Charles Gaba's blog

UPDATE 4/03/21: I've confirmed with a highly-trusted source that this isn't happening...at least not before the Supreme Court issues their ruling, anyway.

As noted below (scroll all the way down), it appears that a $1.00 penalty would be too small to make the reconciliation cut, which means the only way to #MootTheSuit via reconciliation would be to change the mandate back to an amount large enough to have a significant impact on the budget...which presumably means several hundred dollars.

I mean, if they're gonna do that, they might as well just restore it to the original $695/2.5% of income while they're at it.

 

All 50 states + DC have re-opened enrollment on their respective ACA exchanges in response to both the ongoing COVID-19 pandemic and the American Rescue Plan (ARP), which substantially expands and enhances premium subsidies to millions of people!

If you've never enrolled in an ACA healthcare policy before, or if you looked into it years ago but weren't impressed, please give it another shot now. Thanks to the ARP (and some other reasons), it's a whole different ballgame this spring & summer.

Here's 10 important things to understand when you #GetCovered:

via Nevada Health Link:

Nevada Health Link Announces Health Insurance Savings Through the American Rescue Plan Act

  • Nevadans seeking health coverage can access increased or expanded subsidies and premium savings, healthcare tax credits, expanded COBRA protections and increased plan options

CARSON CITY, Nev. (April 16, 2021) – Nevada Health Link, the online health insurance marketplace operated by the state agency, the Silver State Health Insurance Exchange (Exchange), is offering even bigger coverage savings to eligible uninsured and insured off-Exchange Nevadans. These new enhancements are in accordance with the newly-enacted American Rescue Plan Act (ARPA or American Rescue Plan) of 2021 passed by Congress and signed into law by President Biden on March 11, 2021.

The Urban Institute has come out with a brand-new analysis which projects the impact of making the ACA subsidies which have been expanded & enhanced temporarily under the American Rescue Plan permanent. In other words, this is what they expect the real-world impact would be if Congress were to finally #KillTheCliff and #UpTheSubs permanently (as opposed to for just 2021 - 2022), as I and other healthcare activists been pushing for for years now.

A couple of weeks ago, I used the COVID Special Enrollment Period (SEP) data I had for HealthCare.Gov through the end of March, combined with limited SEP data from some state-based ACA exchanges, to extrapolate out a rough estimate of how many new Qualified Health Plan (QHP) selections may have happened since the new "Spring 2021 Special Enrollment Period" was launched on February 15th, 2021.

At the time, I estimated that perhaps 15,800 people per day on average had newly enrolled in ACA exchange policies as of the end of March, or roughly 710,000 nationally. This included the 528,000 confirmed enrollees via HealthCare.Gov, plus another 183,000 or so via the 15 state-based exchanges.

via Pennie:

Savings to the Rescue – Pennie is Now Open with Increased Savings

  • Pennie Customers Can Now See Savings When Shopping for Health Coverage
  • Uninsured Pennsylvanians will be able to receive significant savings in health coverage as a result of the American Rescue Plan

Harrisburg, PA – April 16 – As a result of the recent American Rescue Plan, also known as the COVID-19 relief package, provisions specific to the Affordable Care Act have impacted the way health insurance is available in Pennsylvania. These provisions include significant impacts, including an increase in savings, for Pennsylvanians seeking individual market coverage and those already enrolled through Pennie, as well as those who may lose their employment and rely on COBRA to maintain their employer coverage. Pennie is excited to announce that these savings are now available at pennie.com for those looking to enroll in quality, affordable coverage.

via Get Covered NJ:

Good news! More financial help is now available through Get Covered New Jersey

New Federal and State Savings

The federal government recently passed a COVID-19 relief bill, the American Rescue Plan Act of 2021, which was signed into law by President Biden on March 11, 2021. The new law will reduce health insurance premiums by providing more financial help to eligible consumers who purchase a plan through Get Covered New Jersey. The State of New Jersey is also providing more financial help to lower health insurance costs for residents enrolling at Get Covered New Jersey.

More people than ever will qualify for financial help. If you did not qualify for financial help before because your income was too high, you may qualify under the state and federal changes. If you already receive financial help, you will likely be eligible for additional premium reductions. These new changes make coverage more affordable at many income levels.

A picture is worth 1,000 words and all that.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle.

More than 1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.

More than 1 out of every 9 residents of Iowa, Utah, Tennessee, Arizona and Nebraska have tested positive.

More than 1 out of 10 in Arkansas, South Carolina, New Jersey, Alabama, Kansas, Indiana, New York, Mississippi, Idaho, Delaware, Illinois, Georgia, Wisconsin, Nevada and Florida.

More than 1 out of 20 in every state & territory EXCEPT Guam, Oregon, Maine, Vermont, U.S. Virgin Islands, Hawaii, N. Mariana Islands and American Samoa.

OK, this is a first...while most other states have been simply extending their existing COVID Special Enrollment Periods out through August to allow for the newly-expanded ACA subsidies, Connecticut is shutting theirs down at midnight tonight (April 15th)...but relaunching it again on May 1st:

Just posted by Access Health CT:

American Rescue Plan Act of 2021: Savings Coming for Connecticut Residents

  • You Can Start to Take Action & See Savings After May 1, 2021

A new federal law was passed in March 2021, the American Rescue Plan Act, and it changed the way we calculate financial help for customers for this year and 2022. Many more customers will now qualify for financial help to make plans more affordable. Whether you’re a first-time shopper, or an existing customer, there could be big changes ahead for your household, and we want to make sure you know how to take advantage of the new financial help available.

As a result of this new federal law:

via Connect for Health Colorado:

Connect for Health Colorado Offers More Savings to More Coloradans on Health Insurance Costs

Many Residents Can Find Coverage for Just A Few Dollars a Month

DENVER – Starting today, Thursday, April 15, Coloradans seeking health insurance can access more savings as a result of the American Rescue Plan (also known as the “COVID relief package”) when they shop through Connect for Health Colorado®. The American Rescue Plan expanded financial help for health insurance plans that people buy via the federal and state health insurance exchanges through 2022. And, for the first time, ever, Colorado individuals and families of all income ranges can qualify for reduced premiums.

“We’re ready and eager to provide these savings to more Coloradans who need relief right away,” said Chief Executive Officer Kevin Patterson. “I encourage those who need coverage to sign up. If you were unable to obtain financial help in the past, now is the time to re-apply. You might be surprised how much you can save.”

What’s Different Now?

 

So, the American Rescue Plan includes two important provisions whch I've been fighting for for years: #KillTheCliff and #UpTheSubs. The only downside is that, for now at least, these ACA enhancements are only included for two years (including 2021...the beefed-up & expanded subsidies are retroactive to January 1st of this year).

As a reminder (this is like the 20th time I've posted a table like this), here's the official ACA subsidy formula compared to the improved formula under the American Rescue Plan (ARP):

Note: The Federal Poverty Level (FPL) is 15% higher per household in Hawaii and 25% higher in Alaska.

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

Important:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 187 swing districts (out of over 3,100 total), with around 33.7 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.

With those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, April 14th, 2021 (click image for high-res version).

  • Blue = Joe Biden won by more than 6 points
  • Orange = Donald Trump won by more than 6 points
  • Yellow = Swing District (Biden or Trump won by less than 6 points)

A few weeks ago, I noted that one of the numerous ACA-related provisions of the American Rescue Plan was this one:

Put simply, subsidized enrollees last year received around $6.3 billion in "excess subsidies"...they underestimated their income for the year 2020 and would normally be required to pay them back, but the ARP is waiving that "clawback" of overpayments for one year only in response to the pandemic.

