breaks, etc.) for easier readability, but have otherwise left her entire thread as is. I strongly advise that folks read it all...food for thought:

Last May, New Jersey Democratic legislators were pushing through over a dozen bills which would effectively lock in nearly all of the ACA's "Blue Leg Protections", as I refer to them, at the state level. The main reason for this, of course, is to replicate federal ACA protections for enrollees just in case the U.S. Supreme Court does ultimately strike down the Affordable Care Act (or at least strikes down the consumer protection parts of it).

Well, I kind of lost track of the status of those bills over the summer and fall, but apparently most of them passed through both the New Jersey state House and Senate because just moments ago, NJ Governor Phil Murphy issued the following press release:

This Just In via Covered California:

Covered California Continues to See Strong Interest and Reminds Consumers That Penalty Is Back for 2020 as Open-Enrollment Deadline Approaches

• More than 269,000 consumers have newly enrolled during the current open-enrollment period, which continues in California through Jan. 31.
• A new law requires Californians to have health insurance in 2020 or face a penalty when they file their taxes with the Franchise Tax Board in 2021.
• The penalty can be $2,000 or more for a family of four.
• New research shows that many Californians, particularly the uninsured, are unaware of the new penalty or the new financial help that is available for the first time this year.

SACRAMENTO, Calif. — Covered California announced new data as it approaches the final two weeks of the annual open-enrollment period and reminded consumers about the new state penalty and additional financial help that went into effect with the new year.

As of Saturday, Jan. 4, more than 269,000 consumers had newly signed up for health insurance through Covered California during the current open-enrollment period, which is an increase of 18 percent above the number of consumers who had enrolled at this time last year. In addition, more than 1.15 million existing Covered California members have renewed their coverage for 2020.

This is the last in my 2020 Democratic Presidential Candidate Healthcare Policy series. In some cases I did wonky, in-depth analyses; in others I've simply given an overview with some notes here and there.

Andrew Yang's falls into the latter category, not because of any bias against him, but simply due to a lack of time on my part to give it a more detailed review.

Officially, Yang supports "Medicare for All", but like several other candidates both now and in the past, this isn't quite the same "Medicare for All" that Bernie Sanders is pushing (and which Elizabeth Warren is mostly still pushing):

We are having the wrong conversation on healthcare.

Instead of addressing the underlying problems driving unaffordability and access, we Democrats are spending all our time arguing over who is the most zealous in wanting to cover Americans. Over who has wanted to do so longer. Over who cares more about the health of Americans.

via the official CNN Democratic Debate Transcript (Part 1, Part 2)

PHILLIP: Let's turn to health care, the top issue for Iowa Democrats. Donald Trump is trying to repeal Obamacare, including the protections for pre-existing conditions. We all know that each of you vigorously opposes that. Still, there are some questions about what each of you would do.

This was the only time throughout the entire healthcare portion of the debate that anyone said a peep about the Texas vs. Azar lawsuit...and it wasn't even one of the candidates; it was the moderator.

Senator Sanders, you have consistently refused to say exactly how much your Medicare For All plan is going to cost. Don't voters deserve to see the price tag before you send them a bill that could cost tens of trillions of dollars?

An important reminder from AccessHealth CT...

Close To 20 Percent Of Access Health CT Customers Still Need To Submit Verification Documents To Stay Covered

• Customers can scan and submit verification documents at Enrollment Fairs, via mail or online
• Some AHCT customers will receive letters in the mail requesting specific documents to confirm information in their application.
• Documents can be submitted online, at an Enrollment Fair where documents can be scanned and uploaded immediately or by mail. 
• Failure to submit documents by the deadline can result in loss of coverage or financial help.

HARTFORD, Conn. (January 13, 2020)—Open Enrollment to sign up for a 2020 health insurance plan through Access Health CT (AHCT) ends at midnight on Wednesday, January 15, 2020. Connecticut residents can still enroll online, over the phone, or in-person at any of our Enrollment Fairs or five Enrollment Locations—and some might need to submit verification documents.

I've been reluctant to add Tom Steyer's healthcare plan into my candidate analyses, but like Michael Bloomberg, Steyer has managed to flood the airwaves with well over $100 MILLION of his own money in TV ads and it's at least partly paid off. He's been in a couple of the Democratic debates, and is placing in 2nd or 3rd in a couple of South Carolina primary polls, so I guess he's justified my taking a look at his plan:

Health care is a right for all

Every American has the Right to Health Care. Health is the foundation for a full and productive life. Yet for far too long, the corporate stranglehold on our health care system has kept Americans from accessing and affording the health care they need.

Costs are simply too high. Patients in the United States spend on average $9,892 a year on health care, which is 25% higher than the next highest-cost nation. Predatory drug companies, insurance providers, and hospitals squeeze every last dollar in profit possible from the system. As these corporations deliver skyrocketing returns to shareholders, politicians in Washington, D.C. do nothing to help the hard-working families whose budgets are being held hostage.

Someone pointed me towards an official ACA Open Enrollment report for the DC Health Link from a few days ago. There's a bunch of demographic data broken out, but the bottom line is:

• 18,611 people have selected individual market Qualified Health Plans (QHPs) for 2020
• Officially, this is down over 5% vs. last year...however...
• ...the final official total for the 2019 Open Enrollment Period was only 18,035 due to some last-minute clerical error corrections and/or purging of last-minute cancellations.

