Charles Gaba's blog

Over the past day or so, in response to the shocking and horrifying news that a racist, misogynistic, xenophobic con-artist sexual predator moron has been elected our next President and who has also stated point-blank that he intends to help the now-100%-Republican-controlled Congress eliminate the Affordable Care Act, I noted that this would likely cause 2017 enrollments to plummet as a result.

I figured that a lot of people who were planning on enrolling for 2017 policies might decide not to bother anymore, reasoning that if the ACA is about to be repealed, why should they go through the hassle and bother of signing up for a policy which is likely to be scrapped within a couple of months of it taking effect anyway?

I even whipped up a crude modified version of The Enrollment Graph:

In fact, I was feeling so despondent that earlier today I even swapped out the header logo with this:

OK, so Mitch McConnell has now confirmed that yes, repealing the Affordable Care Act is indeed Priority 1 for the incoming 100% GOP-controlled Congress now that they know they'll have President Trump (good God, I'll never get used to writing that) ready to sign it with his big Sharpie.

The only saving grace I keep seeing being thrown around today is the assumption that the Senate will in all likelihood simply dust off the repeal bill they passed in 2015 (the one which President Obama vetoed), cross out the date and pass that one...which included keeping the existing APTC subsidies in place through the end of 2017.

This would still suck royally, but at least it would buy everyone one more year to figure out what the hell they're gonna do for a healthcare policy starting in 2018, right?

Well...perhaps. But there's a catch, which Amy Lotven of Inside Health Policy wrote about back in September and which I discussed with Prof. Nicholas Bagley from the University of Michigan:

Don't worry, I'm not gonna rehash the whole thing, but some of you may recall that way back in January (a lifetime ago, this morning), I caused a bit of a brouhaha (or a "bro-ha-ha") when I noted that Bernie Sanders' Single Payer Healthcare Plan (aka "Medicare for All"), while sounding awesome in theory, was not only absurdly lacking in detail even for a general campaign outline, but that there were simply too many logistical problems for it to go into effect within such a short timeframe (which I assumed would be perhaps the same 5-year timeline as the ACA, since Sen. Sanders didn't specify any sort of timeline himself).

The response from Bernie's supporters was, to put it mildly, negative.

While I knew that a national single payer system was a non-starter, I thought that perhaps it might be feasible to get one through at the state level (assuming the funding mechanism could be adequately resolved, which was the Achilles' heel of Vermont's failed attempt a few years earlier).

Margot Sanger-Katz of the New York Times and Sarah Kliff of each take a crack at what the Republican Party and their leader and official face for the next generation, Donald Trump, repealing the Affordable Care Act would actually look like in practice.


The kind of partial repeal possible through the reconciliation process could lead to greater instability than total repeal. That means that it could lead to more people losing health insurance than the estimated 20 million who have gained it under the law. The health law was designed with a number of interdependent provisions devised to keep insurance affordable. By removing only some of them, a partial repeal could disrupt insurance arrangements not just for people newly insured under the law, but also for those who had purchased their own insurance before the law.


UPDATE: This comment (from a cross-post over at dKos) is exactly what I'm talking about:

Yeah, I don’t know what to do.  I filled out the first part of the application last week.  I guess I’ll finish the process.  But what’s the point if it’s going to be repealed “Day One”?

I made a commitment to keep this site up and running through next spring, and I intend on keeping this commitment. Beyond that, I have no idea what my plans for the site are.

After yesterday's atrocity, however...I'm honestly dreading the thought of what most of my charts, graphs, spreadsheets and blog entries are going to look like.

You see those impressive-looking odometer-style numbers at the top of the home page? Yeah, forget about those. They're meaningless now.

A lot of people will still sign up, but I'm guessing many who were planning on doing so once they were certain the ACA would still be around next year are now going to take a pass. And that's simply the beginning.

Beyond's 4:30am. I'm exhausted, my stomach hurts and my hands are shaking.

God help us all.

This just in...

First 4 days of Open Enrollment → More than half a million apps submitted thru @HealthCareGov for 2017 coverage. #GetCovered

— HHS Media (@HHSMedia) November 7, 2016

It's important to keep in mind that applications submitted are not the same as healthcare policies selected. A submitted application simply means you've created an account and filled out all of your personal data, household data, financial data and so forth; actually shopping around and selecting a plan is the next major step.

Having said that, how does this year compare with last? Well, as I noted the other day, the 150,000 applications submitted on Nov. 1st this year was higher than last year (HHS didn't provide a Day One total but did list it as 250K for the first two days).

Minnesota's ACA exchange, MNsure, continues to absolutely obliterate last year's open enrollment numbers during the first week:

The numbers as of Friday morning:

  • 13,040 people completed enrollment for health coverage
  • 187,683 visits to the MNsure website
  • 43,298 sessions or visits on the comparison shopping tool
  • 4,027 page views on the Assisters page
  • 12,121 accounts created
  • 13,701 applications completed

Assuming "Friday morning" means around 8am, that's 13,040 people actually enrolling in a healthcare policy in 3.3 days, or about 4,000 per day on average.

As I noted Thursday:

As i noted back in August:

I don't write about Idaho much, which is a bit surprising when you think about it because it's kind of a unique state when it comes to the ACA exchanges. Most states never set up their own exchange platform. A dozen or so set them up and are still using them. Two states (Massachusetts and Maryland) scrapped their original, failed platforms and completely overhauled them. Three states started out with their own platform but gave up when they failed, moving home to the mothership (HealthCare.Gov). One state, New Mexico, was supposed to move off of after the first couple of years, but changed their mind and is still hosted by the federal platform. Oh, and there's also Kentucky, which is scheduled to scrap their perfectly-functioning tech platform for absolutely no good reason other than the petty whim of their new Governor, Matt Bevin.

And then there's Idaho.

Last year, MNsure, Minnesota's technically (and actuarially) troubled ACA exchange enrolled "several hundred" people in Qualified Health Plans (QHPs) in the first day, and exactly 6,864 people in the first 17 days...which breaks out to an average of 404 per day for the first couple of weeks.

This year, just as I estimated last night, MNsure has already enrolled over 10,000 just the first 2 days of operation:

With improvements at the call center and on the website, MNsure has enrolled a record number of Minnesotans in coverage, O’Toole said.

“We’ve helped more Minnesotans than we have in any two day period in our history,” she said. “We’ve now enrolled more than 10,000 Minnesotans. That’s a benchmark that we didn’t hit until after Thanksgiving last year.”

Last week, ahead of the launch of the 2017 Open Enrollment Period, I took a look at what's new over at HealthCare.Gov this year. For the most part I was pretty impressed; they've made it more mobile-friendly, added refinements and changed the plan filtering interface so that it's consistent across both desktop, laptop and mobile devices.

The actual enrollment process itself also appears to be running smooth as silk; here's a comment from just this morning:

However, there are still a few user interface glitches which need to be addressed, at least on the "Window Shopping" tool. Here's two of them (three, really, although two are the same problem for different functions):

Problem #1. The "Household Member" Glitch: