Charles Gaba's blog

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I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this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

The New York Times, December 2nd:

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

Having talked to a number of CEOs & states, @SabrinaCorlette is right, if not understating.

— Andy Slavitt (@ASlavitt) December 3, 2016

I'm stuck in a loop of:
1. Reading this article...

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

Earlier today I posted fully broken-down estimates of just how many people would be directly impacted by a full & repeal of the Affordable Care Act this spring, assuming that the repeal took immediate effect and there was no replacement plan in place for the various provisions of the law.

The largest single category of enrollees in my estimates are those enrolled in Medicaid/CHIP due specifically to the ACA's Medicaid expansion provision. I estimated this to be roughly 11.3 million people nationally.

However, I was just informed of a new report released by the Foundation for Government Accountability, an anti-ACA think tank, which has compiled their own estimates of ACA Medicaid expansion enrollment on a state-by-state level. Here's what they've come up with:

01/12/17: PLEASE NOTE: I know there's a whole bunch of updates/revisions below; this is because I'm constantly updating both the Medicaid expansion and exchange policy numbers daily, in real time as I'm able to compile the most recent enrollment numbers. In most cases the numbers are quietly increasing, although in a few cases I've revised them downward.

I operate this site by myself and I do have a day job, family, etc, so if I haven't updated your state, be assured I'll get to it as soon as possible.

Now that we're past Thanksgiving weekend and the big December 15th deadline (for January coverage) is coming up fast, OE4 enrollments should have started ramping up significantly, on the order of 250,000 per day or more nationally (around 190K via

As noted last week, so far, total enrollments have been pacing my overall projections almost perfectly...slightly ahead of my estimates for the first month, in fact. Assuming this continues, national QHP selections should have broken 4.1 million nationally sometime Monday night (12/05), with around 3.1 million of those coming via the federal exchange.