...which means that at least for the moment, DC is up 3.2% year over year.

Remember, DC residents can still #GetCovered through the end of January for coverage starting in either February or March, so this number should increase a bit more yet.

Last year, California passed several important bills related to expanding coverage in their ACA exchange, Covered California. Two of the biggest changes were the expansion of subsidies to middle-class enrollees earning 400-600% FPL (as well as enhancing subsidies for existing enrollees), and the reinstatement of the individual mandate penalty (the revenue from which is actually supposed to be used to help finance the expanded subsidies).

Just before Christmas, I noted that there may be a major awareness problem with the first of these:

Again, there's still another five full weeks of Open Enrollment in California (six, if you include the missing data from last week). As I've noted, they'll have to add at least 134,000 total enrollees to beat last year, or nearly 200,000 to beat their all-time high. From the looks of things, they're on track to hit that 615K figure in the 200-400% range, but the 400-600% range is gonna be a much steeper climb...which is ironic since that's the population which is eligible for the most dramatic price cuts.

Even as I'm typing this, Democratic (!) Kansas Governor Laura Kelly and Republican legislative leaders are holding a press conference to announce an agreement to finally expand Medicaid under the ACA:

TOPEKA, Kan. (KWCH) Gov. Laura Kelly and Republican leadership announce an agreement on Medicaid expansion in Kansas.

During a press conference on Thursday, the governor said the program would be funded by the hospital administrative fee. At this time, it's unknown if that fee would be passed on to patients.

Kelly said the hospitals have endorsed the program.

Kansas Senate GOP Majority Leader Jim Denning said the bill would be pre-filed on Thursday with 22 co-sponsors.

If passed in the Kansas Senate and House, the full expansion would go into effect no later than Jan. 1.

(Obviously that's January 1st of 2021 at this point, of course)

Here's some live tweeting of the event by a Kansas-based political reporter:

I just received the following 2020 Open Enrollment report from the Massachusetts Health Connector (via email, no link):

Here are numbers as of yesterday:

• We have 290,769 members enrolled in January coverage
• We have 4,444 members enrolled in February or March coverage
• We have 5,270 plans selected (1st premium not paid yet)
• That’s a total of 300,483 people
• We have 41,477 new enrollments.

I wish every ACA exchange would break out their numbers this way. Simple and to the point, but also with relevant details...not only "renewals vs. new" but also how many are enrolled for January vs. February or March coverage and even how many have/haven't paid yet! The last is a bit unfair since Massachusetts is one of only two states, I believe, which actually handle premium payments (Rhode Island does as well...Washington State used to but doesn't anymore).

Maine Governor Janet Mills had already announced her intentions regarding moving Maine to a state-based ACA exchange last fall, but now she and state legislative leaders are making it official with the rollout of a new bill...but they're including several other important improvements as well, and I'm mostly cheering all of these, although the logic is a bit confusing on a couple of points:

Mills, Jackson & Gideon Announce Bill to Improve Health Insurance for Maine People and Small Businesses

Augusta, MAINE – Governor Janet Mills, Senate President Troy Jackson, and Speaker of the House Sara Gideon today announced legislation to improve private health insurance for Maine people and small businesses. LD 2007, The Made for Maine Health Coverage Act, would make some of the most common medical visits free or less costly, simplify shopping for a plan, leverage federal funds to help make premiums more affordable for small businesses, and put Maine in the driver’s seat to ensure that all Maine people have clear choices for their coverage.

I don't normally post blog entries about the occasional Twitter flare-ups I get into with die-hard Medicare for All supporters, but this one strikes me as being especially noteworthy for several reasons.

David Klion is the News Editor at JewishCurrents and a writer for The Nation and The New Republic. As you can imagine, he's a pretty left-wing/progressive kind of guy, and a devout Bernie Sanders supporter. He has a verified account (as I do) and has about 55,000 Twitter followers (compared to my 35,000, FWIW). In other words, both of us have small but respectable followings on social media and are what the powers that be would likely consider "low-level" (?) Twitter influencers.

He and I have followed each other on Twitter for several years. We don't directly talk to each other very often, however.

Anyway, about an hour ago, Klion posted a thread with an admittedly depressing and all-too-common Consumer Hell story about his health insurance woes. I'm reposting the whole thing here; it is indeed an indictment of our current system. I've cleaned up the formatting for readability:

A new, if not surprising, development in the Republican Party's absurd "Texas Fold'em" lawsuit against the ACA:

Attorney General Becerra Leads Coalition Seeking Supreme Court Review of ACA Repeal Case

Friday, January 3, 2020

SACRAMENTO – California Attorney General Xavier Becerra today, leading a coalition of 20 states and D.C., filed a petition to the U.S. Supreme Court seeking review of the Fifth Circuit’s recent decision in Texas v. U.S. The decision held the individual mandate of the Affordable Care Act (ACA) unconstitutional and called into question whether the remaining provisions of the ACA could still stand, including those that protect and provide coverage to Americans with pre-existing conditions. Because this decision causes uncertainty that may harm the health of millions of Americans, as well as doctors, clinics, patients, and the healthcare market, Attorney General Becerra and his coalition are petitioning the Supreme Court to take up the case and resolve it before the end of the Court’s current term in June.