Again, these are subsidies which were already paid out in 2020. The money is already in the hands of the enrollees (well, technically it's in the hands of the insurance carriers, but that in turn freed up an equal amount in the bank accounts of the enrollees, anyway). This provision simply says that the enrollees don't have to pay it back.

Back in January, I posted a story about the ACA subsidy improvements to be included in the then-pending American Rescue Plan (ARP). At the time, I noted what seemed to be a pretty big scoop:

...there's also another small but critical detail included in the table above which escaped my attention last summer in H.R. 1425.

Take a look at the first line of Rep. Underwood's 2019 version (H.R 1868):

  • Over 100.0 percent up to 133.0 percent

Now take a look at the first line under both H.R. 1425 and H.R. 369:

  • Up to 150.0 percent

Notice the difference? I'm not talking about the "up to 150%" part. I'm talking about the removal of the "Over 100.0 percent" part.

If this were to pass the House & Senate and be signed into law by President Biden using this exact language, it would apparently eliminate the Medicaid Gap...albeit with a couple of major caveats.

UPDATE 4/13/21: An earlier version of this post had misinterpreted Linda Blumberg's estimate how much S.499 would cost--I thought that the $350 billion estimate was the gross projected 10-year cost without taking into account the impact of eliminating Silver Loading, but it turns out that it's the net cost after taking that into account as well. My apologies for such a bone-headed error.

Having said that, there's still the possibility of up to $196 billion in additional savings elsewhere, so it's still worth discussing the relative costs of both proposals and seeing whether both, or at least parts of both, could still be worked into the American Families Plan. I've significantly reworked the the wording of the post accordingly.

This was apparently decided awhile ago (there was no press release), but I just learned about it today thanks to Louise Norris:

Nevada’s Response to Coronavirus

Nevada Health Link opened a Special Enrollment Period (SEP) for uninsured Nevadans, starting February 15 through August 15, 2021. The SEP is in accordance with the Executive Order issued by President Biden last month, in response to the ongoing national emergency presented by COVID-19.

  • Coming soon! Thanks to the recently passed American Rescue Plan, we’ll soon be offering more money to help pay for your coverage. Learn more here.

Visit here to learn more.

Nice catch by Andrew Sprung. Via the NJ Dept. of Banking & Insurance:

EXTENSION OF COVID-19 SPECIAL ENROLLMENT PERIOD

On January 29, 2021, the Department of Banking and Insurance (“Department”) issued Bulletin No. 21-03 advising carriers and other interested parties that an emergency COVID-19 Special Enrollment Period (“COVID-19 SEP”) would go into effect on February 1, 2021 and extend through May 15, 2021. The COVID-19 SEP ensured that New Jersey residents have access to quality affordable health insurance during a critical time in which the need to protect public health is paramount. Specifically, the COVID-19 SEP made sure that individual market coverage was available to uninsured individuals during the pandemic. It also aligned New Jersey with the Federal Special Enrollment Period which runs through May 15, 2021 and the Federal Public Health Emergency.

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

Important:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 187 swing districts (out of over 3,100 total), with around 33.7 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.

With those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, April 8th, 2021 (click image for high-res version).

  • Blue = Joe Biden won by more than 6 points
  • Orange = Donald Trump won by more than 6 points
  • Yellow = Swing District (Biden or Trump won by less than 6 points)

Two months ago, I noted that the Washington state legislature had decided to beef up their quasi-Public Option law to make the PO plans (called "Cascade Select") more robust and less expensive:

Let's step back a moment: There's actually up to three types of policies being offered depending on the carrier:

  • Qualified Health Plans (QHPs)...these are the normal policies which comply with ACA regulations offered by most carriers.
  • Cascade (Standard)...these are QHPs which also follow another state law passed last year (see below), and
  • Cascade (Select)...these are Standardized QHPs which are also public option plans.

Here's the distinction between Cascade "standard" and Cascade "select":

A picture is worth 1,000 words and all that.

I've done my best to label every state/territory, which obviously isn't easy to do for most of them given how tangled it gets in the middle.

More than 1 out of every 8 residents of North Dakota, South Dakota and Rhode Island have tested positive for COVID-19 over the past year.

More than 1 out of every 9 residents of Iowa, Utah, Tennessee and Arizona have tested positive.

More than 1 out of 10 in Nebraska, Arkansas, South Carolina, New Jersey, Alabama, Kansas, Indiana, Mississippi, Idaho, New York, Georgia, Illinois, Wisconsin and Delaware.

More than 1 out of 20 in every state & territory EXCEPT Washington, Guam, Oregon, Maine, Vermont, U.S. Virgin Islands, Hawaii, N. Mariana Islands and American Samoa.

A couple of weeks ago, I used the limited COVID Special Enrollment Period (SEP) data I had for HealthCare.Gov from the last two weeks of February, plus some limited SEP data from a handful of state-based ACA exchanges, to extrapolate out a rough estimate of how many new Qualified Health Plan (QHP) selections may have happened nationally.

At the time, I estimated that perhaps 18,500 people were enrolling per day nationally the final two weeks of February, and that IF that pace remained the same throughout the entire month of March, it would amount to upwards of 832,000 new people enrolling by the end of March (666,000 via HealthCare.Gov, plus another 166,000 via the 15 state-based exchanges).

It's important to note that this wasn't a hard estimate--I was pretty sure that the actual enrollment pace would slow down somewhat after the inital surge, at least until expanded subsidies via the American Rescue Plan (ARP) were officially available in most states, which didn't happen until April 1st.

This just in via Connect for Health Colorado:

More Coloradans Than Ever Are Using Colorado’s Exchange to Get Covered

DENVER — In a report released today by Connect for Health Colorado, nearly 180,000 Coloradans signed up for a health insurance plan by the end of the Open Enrollment Period on Jan. 15 for 2021 coverage. The new report includes more detailed information about changes to premium costs and financial help by county, the improved customer experience and our outreach tactics.

The main number here is nothing new; C4HCO had already announced the 180K figure back in January. The report itself contains a ton of key demographic stats & details, however, which I'll get to below.

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:

March 2, 2021:

The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...

Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).

Note: A few weeks ago, I ran a rough back-of-the-envelope extrapolation of partial data from the first 2 weeks of the ongoing COVID Special Enrollment Period and concluded that IF enrollment via the 36 HealthCare.Gov states was representative nationally, and IF the pace of the last 2 weeks of February held perfectly steady, it would mean around 666,000 new enrollees via HC.gov and 832,000 nationally by the end of March. Those were two pretty big caveats, of course, and as you'll see below, the reality wasn't quite as eyebrow-raising, though it's still pretty impressive.

This just in via the Centers for Medicare & Medicaid Services (CMS):

2021 Marketplace Special Enrollment Period Report

February 15 – March 31, 2021

The date on this press release is April 1st, but I didn't see it on the MD Connect website until today:

AMERICAN RESCUE PLAN ACT DRAMATICALLY LOWERS HEALTH CARE COSTS FOR MANY MARYLANDERS

Low income individuals and families will pay nearly nothing for private health plans, higher income will be eligible for savings for the first time

(BALTIMORE) — Gov. Larry Hogan and Maryland Health Connection today announced reductions in the health plan costs that reflect additional financial help available through the federal American Rescue Plan Act. The new law means that:

This is mostly an updated version of a post from last week, but there's some important new (potential) developments. Via Amy Lotven of Inside Health Policy:

The White House is expected to roll out the health care priorities for its two-part infrastructure package sometime this Spring, and the health piece potentially could move separately now that the Senate parliamentarian has agreed Democrats have another shot passing their priorities through a simple majority. While there appears to be consensus that the bill will expand, or make permanent, the Affordable Care Act tax credits from the American Rescue Plan, other policies are less clear and will likely depend on the amount of offsets lawmakers can glean from drug-pricing measures.

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