Charles Gaba's blog

Last May, I noted that the Illinois state legislature had passed a law which made my heart sing:

Last fall Oregon moved to the next step on their Basic Health Plan program (via Oregon Public Broadcasting):

Oregon becomes 3rd in nation to seek federal approval for a basic health program

A group of volunteer advisors to the Oregon Health Authority has voted Tuesday to make the state the third in the nation to seek federal approval for a basic health program.

...The Oregon Health Policy Board voted unanimously to approve Oregon’s blueprint application. It was the last step in a lengthy policy-making process needed for state approval of the plan after a task force last year recommended moving forward with it.

Arkansas is a problematic state for many reasons, but I have to give their insurance dept. website high praise for posting their annual rate filings in a clear, simple & comprehensive fashion (which is to say, not only do they post the avg. premium changes for each carrier, they also post the number of covered lives for each, which is often difficult for me to dig up). Better yet, they also include direct links to the filing summaries and include the SERFF tracking number for each in case I need to look up more detailed info.

Anyway, there's nothing terribly noteworthy in the 2025 filings. Insurance carriers are seeking an average 4.2% rate hike on the individual market and 9.6% for small group plans.

HMO Partners (Health Advantage) appears to be dropping out of the small group market, but otherwise it looks pretty calm.

I last checked in on the "Georgia Pathways" program (the Peach State's partial-Medicaid expansion program which offiically extends up to 100% of the Federal Poverty Level but which also includes a draconian work reporting requirement) back in January.

At the time, only around 2,500 Georgians had actually enrolled in Georgia Pathways, for a number of rather obvious reasons:

As Leonardo Cuello of the Georgetown University McCourt School of Public Policy noted last winter:

Back in May I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 450,000 of the estimated 600,000 NC residents eligible for the program.

Cut to a few days ago:

North Carolina Celebrates More Than 500,000 Enrolled in Medicaid Expansion

PRESS RELEASE — More than half a million North Carolinians have now enrolled in Medicaid expansion since the program began seven months ago. Beneficiaries are now able get the quality health care they need at low cost. Governor Roy Cooper was joined by North Carolina Department of Health and Human Services Secretary Kody Kinsley, Dr. Karen L. Smith MD, FAAFP, a family physician in Raeford and Verlina Lomick,CHW-IV, Director of Community Outreach & Advocacy for Kintegra Health and health care advocates to celebrate reaching this major milestone, which had originally been projected to take as long as two years.

Just yesterday I noted that the Michigan state senate has passed a bill to establish a state-based ACA exchange, joining 21 other states (Georgia is scheduled to launch theirs this fall, and Illinois in time for the 2026 Open Enrollment Period). The bill now moves to the state House, where I'm expecting it to pass and be signed into law by Gov. Whitmer without too much controversy. If so, Michigan would also split off of the federal exchange in time for the 2026 OEP.

Well, it turns out that another state may end up beating Michigan to the punch, and it's probably the last state you'd expect it to happen in: Mississippi!

From April:


I originally wrote about this back in April:

Cut to 2024: Michigan Democrats now hold control of the state Senate as well as (barely) the House...and Democratic Representative Kevin Hertel is now Senator Kevin Hertel, who also happens to be the Health Policy Committee Chair...and one of his priorities this session, according to his latest constituent newsletter, is indeed to move Michigan to a state-based ACA exchange:

Legislative Updates

Expanding Access to Health Care Through a State-Based Exchange

Disclaimer: Health Sherpa is one of's banner ad sponsors.

Over at the Wiley Online Library, Aleka Gurel, Director of Government Affairs at HealthSherpa, has published an excellent, in-the-weeds analysis of the history & impact of private insurance brokers & agents on ACA marketplace (on exchange) enrollment.

Here's an excerpt (note that this website is actually among the data sources she cites):

Last spring, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

Across these 19 states alone, ACA Medicaid expansion enrollment is up 788,245 people since last March, or 6.7% overall. If you remove Missouri and Oklahoma, it's still up 4.28% since then, and again, this is still as much as 8 months out of date depending on the state. Assuming Illinois is wrong, removing it as well puts expansion enrollment up 5.4% since last March.

Assuming these states are representative, it's safe to assume that Medicaid expansion is up at least 4.3% nationally since March 2022, or around an additional 960,000 people. If you go with the higher end estimate (+5.4%), it would be up over 1.2 million nationally.

That puts the grand total at somewhere between 39.9 - 40.1 million people with ACA-enabled healthcare covered nationally.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of March 2024: