Charles Gaba's blog

Starting today, November 1st, the Seventh Annual ACA Open Enrollment Period is upon us! As I do every year, here's a list of important things to remember when selecting a health insurance policy. Some of these are the same every year and apply nationwide; others are specific to the 2020 enrollment period and/or to particular states.

1. DON'T MISS THE DEADLINE!

California actually launched Open Enrollment for 2020 on October 15th, but for the other 49 states (+DC) it starts on November 1st. The deadline for Open Enrollment is December 15th in most states for coverage starting January 1st, 2020, but eight states which operate their own ACA exchanges have extended deadlines:

I've written a lot over the past nearly three years about the damage caused to ACA policy enrollment caused by the Trump Administration's slashing of 90% of HealthCare.Gov's marketing, awareness and outreach budgets.

A significant portion of the reduction in ACA exchange enrollment in 2017, 2018 and 2019 can be blamed squarely on this.

That's not just my opinion; it's been supported by detailed analysis as well as the corresponding increase in enrollment on state-based exchanges, which operate their own marketing/outreach budgets.

The following graph compares the two over the first six Open Enrollment Periods. I've had to adjust for the fact that since 2014, several states have switched from state exchanges to the federal one or vice-versa, but even so, the contrast is dramatic and clear:

Arrrrgh! Don't ask me why, but for some reason I forget about this weird policy of NY State of Health every year:

Press Release: NY State of Health Announces Annual Renewal Begins Saturday

  • 500,000 New York State Households Expected to Renew Their Health Plan for the 2020 Plan Year
  • Consumers Must Enroll or Renew by December 15 for Coverage Effective January 1

ALBANY, N.Y. (November 14, 2019) - NY State of Health, the state’s official health plan Marketplace, today announced that beginning November 16, the Marketplace will be open for individuals looking to renew or change their health plan for 2020. Open Enrollment for new customers seeking to enroll in a Qualified Health Plan began November 1 and runs through January 31, 2020.  New Yorkers must enroll by December 15 for coverage beginning January 1, 2020.

Press release from the DC Health Link website:

Mayor Bowser Encourages DC Residents to Get Covered During 2020 Open Enrollment Period

Wednesday, November 13, 2019

Residents Must Enroll at DCHealthLink.com by December 15 for Coverage to Start January 1 

(Washington, DC­­) – Mayor Muriel Bowser is encouraging DC residents to sign-up for high-quality, affordable health insurance at DCHealthLink.com, the District’s online state-based health insurance marketplace established under the Affordable Care Act. Open enrollment for District residents runs through January 31, 2020. For coverage to be effective January 1, 2020, residents must enroll by December 15.

“If you are a District resident in need of health insurance, there is no better time to find an affordable, high-quality plan,” said Mayor Bowser. “We are proud that the District has been able to build on the Affordable Care Act and ensure every family has access to health insurance and the peace of mind that coverage provides.”

As my regular readers know, I've been a strong proponent of encouraging states to pass laws locking in as many ACA "blue leg" protections as possible in the event that the ACA itself is actually struck down by the idiotic #TexasFoldEm lawsuit (again: the ruling by the 5th Circuit Court of Appeals is due to drop at any time).

However, I've also tried to make it clear that there would be a trade-off involved: If you're going to lock in all of those "Blue Leg" protections (Guaranteed Issue, Community Rating, Essential Health Benefits, No Annual/Lifetime Caps, etc), that will mean that the premiums/deductibles will be higher than they are without those protections.

This is precisely why so-called "short-term, limited duration" policies (aka #ShortAssPlans) and other non-ACA compliant policies cost so much less at the front end...they cherry pick their enrollees and don't cover the more expensive treatments many people require.

Personally, I still think states should lock in those protections anyway, since there's only two ways this can play out:

Last year, Minnesota's ACA exchange, MNsure, reported the following QHP selections numbers for the first two weeks of Open Enrollment (technically the first 13 days):

BY THE NUMBERS—

  • Private health plan sign ups—97,944
  • Call volume—14,335
  • Average speed of answer—7 seconds
  • Plan comparison sessions—49,064

The sign-ups reported include new consumers, renewing consumers who have come back and shopped for a new plan for 2019, and renewing consumers who are continuing their previous plan for 2019.

Of those, around 2,400 were new enrollees; the other 95.5K were renewals of existing enrollees (either active or auto-renewals).

For 2020, this just came in from MNsure:

Strong Interest During MNsure's First 10 days; Open Enrollment Update = November 13, 2019

This Just In from the Centers for Medicare & Medicaid...

Federal Health Insurance Exchange Weekly Enrollment Snapshot: Week 2: Week 2, Nov 3-9, 2019

In week two of the 2020 Open Enrollment, 754,967 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

I know I haven't posted much the past few days; part of this is due to dealing with the snowstorm which hit us here in the midwest (snow day for my kid, broken snowblower, etc.), while part was due to prepping for a healthcare town hall event I participated in last evening.

The town hall was centered on healthcare at the county level. Oakland County, Michigan, has over 1.25 million residents, and after decades of solid Republican control, a combination of last year's "blue wave" election plus the death of longtime GOP County Executive L. Brooks Patterson over the summer has resulted in Democrats taking control of both the executive and legislative branches of county government for the first time in forever.

OK, this is a bit confusing. Over the past few years, more and more of the state-based exchanges have shifted from waiting until the end of Open Enrollment to officially report auto-renewals of existing enrollees...to going ahead and auto-renewing everyone up front, and then subtracting those current enrollees who actively cancel their renewals.

This has caused a bit of confusion, since the exchanges don't always make it clear who's being counted and when.

Case in point: Access Health CT, Connecticut's ACA exchange. Last year they reported 12,777 enrollees during the first two weeks of Open Enrollment...and also noted that there were another 85,000 existing enrollees who hadn't yet actively renewed their policies as of 11/18.

This year, their press release page states the following:

2020 Open Enrollment Results (Stats will be available starting Friday November 8, 2019 by 5pm EST)

Qualified Health Plans (QHP):

Over the past few months, I've written overviews of the preferred Big Healthcare Reform proposals from several of the Democratic Presidential candidates:

Over the past few months, I've written overviews of the preferred Big Healthcare Reform proposals from several of the Democratic Presidential candidates:

Over the past few months, I've written overviews of the preferred Big Healthcare Reform proposals from several of the Democratic Presidential candidates:

A few weeks ago I noted the following press release from Democratic Virginia Governor Ralph Northam, just ahead of the critical state legislative elections:

It took me a couple of days to post this, but it's an important development, especially on the cusp of the Virginia legislative election next month which could flip both the state House and Senate to the Democrats; thanks to Esther Ferington for the heads up:

Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians

“Health coverage should be both meaningful and affordable, but unfortunately, policies from Washington threaten to increase the number of families who are uninsured or underinsured,” said Governor Northam. “It’s more important than ever that we identify and implement policies at the state level that control costs and ensure that Virginians can afford to buy health insurance that covers their health care needs.”

Disclosure: HealthSherpa has a banner ad on this site...for the following reasons:

  • Their website only sells ACA-compliant plans.
  • They display all of them equally (as opposed to hiding or favoring one over another).
  • They only sell them on-exchange (if you're eligible for ACA subsidies you get them through HS's site as well)
  • They make it easy to enroll fro Medicaid/CHIP if the enrollee isn't eligible for a subsidized ACA policy.

It's really, really important to me to make the above very clear, for the following reasons as laid out by Tara Straw of the Center on Budget & Policy Priorities:

This was posted by NJ Governor Phil Murphy a week ago but it's still noteworthy, especially considering that NJ is in the process of splitting off from HC.gov onto their own full ACA exchange next year as Nevada just did:

Governor Murphy and New Jersey Department of Banking and Insurance Kick Off ACA Open Enrollment Period

Governor Announces Strengthened ACA Efforts, including $3.1 Million to Support Outreach and Enrollment Efforts and Bolstered Get Covered NJ Awareness Campaign

TRENTON – Governor Phil Murphy, joined by Department of Banking and Insurance (DOBI) Commissioner Marlene Caride and enrollment assisters from across the state, today announced Navigator grant awards totaling $1.1 million to provide enrollment assistance to residents shopping for health coverage during the six-week open enrollment window. DOBI plans to release approximately $500,000 more in grants in the coming days.

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