Charles Gaba's blog

Hmmm...MNsure has issued a press release containing their latest enrollment numbers...but I'm a little confused about the "thru date", which is pretty important as we're ramping up for the final days before the 12/15 deadline for January coverage:

Since the start of open enrollment, there have been:

This lede by Noam Levey in the L.A. Times today is a hell of a thing:

As they race to repeal large parts of the Affordable Care Act, President-elect Donald Trump and congressional Republicans are leaving behind nearly everyone but their base voters and a handful of conservative activists.

Not a single major organization representing patients, physicians, hospitals or others who work in the nation’s healthcare system backs the GOP’s Obamacare strategy.

New polls also show far more Americans would like to expand or keep the healthcare law, rather than repeal it.

Even many conservative health policy experts caution that the emerging Republican plan, which calls for a vote in January to roll back insurance coverage followed by a lengthy period to develop a replacement, could be disastrous.

He goes on to document just a handful of the organizations screaming from the rooftops what an utter disaster repealing the ACA without a reasonable replacement plan already in place would be:

The Republican Party already has their playbook for how to repeal the Affordable Care Act, cause massive disruption and damage to the healthcare market, kick potentially up to 29 million people off their healthcare coverage and get away with it by blaming it on the law itself (and, of course, President Obama). They're so certain that their plan will work that some of them are openly admitting the jaw-dropping chutzpah of it all:

That could lead to a mess for the roughly 10 million Americans currently getting coverage through the government-run marketplaces — and backlash against the GOP.

...But the enticements most likely to keep insurers in the exchanges are the ones in Obamacare that Republicans spent years denouncing as industry “bailouts” — subsidies that were supposed to insulate plans from big losses.

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

I haven't written a single word about Maryland since early October. Last year their ACA exchange was very good about posting fairly regular enrollment updates; this year they've been dead silent about it so far, which is rather surprising (and no, I don't think it's because their numbers are bad...every other state I have data for seems to be doing pretty well or even better than last year so far).

Anyway, there's one bit of news out of the Old Line State (yes, I had to look it up to find out what their nickname is) today which is disappointing but not surprising when you understand the circumstances:

The Maryland Insurance Administration barred Evergreen Health from selling health insurance policies for individuals until federal and state regulators decide whether to allow the cooperative to convert to a for-profit insurer and receive a much-needed cash infusion.

A couple of weeks ago, I noted that Massachusetts had confirmed just over 23,000 QHP selections for 2017 as of 11/17, consisting of around 15,800 renewing enrollees and 7,200 new people signing up.

Today I've received the latest enrollment data out of the Bay State:

As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.

That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.

OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.

Republican House Speaker Paul Ryan was asked this question earlier today.

His response?





Seriously. That was pretty much what he said:

"We’ll get to that next year," Ryan told reporters when asked how long the transition away from Obamacare would be. "We just had a meeting with all our authorizers this morning about working on this with the Senate and the transition team. Those talks are ongoing."

..."We’re going to have these kinds of conversations. I don’t have an opinion on exactly what that timeline will be," he said. "There’s a lot of moving parts, and we have a lot of dialogue that we have to have with just our friends in the Senate and with the White House on the transition. So it’s just premature to suggest that we know how exactly long this transition is."

Oh, good. I'm sure this will make all those healthcare actuaries feel better.

There's exactly 7 days just 3 days to go before the first major 2017 Open Enrollment Period deadline (the 12/15 deadline in most states for coverage starting January 1st), so let's see where things stand.

  • I've confirmed 2,903,199 QHP selections nationally, of which 2,137,717 are via the federal exchange and 765,482 are via the dozen state exchanges.
  • However, most of this only runs through November 26, and I still have no enrollment data at all for DC, Idaho, Maryland, New York, Vermont or Washington State.
  • estimate that the actual national total broke through 4.5 million last night, and should break 5.0 million by tomorrow (Friday) night.
  • Enrollments should have started ramping up dramatically as we go into the final few days before the big 12/15 deadline, culminating in around 7.7 million by the 15th.
  • After that, the auto-renewals should be tacked on somewhere around 12/17 - 12/18.

As recently as 11/26/16, enrollments on both the federal and most state exchanges was either pacing or somewhat ahead of my projections, with no "Trump Factor" to speak of. I won't know for sure whether this is still the case until the Week 5-6 Snapshot report is released, which likely won't be until next Wednesday.

I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this site and everything...)

Rhode Island, which issued regular weekly enrollment reports last year, has been unusually silent so far this year...until today:

HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, December 3, 2016 for Open Enrollment.

As of December 3, 2016

Last week I attempted to figure out just how many Trump voters would lose their healthcare coverage if/when the ACA is repealed by the Republican Party. Paul Krugman took a "big picture" approach and came up with numbers in the 4-6 million range. My own back-of-the-envelope math came in higher, at perhaps 9 million. I concluded that the actual number is likely somewhere in the middle (4-9 million).

I mention this because this morning the Urban Institute issued their own detailed analysis of just how many people would lose coverage after a partial repeal of the Affordable Care Act shortly after my own projection of lost coverage from a full repeal. Ironically, a partial repeal would be even worse (29.8 million losing coverage) than the already-devastating numbers from a full repeal (23.1 million losing coverage).

Amy Goldstein in the Washington Post reports:

The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

The two main trade groups for U.S. hospitals dispatched a letter to the incoming president and Capitol Hill’s top four leaders, saying that the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients.

More specifically:


In modeling the repeal of the ACA as laid out in H.R. 3762, we found that between 2018 and 2026: